Mathematics for Medication Administration Interpreting Medication Orders and

Understanding Drug Labels

Interpreting Medication Orders and

Understanding Drug Labels
Introduction
In this module, you will gain a full understanding of the information contained in a
medication order. This will include common abbreviations used to convey information.
You will also gain familiarity with the components of a typical medication label. By
employing this knowledge, you will become self-sufficient in performing dosage
calculations, a core skill for the practical nurse.

Overview
 Components of a Medication Order
 Abbreviations used in Medication Orders
 Components of a Medication Label
 Dosage Calculations

Module Outcomes
 Recognize the seven components that constitute a full medication order.
 Gain familiarity with abbreviations that commonly appear in medication orders, as
well as those which are prone to causing medication errors.
 Identify and interpret the various components of a medication label.
 Use a medication order and a medication label to accurately calculate a dosage.

Interpreting Medication Orders

Prescribers use medication orders to communicate the details of medication therapy to
other healthcare practitioners. Quite often, nurses carry out the requirements of these
orders by administering medication directly to patients. Prescribers can be physicians,
dentists and, to some extent, nurse practitioners, pharmacists, midwives and
chiropodists.

Medication orders are most reliably communicated in writing, either electronically or by

hand. In time-critical situations, they can also be given verbally, by phone or by fax;
however, these methods have been shown to increase the likelihood of medication
errors, and should be avoided.

A complete and legal medication order consists of the following seven components.

Patient’s Name
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Understanding Drug Labels

The intended patient’s first and last names are included, in order to avoid confusion with
patients who have similar sounding names.

Name of Medication
Either the generic name or the brand name of the prescribed medication is included in a
medication order. A drug's generic name is not specific to any particular manufacturer or
formulation. For example, acetaminophen is the generic name of a common, over-the-
counter pain reliever.

Quite often, pharmaceutical manufacturers distribute drugs under brand names that are
more marketable. McNeil Consumer Healthcare, for example, produces acetaminophen
under the brand name Tylenol. Incidentally, GlaxoSmithKline, another drug
manufacturing company, sells this very same medication under the brand name
Panadol. Brand names are sometimes referred to as trade names or proprietary names.
Generic names of drugs are also termed non-proprietary names. Brand names are
proper nouns and should be capitalized. Generic names are common nouns and should
not be capitalized.

When a prescription is written, the prescriber may specify a particular brand, rather than
prescribing the drug by its generic name. Some brands have unique formulations,
excipients and combinations with other drugs that may either be preferable, or cause
complications for the patient.

Drugs also have chemical names, but these are rarely used in patient care. Members of
the scientific community use these technical terms to communicate detailed information
about compounds at the molecular level. For instance, the chemical name for
acetaminophen is N-(4-hydroxyphenyl)ethanamide.

Dosage of Medication
An order will indicate the amount of medication required by the number of g, mg or mcg
to be administered, not the number of mL, tab or cap. The latter is ambiguous, since
many medications are available in different strengths or concentrations. For certain
medications, the prescribed dosage is expressed in milliequivalents (mEq) or units. In
essence, mEq are a count of the number of ions that make up the desired dose;
whereas, g, mg and mcg are measures of mass. Units are a measure of the therapeutic
"work” done by a medication. They are unique to the drug being administered. For
instance, insulin and heparin are both drugs that are prescribed and measured in terms
of units; however, 1 unit of insulin is unrelated to 1 unit of heparin.

Units should never be abbreviated as "u". This could be mistaken for a zero.

Route of Administration
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Understanding Drug Labels

Oral medications may be given in the form of tablets, capsules or oral liquids. The form
may be explicitly indicated in the order. The route for parenteral fluids is specified as
intramuscular, intravenous, subcutaneous or intradermal.

Some drugs are available in multiple formulations, and can be delivered by more than
one route; however, each route of administration has a unique purpose and rate of
absorption.

Frequency of Administration
Medication orders indicate how often a dose should be taken. Drugs may be prescribed
to be administered on an hourly, daily, weekly or even monthly basis. A prescription for
60 mg of medication twice a day requires that the patient receive 60 mg at each of
these doses (60 mg in the morning, and another 60 mg in the evening). A common error
is to misinterpret this order as requiring 30 mg at each dose, totalling 60 mg for each
day.

The duration of administration may also be included in the medication order. For
instance, a patient may be prescribed 100 000 units of a certain drug every 8 hours, for
one week. The term LOS is sometimes used to abbreviate "length of stay". This implies
that the prescription is to remain active for the duration of the patient's stay in hospital.

The prescriber may further specify conditions under which the medication is to be
administered. For instance, an analgesic (painkiller) may be prescribed every 4 hours
as needed for pain. The abbreviation p.r.n. is often used as shorthand for "as needed"
or "as required."

Date and Time of Order

A drug is prescribed to treat a disease state at the time the medication order is written.
In order to avoid unnecessary treatment, drug therapy should commence soon after the
order is made. The date and time of the medication order are included in order to
indicate when the medication is required.

Prescriber’s Name and Signature

The prescribing authority is the main point of contact for any issues or recommended
changes to the therapy, as outlined in the medication order. His or her contact
information is often included for this reason. The prescriber's signature deems the
medication order valid.

All seven of these components are required to establish a complete, legal and safe
medication order. The directions must be followed precisely. In the event that any
information is questionable or missing, the prescriber should be contacted for
clarification.
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Understanding Drug Labels

In certain circumstances–a life-threatening, allergic reaction, for example–some of this

information may be implicit. For instance, a verbal order for 0.5 mg of epinephrine by
intramuscular injection has an implied patient, date, time, prescriber and, arguably,
frequency.

For the purposes of this course, the patient's name; date and time of order; and
prescriber's name and signature will be omitted. The remaining four components will
comprise a full medication order.

Interpreting Medication Orders Activity 1

Listed below are some representative examples of medication orders. Indicate the
medication name, dosage, route and frequency prescribed in each order.

 Give 50 mg meperidine by intramuscular injection, every 4 hours.

Answer: Medication name: meperdine; dosage: 50 mg; route: intramuscular
injection; frequency: every 4 hours.
 Administer Neupogen 300 mcg by subcutaneous injection, every evening.
Answer: Medication name: Neupogen; dosage: 300 mcg; route: subcutaneous
injection; frequency: every evening.
 Administer 7.5 mg meloxicam by mouth twice daily, as needed for arthritic pain.
Answer: Medication name: meloxicam; dosage: 7.5 mg; route: by mouth; frequency:
twice daily, as needed for arthritic pain.
(The maximum amount of meloxicam to be administered by this medication order is
15 mg in one day (7.5 mg at each of the two doses). If the patient is still in pain, a
third dose should not be administered without first consulting the prescriber.)
 Give 750 mg Flagyl ER by mouth once per day, for seven days.
Answer: Medication name: Flagyl ER; dosage: 7.5mg; route: by mouth; frequency:
once per day, for seven days.

Interpreting Medication Orders Activity 2

State the missing component of each order.
 Give 0.2 mg Methergine orally.
Answer: frequency
 Administer Morphine by IM three times per day, as needed for pain.
Answer: dosage
 Give 0.25 mcg IV twice daily, for 3 weeks.
Answer: medication name
 Give 20 mg Prednisone every 6 hours.
Answer: route

Quite often, medication orders are written in shorthand using conventional

abbreviations, many of which have Latin roots. It is essential to be familiar with the
common ones in order to fully appreciate the prescriber's intentions.
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In addition, once a medication order has been received and verified, it is the nurse's
responsibility to transcribe this information onto the patient's medication administration
record (MAR), informally referred to as a chart.
MARs are used in clinical settings to document a patient's prescriptions, and to keep
record of all doses that have been administered.

Interpreting Medication Orders Table 1

Abbreviations are written in upper- or lower-case letters and with or without periods.

Abbreviation for Route Route

p.o orally
p.r by rectum
(The letter p usually stands for per (by). For instance, the
abbreviation p.r. represents “by rectum”.)
IM intramuscular
IV intravenous
IVPB intravenous
(Intravenous piggyback infusion is used to administer two piggyback
separate IV solutions through one IV line.)
SC; SQ; subcut; subQ subcutaneous
ID intradermal
supp suppository
(Be careful not to mistake this abbreviation for susp.)
susp suspension
(Be careful not to mistake this abbreviation for sup.)
cap capsules
tab tablet
SL sublingual
IN; NAS nasogastric tube
OD right eye
(The use of some abbreviations is discouraged because
they have the potential to contribute to medication errors.
The abbreviation OD, for example, stands for both "daily"
and "right eye". Nonetheless, they are encountered in
practice and healthcare professionals should be familiar
with commonly-used abbreviations.)
OS left eye
OU both eyes
Interpreting Medication Orders Table 2
Abbreviation for Frequency/Time Frequency/Time
q.d.; q1d; OD once daily
(The abbreviations QID, Q1D, QOD, QD and OD are
likely to be mistaken for one another. Their use is greatly
discouraged.)
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Abbreviation for Frequency/Time Frequency/Time

b.i.d. twice per day
t.i.d. three times per day
q.i.d. four times per day
q.o.d. every other day
b.i.w. twice per week
t.i.w. three times per week
(BIW and TIW are often mistaken for BID and TID, which
may lead to a seven-fold overdose.)
q every
(Some abbreviations can be combined to form new
meanings. For example, qPM means "every evening".)
q.h. every hour
q6h every 6 hours
q8h every 8 hours
q12h every 12 hours
(A dosage given q12h would result in two doses per day
(BID). Similarly, q8h corresponds to TID, and q6h
suggests QID. There is a subtle difference, however.
Drugs prescribed BID, TID and QID are given at specific
times according to the standing medication schedule,
which usually runs from 0800 to 2200 depending on
hospital policy. On the other hand, drugs prescribed q6h,
q8h, q12h, etc. need not be administered at particular
times throughout the day.)
q.h.s. at bedtime
stat immediately
p.r.n. as needed; as
required
a.c. before meals
p.c. after meals
(To remember a.c. and p.c., think a.m. and p.m.)
Interpreting Medication Orders Table 3
Abbreviation Full Form
XL; LA long acting
XR; ER extended release
SR sustained release
c; w/ with
s; w/o without
sol, sol’n solution
n.p.o. nothing by mouth
amp ampule
gtt drops
IU international unit (same as unit)
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Abbreviation Full Form

(Units and international units should
never be abbreviated with a "u". Instead,
write the word "units".)
SOS repeat, if necessary
LOS length of stay(This refers to the patient's
length of stay in hospital)

Interpreting Medication Orders Activity 3

Translate the following abbreviated medication orders into full form.
1. Original: Administer 5 000 units heparin by subcutaneous injection, three times per
day.
Full Form: Administer 5 000 units heparin subQ TID
(For clarity, long numbers should be spaced out every three digits.)
2. Original: Give 1 mg atropine IV Q2H, prn bradycardia.
Full Form: Give 1 mg atropine by intravenous injection every two hours, as needed
for bradycardia.
(Bradycardia is defined as a resting heart rate that has slowed to 69 bpm or less.)
3. Original: Give 500 mcg Lanoxin p.o. STAT, then q8h
Full Form: Give 500 mcg Lanoxin by mouth/orally immediately, then every eight
hours.
4. Original: Administer 25 mg tramadol PO q.a.m. x 3 days
Full Form: Administer 25 mg tramadol by mouth/orally every morning, for three
days.

Reading Medication Labels

With a medication order in hand, a drug bottle or vial is all that a nurse needs to
competently calculate and safely administer a dosage. Medication labels list important
information that is required to carry out this task. Unlike medication orders, in which all
seven components are specified, drug labels are prepared without an established
format. The components of a medication label that nurses must be able to identify are
discussed below.

Medication Name
While all drugs have a generic name, there are several that do not have a distinct brand
name. In other words, these drugs are marketed and prescribed using a generic name
only. Calcium gluconate, for instance, is produced by many pharmaceutical
manufacturers, but is sold only under its generic name, calcium gluconate. At the other
end of the spectrum, acetaminophen has more than 100 associated brand names
worldwide.

Because of this, not all medication labels list a brand name, but a generic name will
always appear. When both are present, the brand name is prominently displayed, and
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

may be accompanied by a trademark symbol, such as ® or ™. Generic names are less

conspicuous and are usually printed below the brand name.

Concentration
The dosage strength or concentration of the medication is always indicated on the label.
This specifies how much of the active ingredient is contained within each unit–for
instance, the number of mcg in each capsule (mcg/cap). Some liquid medication
concentrations are expressed using multiple milliliters. For example, Amoxil is a solution
that contains 250 mg of amoxicillin in each 5 mL of solution.

This ratio can be reduced for ease of calculation:

mg 250 mg ÷5 50 mg mg
250 5 mL = 5 mL ÷5 = 1 mL = 50 mL.
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A concentration is a ratio that states how strong the medication is. It is entirely unrelated
to the total amount of medication, or the total volume of the vial. This bottle of Prozac
has 20 mg of fluoxetine hydrochloride for every 5 mL of solution.” [Refer to label below.]
This neither indicates that there are 20 mg of active ingredients in the bottle, nor that
there are 5 mL of solution altogether. Evidently, the bottle contains 120 mL of solution
and 480 mg of medication. The concentration, not the total amount/volume, is vital
information for performing dosage calculations.

Quite often, medications in tablet or capsule form omit the terms “per tablet” or “per
capsule” from their drug labels. Epivir, for instance, is labelled 150 mg. Healthcare
professionals must recognize that this implies a concentration of 150 mg per tablet. A
common error is to mistake this for 150 mg per 60 tablets. Remember that the total
amount/volume, 60 tab in this case, is never used in a standard dosage calculation.
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Total Amount/Volume
Medication containers usually have the total amount, for tablets and capsules, or the
total volume, for liquid forms, printed on their labels. This information is never used in
dosage calculations. It can, however, be used to predict how long a medication supply
will last for a particular prescription.

Form
The form of a medication is often included on the drug label, or implied by other
information. Some medication forms include tablets, capsules, suppositories, solutions,
suspensions and syrups. Liquid medications often do not state the form explicitly on the
drug label. For example, morphine exists as an injectable solution, but this term appears
nowhere on the label.” [Refer to drug label.] “However, the terms ‘FOR SC, IM OR
SLOW IV USE’, ’15 mg/mL’, ’20 mL Multiple Dose Vial’, etc. imply that the vial contains
liquid, not tablets or capsules. Note that SC, IM and IV are not forms of medication;
rather, they are routes of administration.

Route of Administration
Some medication formulations are intended to be administered by a particular route,
based on concentration and location of the target site, among other factors. The
prescription dictates the route of administration, and a drug should be selected only if it
is designed to be administered by that method. For instance, ketorolac tromethamine is
available in one form intended for IM use only, and another for topical ophthalmic
administration (eye drops).” [Refer to labels.] “It is unsafe to administer a drug by any
means other than its intended route. Drug labels for tablet and capsule forms of
medication often do not explicitly state their route of administration.
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Other Information
Other information sometimes indicated on medication labels includes:
 expiration dates;
 safe storage instructions;
 precautions for handling and usage; and
 controlled substance labelling.

Reading Medication Labels: Example

Shown below are two examples of medication labels.
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Reading Medication Labels: Activity

Identify the route, total volume, brand name, generic name, form, storage instructions,
concentration and usage precautions for the drug label below.

Answer:
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Dosage Calculations
Dosage Calculations: Example
Using the medication order and drug label below, determine the volume (mL) of
Neupogen that you will administer at each dose.
Order: Give 250 mcg Neupogen subcut od, LOS
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Since 250 mcg (the order) is less than 300 mcg (from the concentration), we expect the
final answer to be less than 1 mL. It's always a good idea to estimate the answer before
formally calculating a dosage.

Step 1: Express the medication order and concentration as fractions.

250 mcg 300 mcg
,
1 1 mL

Step 2: Flip the fractions so that the mcg units cancel out, and only the goal unit (mL)
remains
250 mcg 1 mL
,
1 300 mcg

Step 3: Onve you have the correct configuration, multiply the fractions together
250 mcg 1 mL
×
1 300 mcg

Step 4: Simplify.
250 mcg 1 mL 250 𝑚𝐿
× = ̅̅̅̅̅̅̅𝑚𝐿 ≈ 0.8𝑚𝐿
= 0. 83333
1 300 mcg 300

Note: Most doses are rounded to the nearest tenth (one decimal place).
Recall that heparin and paediatric medications are rounded to the nearest hundredth
(two decimal places).

Step 5: Validate your answer:

300 mcg 250 mL
=
1 0.83 mcg
300 ≈ 312.5
The correct answer is 250 divided by 0.8, which equals 312.5. We see that 312.5 is
roughly equal to 300. Since the left side equals the right side, the answer (0.8 mL) must
be correct. The two values are only approximately equal because 0.8 mL was rounded
̅̅̅̅̅̅̅𝑚𝐿.
down from0. 83333

Finally, Shade in the syringe to indicate the dosage that you will administer

Answer:
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Dosage Calculations: Activity 1

Using the medication order and drug label below, determine how many tablets of Paxil
you will administer at each dose.

Order: Give Paxil, 60 mg q.d. PO

Solution:
Begin by expressing the medication order and concentration as fractions.
60 mg
Order: 1
20 mg
Concentration: 1 tab

60 mg 1 tab
× = 3 𝑡𝑎𝑏
1 20 mg

Validation:
20 mg 60 mg
=
1 tab 3 tab
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Understanding Drug Labels

20 = 20
Tablets and capsules are generally administered no more than three at a time. If you
calculate more than this in one dose, double-check your calculations or consult the
prescriber.

Dosage Calculations: Activity 2

Using the medication order and drug label below, determine the volume of loperamide
that you will administer at each dose.

Order: Administer 2.5 mg loperamide HCl p.o. TID

Solution:
Begin by expressing the medication order and concentration as fractions.
2.5 mg
Order: 1
1 mg
Concentration: 5 mL
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

2.5 mg 1 mg
× = 12.5 𝑚𝐿
1 5 mL

Validation:
1 mg 2.5 mg
=
5 mL 12.5 𝑚𝐿

0.2 = 0.2

Although this medication is to be delivered three times per day (TID), the dosage is
calculated for one dose only. In other words, 2.5 mg is to be given three separate times
throughout the day. There is no need to multiply or divide by three.

Dosage Calculations: Activity 3

Using the medication order and drug label below, determine the volume of
glycopyrrolate that you will administer at each dose.
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Order: Administer 160 mcg glycopyrrolate IM q6h

Solution:
Begin by expressing the medication order and concentration as fractions.
160 mcg
Order: 1
0.2 mg
Concentration: 1 mL
1 mg
Conversion Factor: 1000 mcg
160 mcg 1 mL 1 mg
× × = 0.8 𝑚𝐿
1 0.2 mg 1000 mcg
Validation:
200 mcg 160 mg
=
1 mL 0.8 𝑚𝐿

200 = 200

Unit conversions can either be integrated into the solution, or performed beforehand.
Whether the concentration or the order is converted is irrelevant. In this case, 160 mcg
could be converted to 0.16 mg; or 0.2 mg/mL could be converted to 200 mcg/mL.

Dosage Calculations: Activity 3

Using the medication order and drug label below, determine the volume of calcium
gluconate that you will administer at each dose.
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Order: Give 15 mEq calcium gluconate daily, by IV over 30 min.

Solution:
Begin by expressing the medication order and concentration as fractions.
15 mEq
Order: 1
23.25 mEq
Concentration: 50 mL
15 mEq 23.25 mEq
× = 32.3 𝑚𝐿
1 50 mL
Validation:
23.25 mEq 15 mEq
=
50 mL 32.3 mL

0.465≈ 0.464
By default, doses are rounded to the nearest tenth (1 decimal place).

Dosage Calculations: Percentage Concentrations

Occasionally, drug labels for medication solutions have concentrations expressed as
percentages. Here, it is assumed that the % sign expresses the weight of medicine
contained in a volume of solution (% w/v), unless otherwise indicated. There are several
other ways of expressing concentrations as percentages, including % w/w, % v/v and %
v/w. This vial of calcium chloride, for example, has a concentration of 10%.
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Understanding Drug Labels

As written, 10% is not very useful. It needs to be converted into a format that can be
used in a dosage calculation. This can be done with the following two steps.

Step 1: Convert 10% into a fraction.

10
10% =
100

Step 2: Insert the units. By convention, the numerator is in grams and the denominator
is in millilitres. This is rule that is universally recognized.

10 g
10% =
100 mL

Dosage Calculations: Percentage Concentrations Example

Quite often, drug labels with percentage concentrations omit the symbol w/v. However,
it is assumed that the % sign represents % w/v when working with medication.
Aminohippurate sodium, for example, is available as a 20% solution. Express this
concentration as a fraction, including the appropriate units of measure.

Answer:
20 g
20% =
100 mL
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Understanding Drug Labels

Using the medication order and drug label below, determine the volume of
aminohippurate that you will administer at each dose.
Order: Prepare 375 mg aminohippurate sodium for IV infusion STAT.

Solution:
Begin by expressing the medication order, concentration and conversion factor as
fractions.
375 mg
Order: 1
20 g
Concentration: 100 mL
1g
Conversion Factor: 1000 mg
375 mg 100 mL 1 mg
× × = 1.9 𝑚𝐿
1 20 𝑔 1000 mcg
Validation:
20 000 mg 375 mg
=
100 mL 1.9 𝑚𝐿

200 ≈ 197.4

Dosage Calculations: Ratio Concentrations

Drug concentrations are also sometimes expressed using ratios. The same rules apply
to convert this ratio into a fraction that can easily be used in a dosage calculation. For
example, this solution of epinephrine has a concentration of 1 : 1 000.

Step 1: Convert 1 : 1 000 into a fraction.

1
1 ∶ 1 000 =
1 000

Step 2: Insert the units.

1g
1 ∶ 1 000 = 1 000 mL The units are always grams in the top and millilitres in the bottom.

This concentration can be simplified by converting grams to milligrams, then reducing.

1g 1 000 mg ÷ 1 000 1 mg mg
= = =1
1 000 mL 1 000 mL ÷ 1 000 1 mL mL

Dosage Calculations: Ratio Concentrations Example

Using the medication order and drug label below, determine the volume of epinephrine
that you will administer at each dose.
 Mathematics for Medication Administration Interpreting Medication Orders and
Understanding Drug Labels

Order: Administer 0.3 mg epinephrine subQ STAT, then q2h prn for dyspnea

Solution:
Begin by expressing the medication order and concentration as fractions.
0.3 mg
Order: 1
1 mg
Concentration: 1 mL
0.3 mg 1 mL
× = 0.3 𝑚𝐿
1 1 mg
Validation:
1 mL 0.3 mg
=
1 mg 0.3 𝑚𝐿

1=1