Detoxicol

SDLS 2008
Medicine for the intoxicated
Subject: Pharmacology Laboratory Topic: Prescription Writing Oral Liquid Preparations Lecturer: MLDDC, DLP, GAM, RGYA Lecture Date: July 7, 2005 Transcriber(s): JC Tayco No. of pages: 7

Oral Liquid Preparations (Syrup, Suspensions, Drops) Take this as an Example:

DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Justine Villanueva 7 years old 25 kg Novaliches, Quezon City Rx Paracetamiol Syrup 250mg/ml Dispense No. 1 bottle (60ml) Label: Take one (1) teaspoonful every four hours for three (3) days. July 20, 2004

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

Note the following in the preceding prescription 1. Opposite the name and dosage form of the drug is the strength or concentration of the preparation . Encircled Above. 2. The subscription consists of the total volume to be dispensed. Underlined above. 3. Ready made preparations of drugs are available in bottles containing 15, 30, 60, 120 up to 250 ml. chose the preparation that will satisfy the total volume require by the patient. The number of bottles to be dispensed will be computed based on the total drug amount that the patient will need. 4. Some oral liquid preparations are available as drops specifically suitable for very young patients. These are dispensed with calibrated droppers. 5. The use of household measure such as teaspoon used to stir a cup of tea) or tablespoon (used in the table when eating ) in administering the drug are allowed. 6. Computation is based on the appropriate equivalent of the household measure used. For this reason, the students are advised to memorize the milliliter equivalents of the common household measures used in administering oral liquid preparations. 7. Based on the lecture for drugs to be administered by drops, we need to convert them to milliliters instead of just writing (N) drops. Then just instruct the one accompanying the patient to use calibrated medicine dropper and the number of drops to instill. 8. Also keep in mind the names of the prohibited drugs and regulated drugs because they require S2 number. The transcriber will not anymore enumerate them because its time consuming. Anyways, they are listed in the laboratory manual in Pharmacology lab pp 51-64. Usually, they are given for relief of excruciating or debilitating pains; and usually , we need to place as necessary at the end of the label. 9. We use the term give in the label for patients 0-12 years old, and for patients who cannot take or administer the medication on their own.

Example: 1. A prescription for the treatment of acute bacterial toncillopharyngitis in a 6 month old infant weighing 8 kg. Using Cephalexin infant drops to be given at a dose of 50mg/kg/day in four divided doses for seven days. (Cephalexin infant drops is available in 125mg/2.25ml, concentration 10 ml bottles. Computations:
Determine how much drug does the patient need in a day. Multiply 50mg Kg x 8kg = 400mg per day

Next, compute for the total amount of drug needed for the entire treatment given the amount of drug required per administration. Multiply 400mg per day to 7 days (therapy lass for 7 days). The answer is 2800mg. Since the drug is in liquid preparation, by means of ratio and proportion, given the concentration of the drug in solution, compute for the volume of the drug to be dispensed.

2800 mg = 125 mg X 1.25 ml X = 28 ml

Next, compute how much drug is needed per administration. Since in the patient, the drug (to be administered per day = 400mg)has to be divided in four doses per day. Divide 400mg by 4. and by means of ration and proportion, given the concentration of the drug in the solution, compute for the voukme of the drug administered.

400mg / 4 = 100mg 100mg = 12mg . X 1.25 ml The volume of drug to be taken by the patient is 1ml per administration. To check the answer is to compute for the total volume of drug for the entire duration treatment given the volume of drug per administration, multiply 1ml by 4 (number of administration of drug) and 7 (number of days of treatment). The product is 28ml. Another way to check the answer is to compute for the volume of drug per administration using the volume of drug for the entire duration of therapy, divide 28 by 7 days (duration of therapy) and 4 (number of administration per day). The product is 1 ml.

Now that we know the dispense number and the volume of drug per administration, we can now write the
prescription. DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234

Cassey Kevin Pasia 6 month-old, 8 kg Male Paraaque city Rx

July 20, 2004

Cephalexin Infant Drop 125mg/1.25ml Dispense no. 3 Bottles (10 ml) Label: Give one (1) mL infant drops every six (6) hours round the clock in full stomach for seven days.

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

Liquid Preparations (Oral, Syrup, Suspension, Drops): Practice Exercises 1. A prescription for the control of fever in a 6 month old infant weighing 6 kg, using Paracetamol drops to be given at 10mg/kg/dose every 4 hours as necessary for 3 days. (Paracetamol drops is available in 30mL and 60 mL bottles containing 60mg/mL.)
Computation: Amount of drug per dose = 10 mg x 6 Kg = 60 mg per dose Kg Volume of Preparation per dose: 60 mg = 60 mg mL X

X = 1 mL per dose Frequency per day or number of doses per day (based on 16 waking hours) = 16 hours / 4 hours = 4 doses per day Total Volume needed = 1 mL x 4 doses x 3 days = 12 mL (therefore prescribe one 30 mL bottle) Dose day Note:

It is acceptable to prescribe a little over than the required amount than fall short Prescribe one 30 mL bottle

DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Moja Mojacko, 6 months old Dasmarias, Cavite Rx Paracetamol Drops 60 mg/mL Dispense Number: 1 Bottle (30 mL) Label: Give one (1) mL using a dropper every 4 hours as necessary for three days July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

2. Aprescription for the treatment of acute otitis media in a 10 year-old child weighing 40kg. using Ampicillin Oral Suspension to be given at a dose of 50mg per kg body weight per day in four divided doses round the clock for 10 days. (Ampicillin is available as 125mg/mL and 250mg/5mL suspension in 30mL and 60mL bottles.)
Computation: Amount of drug per day = 50 mg x 40 Kg = 2000 mg per day Kg Amount of Drug per dose = 2000 mg / 4 doses = 500 mg per dose (therefore use the 250mg/5mL preparation) Volume of Preparation per dose: 250 mg = 500 mg 5 mL X X = 10 mL per dose Total Volume needed = 10 mL Dose x 4 doses x 10 days = 400 mL day OR

Number of Bottles = 400 mL / 60 mL = 6.67 7 Bottles (60 mL) Number of Bottles = 400 mL /30 mL = 13.33 14 Bottles (30 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Remember: if there are to preparations, one in 60 mL Bottle and the other in 30 mL Bottle, the price of the 30 mL preparation is always greater than the half of the price of the 60 mL, thus it is cheaper to prescribe the 7 Bottles (60 mL) Remember that 5 mL is roughly equivalent to one teaspoonful (use common household methods of approximating measures) in this case, give two teaspoonfuls of the drug

DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Patsochay Santos, 10 years old Silang, Cavite Rx Ampicillin Oral Suspension 250 mg/5mL Dispense Number: 7 Bottles (60 mL) Label: Give two (2) teaspoonfuls four times a day, round the clock, for ten days. Shake well before use. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

3. A prescription for the treatment of acute bacterial tonsillopharyngitis in an eight month old infant weighing 10kg. using Cephalexin Infant Drops to be given at a dose 50 mg/kg/day in four divided doses for seven days. (Cephalexin Infant Drops is available in 125mg/1.25mL, concentration 10mL bottles.)
Computation: Amount of drug per day = 50 mg x 10 Kg = 500 mg per day Kg Amount of Drug per dose = 500mg / 4 doses = 125 mg per dose (therefore use the 125mg/1.25mL preparation) Volume of Preparation per dose: 125 mg = 125 mg 1.25mL X

X = 1.25 mL per dose

Total Volume needed = 1.25 mL x 4 doses x 7 days = 35 mL Dose day Number of Bottles = 35 mL / 10 mL = 3.5 4 Bottles (10 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Prescribe 4 bottles (10 mL) DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Kirara Santos, 8 months old Bacoor, Cavite Rx Cephalexin Infant drops 125 mg/1.25mL Dispense Number: 4 Bottles (10 mL) Label: Give1.25 mL, using a dropper, four times a day, round the clock, for seven days. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

4. A prescription for the control of bronchial asthma in a 6 year old boy using Salbutamol Syrup to be given at a dose of 2mg every six hours round the clock for 7 days. (Salbutamol syrup is available in 60ml and 120mlbottles containing 2m/5ml.)
Computation: Volume of Preparation per dose: 2 mg = 2 mg 5 mL X

X = 5 mL per dose

Frequency or doses per day = 24 hours / 6 hours = 4 doses per day Total Volume needed = 5 mL x 4 doses x 7 days = 140 mL Dose day Number of Bottles = 140 mL / 60 mL = 2.33 3 Bottles (60 mL) OR Number of Bottles = 140 mL / 120 mL = 1.167 2 Bottles (120mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Between the two computations for the number of bottles to be dispensed, the first one 3 Bottles (60 mL) is more favorable because it will give less residual drug Based on economy, prescribing one Bottle (120 mL) and one Bottle (60 mL) is more favorable You may prescribe either: 3 Bottles (60 mL) or 1 Bottle (120 mL) and 1 Bottle (60 mL) DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Doraemon Padla, 6 years old Amadeo, Cavite Rx Salbutamol Syrup 2 mg/5 mL Dispense Number: 3 Bottles (60 mL) Label: Give one teaspoonful every six hours, round the clock, for seven days. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

5. A prescription for the relief of toothache in a 7 year old boy weighing 23 kg using Ibuprofen Syrup to be given at a dose of 6.5mg/kg body weight/dose every 4 hours , as necessary, for 2 days. (Ibuprofen is available in 60mlottles containing 100mg/5ml.)
Computation: Amount of drug per dose = 6.5 mg x 23 Kg = 149.5 mg per dose Kg Frequency or number of doses per day (based on 16 waking hours) = 16 hours / 4 hours = 4 doses per day Volume of Preparation per dose: 100 mg = 149.5 mg 5 mL X

X = 7.475 mL per dose

Total Volume needed = 7.475 mL x 4 doses x 2 days = 59.8 mL Dose day Number of Bottles = 59.8 mL / 60 mL = 0.99 1 Bottle (60 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Remember that 5 mL is roughly equivalent to one teaspoonful (use common household methods of approximating measures) in this case, giveone and one half teaspoonfuls of the drug DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Maxx Menthol, 7 years old Bacoor, Cavite Rx Ibuprufen Syrup 125 mg/1.25mL Dispense Number: 1 Bottle (60 mL) Label: Give one and one half teaspoon every four hours for two days as necessary. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

6. A prescription fro the relief of dry irritative cough in a 60year old patient using Codeine Syrup to be given at a dose of 30mg three times a day for 5 days. (Codeine Syrup is available in 60mL bottles containing 10mg/5mL.)
Computation: Volume of Preparation per dose: 10 mg = 30 mg 5 mL X Total Volume needed = 15 mL Dose

X = 15 mL per dose

x 3 doses x 5 days = 225 mL day

Number of Bottles = 225 mL / 60 mL = 3.75 4 Bottles (60 mL) but see the note below!!! Note:

Codeine is a Regulated Drug and is a Narcotic, DDB Form is needed as well as the S2 - License The maximum number of Bottles that can be dispensed is one! The patient needs to come back to your clinic for refills Remember that 15 mL is roughly equivalent to one tablespoonful (use common household methods of approximating measures) in this case, give one tablespoonful teaspoonfuls of the drug DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Pedro Penduko, 60 years old Imus, Cavite Rx Codeine Syrup 10 mg/5 mL Dispense Number:1 Bottle (60 mL) Label: Take one tablespoonful three times a day for 5 days. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345 S2 License: 85678

7. For a 10 year-old weighing 37.5kg with bacterial upper respiratory infection using Amoxicillin Suspension to be given at a dose of 40mg/kg/day in three divided doses round the clock for 7 days. (Amoxicillin Suspension is available in 60mL and 120 mL bottles containing 125mg/mL and 250mg/5mL)
Computation: Amount of drug per day = 40 mg x 37.5Kg = 1500 mg per day Kg Amount of Drug per dose = 1500 mg / 3 doses = 500 mg per dose (therefore use the 250mg/5mL preparation) Volume of Preparation per dose: 250 mg = 500 mg 5 mL X X = 10 mL per dose Total Volume needed = 10 mL Dose x 3 doses x 7 days = 210 mL day

Number of Bottles = 210 mL / 60 mL = 1.75 2 Bottles (120 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Remember that 5 mL is roughly equivalent to one teaspoonful (use common household methods of approximating measures) in this case, give two teaspoonfuls of the drug DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Reg Kent, 10 years old Imus, Cavite Rx Amoxicillin Oral Suspension 250 mg/5 mL Dispense Number: 2 Bottles (120 mL) Label: Give two (2) teaspoonfuls three times a day, round the clock, for seven days. Shake well before use. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

8. A prescription for an 8 year old boy with intestinal colic using Dicycloverine HCl Syrup to be given at a dose of 10mg three times a day for 2 days. (Dicycloverine Syrup is available in 60mL bottles containing 10mg/5mL)
Computation: Volume of Preparation per dose: 10 mg = 10 mg 5 mL X

X = 5 mL per dose

Total Volume needed = 5 mL x 3 doses x 2 days = 30 mL Dose day Number of Bottles = 35 mL / 60 mL = 0.5 1 Bottle (60 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Prescribe 1 bottle (60 mL) Remember that 5 mL is roughly equivalent to one teaspoonful (use common household methods of approximating measures) in this case, give one teaspoonful of the drug DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Gary Santos, 8 years old Bacoor, Cavite Rx Dicycloverine HCl Syrup 10 mg/5 mL Dispense Number: 1 Bottle (60 mL) Label: Give one teaspoonful three times a day for two days. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

9. A prescription for a 10 year old child weighing 30kg with allergy, using Diphenhydramine Syrup a dose of 25mg three times a day for 5 days. (Diphenhydramine HCl Syrup is available in 60mL and 120mL containing 12.5mg/5mL)
Computation: Volume of Preparation per dose: 12.5 mg = 25 mg 5 mL X

X = 10 mL per dose

Total Volume needed = 10 mL x 3 doses x 5 days = 150 mL Dose day Number of Bottles = 150 mL / 60 mL = 2.5 3 Bottles (60 mL) OR Number of Bottles = 150 mL / 120 mL = 1.25 2 Bottles (120 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Between the two computations for the number of bottles to be dispensed, the first one 3 Bottles (60 mL) is more favorable because it will give less residual drug Based on economy, prescribing one Bottle (120 mL) and one Bottle (60 mL) is more favorable You may prescribe either: 3 Bottles (60 mL) or 1 Bottle (120 mL) and 1 Bottle (60 mL) Remember that 5 mL is roughly equivalent to one teaspoonful (use common household methods of approximating measures) in this case, give two teaspoonfuls of the drug DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Moja Mojaru, 10 years old Imus, Cavite Rx Diphenhydramine 12.5 mg/5 mL Dispense Number: 3 Bottles (60 mL) Label: Give two teaspoonfuls three times a day for five days. July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

10. A prescription for long term prevention of bronchial asthma in a one year old child weighing 12kg , using Keotifen Infant Drops at a dose of 0.05 mg/kg body weight twice a day, good for one month. (Ketotifen Infant Drops is available in 30mL bottles containing 1mg/mL)
Computation: Amount of drug per day = 0.05 mg x 12Kg = 0.6 mg per day Kg Volume of Preparation per dose: 1 mg = 0.6 mg mL X Total Volume needed = 0.6 mL Dose

X = 0.6 mL per dose

x 2 doses x 30 days x 1 month = 36 mL day month

Number of Bottles = 36 mL / 30 mL = 1.2 2 Bottles (30 mL) Note:

It is acceptable to prescribe a little over than the required amount than fall short Remember that 5 mL is roughly equivalent to one teaspoonful (use common household methods of approximating measures) in this case, give two teaspoonfuls of the drug DE LA SALLE UNIVERSITY MEDICAL CENTER Dasmarias, Cavite Tel No. 417-1234 Doraemon Santos, one years old Imus, Cavite Rx Ketotifen Infant Drops 1 mg/mL Dispense Number: 2 Bottles (30 mL) Label: Give two 0.6 mL, using a dropper, twice a day for one month July 4, 2005

jctayco
John Carlo L. Tayco, MD License Number: 87658 PTR Number: 12345

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