Pharmacy Technician Web Based Calculations Review

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1 Pharmacy Technician Web Based Calculations Review MODULE PRESENTED BY: Jenifer Maki, JENIFER PharmD MAKI, PHARMD BRETT SALEM, PHARMD WITH CONTRIBUTIONS DEREK LOMAS, FROM: PHARMD Brett Salem, PharmD Derek Lomas, PharmD Objectives Calculate IV flow rates. Understand ratio or percent strength of a medication expressed as weight/weight, weight/volume or volume/volume. Calculate powder volume to prepare solutions. Understand how to prepare solutions using the alligation method. Utilize dilutions so that medications can be measured more accurately and easily The Collaborative Education Institute Compounding The preparation, mixing, assembling, packaging, or labeling of a drug in accordance with a licensed practitioner s prescription. This includes both sterile and non-sterile products Pharmacy technicians may often aid the pharmacist in compounding. The role of the pharmacy technician includes: Calculation of the correct amount of product to be mixed Calculation of dose to be given to the patient Weighing and mixing the product Compounding A pharmacy technician may aid the pharmacist in making: Suppositories Capsules Creams Ointments IV s TPN Reducing and Enlarging Formulas Using the principles of ratios and proportions for extemporaneous compounding Example: Zinc Oxide 50gm Pine Tar 120gm Petrolatum 264gm Total Weight 454gm = 1lb Reducing and Enlarging Formulas How much pine tar would be required to prepare 1kg of ointment? 1kg = 1,000gm 120gm = x 454gm 1,000gm X = gm pine tar 1

2 Reducing and Enlarging Formulas Reducing and Enlarging Formulas How much zinc oxide would be required to prepare 100gm of ointment? 50gm = x 454gm 100gm x = 11gm zinc oxide Flow Rate Flow Rate (Infusion Rate): rate that an IV medication leaves bag and enters patient s blood stream Expressed as ml/hr or drops/min Time of infusion = volume of fluid rate of infusion Flow Rate Calculations A 1L IV bag is running at 125ml/hr. How often will you need to send a new bag? X hr= volume/rate of infusion X hr = 1,000ml/125ml/hr X hr = 8hours Flow Rate Calculations Flow Rate Calculations Rate of Infusion Prepare 750mg of Vancomycin in 75 ml for infusion over 30 minutes. Use a 10 drop set (10drops/ml). How many drops/min will that be? 75ml x 10drops = 25 drops/min 30min 1ml Volume to be Dispensed If the flow rate is 24 drops/min using a 15 drop set (15drops/ml), how many Liters will be delivered in 24 hours? 24drops X 1ml = 1.6ml/mi min 15drops 1.6ml X 1440min x 1L = 2.3 Liter min day 1000ml 2

3 Flow Rate Calculations Amount of Drug the Patient will Receive If a patient receives 40 gtts/min of an IV solution containing 1 gram of drug per Liter calibrated at 15 gtts/ml, how many mg of drug will the patient receive per hour? 40drops x 1ml x 1L x 1gm x 60min x 1,000mg = min 15drops 1000ml 1L 1hr 1gm Flow Rate - Example You have a 1.5 liter bag that needs to be run over 12 hours. What is the flow rate in ml/min? 160mg/hr Flow Rate Answer 1.5L x 1000ml x 1hr = 2.1 ml/min 12hr 1L 60min Flow Rate -Example The following order is sent to the IV room. Medication: Levaquin 250mg/D5W Fluid Volume: 50ml Time of Infusion: ½ hour What volume of ffluid idis administered i dper hour? and What amount of drug is given per hour? Flow Rate -Answer Part 1: What volume of fluid is administered per hour? (ml/hr) ml = 50ml = 100ml/h hr 0.5hr Part 2: What amount of drug is given per hour? (mg/hr) mg = 250mg = 500mg/hr hr 0.5hr Solutions Solution: a mixture of 2 or more substances 2 liquids: a mixed drink Solid in a liquid: Kool-aid Gas in a liquid: carbonated water The concentration of one substance in another substance may be expressed as either a percentage or ratio strength. 3

4 Concentrations are expressed in percentages and there are 3 types Weight-in-weight (w/w) Example: 2 gm drug in 100gm product = 2% Example #1 You have a 1% w/w container of Tinactin powder. How many grams of Tinactin are present in an 8 ounce container of powder? Volume-in-volume (v/v) Example: 5 ml drug in 100ml solution = 5% Weight-in-volume (w/v) Example: 17 gm drug in 100ml = 17% Answer #1 w/w expressed as gm/gm 1% = 1g Tinactin/ 100g powder 8ounces x (28.3g/ounce) x (1g Tinactin/100g gp powder) = Example #2 How many grams of sodium chloride are provided by 500ml of normal saline? (hint: normal saline is 0.9% NaCl) 2.3g Tinactin Answer #2 w/v expressed as g/ml Therefore 0.9% = 0.9g/100ml Example #3 There are 1250mg of hydrocortisone in 5 g of ointment. What is the percentage of drug? 500ml NS x (0.9g/100ml) =4.5g NaCl 4

5 Answer #3 Concentration expressed as w/w: 1 st convert to the same unit of measure 1250mg x (1g/ 1000mg) = 1.25g Example #4 If a patient is to receive 25 mg of drug in 1 Liter of solution, what is the concentration of the prepared product? Then convert to a percentage (1.25gm/5gm) x 100 = 25% Answer #4 w/v expressed as gm/ml If convert to proper units of measure 25mg (1gm/1,000mg) = 0.025gm 1L (1,000ml/1L) = 1,000ml (0.025gm/1,000ml) x 100 = % Calculation used to make dilutions from 2 sources of different concentrations. Final concentration can NOT be higher than the source concentrations. Final concentration can NOT be lower than the source concentrations. Must be a concentration between the 2 sources Problem: If you need to make 250mL of 7.5% dextrose solution and you only have 5% and 50% dextrose solutions available, use the allegation method to determine how much of each to use. Step 1: Set up a box arrangement. At the upper left hand corner, put the higher concentration you have available. At the lower left hand corner, put the lower concentration. In the middle, write the concentration you need to make. 50 % Step 2: Determine how much of each part is needed. Subtract the number in the middle of the box from the higher concentration number in the upper left corner and write the result in the lower right hand corner. Subtract the number in the lower left hand corner from the number in the middle of the box and write the result in the upper right hand corner. 50 % % 7.5 % 5 % % 5

6 The results of the subtraction indicates how many parts of each solution are needed to prepare the mid-range concentration. In this case we will need 2.5 parts of the 50% dextrose solution and 42.5 parts of the 5% dextrose solution to make 250mL of the 7.5% dextrose solution. Step 3: Add together the number of parts needed to determine the total parts of the solution we are preparing. For this problem we will add: 2.5 parts parts 45 parts 50 % 2.5 parts of 50% 50 % 2.5 parts of 50% 7.5 % 7.5 % 5 % 42.5 parts of 5% 5 % 42.5 parts of 5% Step 4: Calculate the volume of each concentration needed. 50% Dextrose Solution x ml = 250mL 2.5 parts 45 parts x ml = (2.5 parts) x 250mL x ml = 13.89mL of D 50 W 45 parts 5% Dextrose Solution x ml = 250mL 42.5 parts 45 parts x ml = (42.5 parts) x 250mL x ml = mL of D 5 W 45 parts To check your work add the two volumes together. They should equal the total volume you need to make ml of D 50 W ml of D 5 W ml s - Example A prescription requires a 15% solution of IPAmycin*, but all you have available in stock is 25% and 10% solutions. How many ml of each solution should you use to make 60ml of a 15% solution? *fictitious drug s - Answer First: 25% 5 parts of 25% 15% 10% 10 parts of 10% Next: Add the number of parts = 15 total parts Finally: Determine amount of each solution by using cross multiplication. xml = 60ml x = 20ml of 25% solution xml = 60ml x = 40ml of 10% solution 5parts 15parts 10parts 15parts **Check your answer: 20ml + 40ml = 60ml total 6

7 Reconstituting Dry Powders Powder volume is the space occupied by dry medication. Powder volume can be determined by subtracting the diluent volume from the final volume. powder volume = final volume diluent volume pv = fv - dv Reconstituting Dry Powders Example #1 A dry powder antibiotic must be reconstituted for use. The label states that the dry powder occupies 0.5mL. Using the formula for solving for powder volume, determine the diluent volume (the amount of solvent added) if the final volume is 15mL. powder volume = final volume diluent volume 0.5mL = 15mL x 15mL 0.5mL = 14.5 ml Reconstituting Dry Powders Example#2 You are to reconstitute 1g of dry powder. The package insert states that you are to add 9mL of diluent to make a final solution of 100mg/mL. What is the powder volume? ou Powder Volume Answer #2 Step 1: Calculate the final volume. (hint 1gm=1,000mg) x ml = 1mL x ml = 1000mg x 1mL = 10 ml 1000mg 100mg 100mg Step 2: Calculate l the powder volume. pv = fv dv pv = 10mL 9mL = 1mL Powder Volume Example #3 Powder Volume Answer #3 You must reconstitute 500mg of Rocephin with 2.1ml of Lidocaine. The final concentration is 125mg/ml. What is the powder volume? 125mg = 500mg 1ml xml x= 4ml pv = 4ml 2.1ml = 1.9ml 7

8 Dilutions Often manufacturers distribute a concentrated product. Frequently, it is necessary to dilute the solution for accurate measurement. A volume less than 0.1ml is usually considered too small to measure accurately. Dilutions - Example Dexamethasone is available from the manufacturer in a 4mg/ml preparation. An infant is to receive 0.4mg. Prepare a dilution with a concentration of 1mg/ml. How much diluent will you need if the original product is in a 1 ml vial and you use the entire vial? Dilution Answer #1 1 st : Determine the volume of the final product. Xml = 1ml x= 4ml 4mg 1mg Dilution Example #2 You have a 20% solution of KCl and must prepare 250ml of a 0.4% solution. How many ml of stock solution and distilled water would you need to prepare this solution? 2 nd : Subtract the volume of the concentrate from the volume of the final product to determine the amount of diluent needed. 4ml- 1ml = 3ml diluent Dilution Answer #2 1 st : Determine how many gm in the final product X = 0.4gm x = 1gm 250ml 100ml 2 nd : Determine how much concentrate is needed 20gm = 1gm x = 5ml of stock solution 100ml x Dilutions Example #3 You need to make 250ml of a 1:500 solution. You have a concentrate solution of 80%. How much of the concentrate and diluent will you need to make the final product? 3 rd : Determine ml of diluent is needed 250ml 5ml = 245ml of distilled water 8

9 First x gm = 1gm 250ml 500ml Next 0.5gm = 80 gm Xml 100ml Finally 250ml 0.625ml Dilution Answer #3 x = 0.5gm in final solution x = ml of concentrate = ml diluent needed Thank You!!!!!! GOOD LUCK ON THE CERTIFICATION EXAM! 9

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