Units for certain dispensing

[baronzb]

A good question for IPPE folk:

What units do you measure certain dosage forms in; for instance, for albuterol HFA, we use mcg, but for tiotropium we use ml. What other examples out there for non-solid dosage would be good to know?

Many patients dont know ml. Should pharmacists use tsp instead, for liquids? (Often, no dropper is included.) For drops, how many mls is the standard--15ml/gtt?

Additionally, other than fenofibrate, and it's many brand names, what other drugs have the same quantity of active ingredient, but are not equivalent?

Anyone think of any other examples?

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[BidingMyTime]

Not IPPE, but:

I have no idea what you are asking in your first question.

2nd question, NO, pharmacists should not ever use tsp for liquids, even though that is what people know, they will use a bent up teaspoon that they inherited with their Grandma's cutlery set, and that is not at all accurate. Always use milliliters, patients need to get a syringe or spoon that measures milliliters, so their dosing is accurate. Every pharmacy should provide these when dispensing a liquid medication (if not, pretty much every other pharmacy will at least sell them.)

For drops, 15ml is standard for suspensions, 20ml for solutions.

Um yes, there are many different drugs which have several different commercially available products which aren't considered equivalent. This is the kind of thing you should have learned in school, or should be learning now. Albuterol, diltiazem, levothyroxine are just a few. Basically, if you don't know that a drug form company A is equivalent to the drug from company B, then *you* need to do the research to figure it out (its not that hard, its called a cough, cough, "Orange Book".) You can't take for granted say that all aripiprazole is equivalent to Abilify.....maybe it is today, but that doesn't mean that a new company's version tomorrow will be.

 

[trailerpark]

Walmart says to use 15 drops per mL for everything to make it simple. Orange book app is easy to use.

 

[baronzb]

Not IPPE, but:

I have no idea what you are asking in your first question.

2nd question, NO, pharmacists should not ever use tsp for liquids, even though that is what people know, they will use a bent up teaspoon that they inherited with their Grandma's cutlery set, and that is not at all accurate. Always use milliliters, patients need to get a syringe or spoon that measures milliliters, so their dosing is accurate. Every pharmacy should provide these when dispensing a liquid medication (if not, pretty much every other pharmacy will at least sell them.)

For drops, 15ml is standard for suspensions, 20ml for solutions.

Um yes, there are many different drugs which have several different commercially available products which aren't considered equivalent. This is the kind of thing you should have learned in school, or should be learning now. Albuterol, diltiazem, levothyroxine are just a few. Basically, if you don't know that a drug form company A is equivalent to the drug from company B, then *you* need to do the research to figure it out (its not that hard, its called a cough, cough, "Orange Book".) You can't take for granted say that all aripiprazole is equivalent to Abilify.....maybe it is today, but that doesn't mean that a new company's version tomorrow will be.

I meant, what is the dose of creams, inhalers measured in? That is, some are mls, some mcg, etc.? Sometimes the physician does not specify what units in the sig. When it is a cream, and sig just says "apply" how do we can we calculate if there is enough supply for the days allotted by the physician and know what unit it's measured in when not a solution, cream, or capsule/tab? What is the resource for that? Is there a retail-centered resource for these things, if even only a tertiary source?

As far as the equivalencies go with dosing of non-bioequivalent drugs, such as fenofibrates, do pharmacists often have to calculate this themselves, that is, does the computer often not have this information? Often, the prescribed drug is in stock and dose is not a problem; occasionally I have to choose whats equivalent and the computer is not sophisticated to know this.

 

[Wheresmyaricept]

I meant, what is the dose of creams, inhalers measured in? That is, some are mls, some mcg, etc.? Sometimes the physician does not specify what units in the sig. When it is a cream, and sig just says "apply" how do we can we calculate if there is enough supply for the days allotted by the physician and know what unit it's measured in when not a solution, cream, or capsule/tab? What is the resource for that? Is there a retail-centered resource for these things, if even only a tertiary source?

As far as the equivalencies go with dosing of non-bioequivalent drugs, such as fenofibrates, do pharmacists often have to calculate this themselves, that is, does the computer often not have this information? Often, the prescribed drug is in stock and dose is not a problem; occasionally I have to choose whats equivalent and the computer is not sophisticated to know this.

Why are you switching fenofibrates. What are you calculating??

As for the creams, depends on the size of the tube and what it's being used for. Acne? 30 days. Small 15 gram tube? 7 days. Large 60-80 grams might get 20-30 days.

 

[BidingMyTime]

I meant, what is the dose of creams, inhalers measured in? That is, some are mls, some mcg, etc.? Sometimes the physician does not specify what units in the sig. When it is a cream, and sig just says "apply" how do we can we calculate if there is enough supply for the days allotted by the physician and know what unit it's measured in when not a solution, cream, or capsule/tab? What is the resource for that? Is there a retail-centered resource for these things, if even only a tertiary source?

It's a guessing game. Make an educated guess. If you guess wrong and they run out soon, then call the ins to have the days supply adjusted.
For the measurements, there is no standard. Most creams will be measured in gram. Inhalers could go either way. What its measured in, probably depends how it was set up in your computer system, so you ust have to learn it for each product.

As far as the equivalencies go with dosing of non-bioequivalent drugs, such as fenofibrates, do pharmacists often have to calculate this themselves, that is, does the computer often not have this information? Often, the prescribed drug is in stock and dose is not a problem; occasionally I have to choose whats equivalent and the computer is not sophisticated to know this.

Legally you can't switch non-bioequivalent drugs without getting a prescription from the doctor to switch. Unless you are in hospital, in which case you would be changing under protocol. If its retail, unless its a back-order situation, then you order the drug that you need. In other words, it would be an extremely rare situation that you would need to figure the dosing of a non-bioequivalent drug, and there may or may not be information available on equivalency in a good reference book-once you've figured out the closest alternative, then call the dr to have it changed.

 

[Carboxide]

Measure them based on whatever the bottle or package says it is measured in. If it says the cream is 15 gm, it's in gms. If it's in mL, use mL. The days' supply is based on the suspected area. If it's something unknown, like triamcinolone cream, I usually give 7 days unless it's a large tube of 60 gm, where I give 14, or a tub, which I usually do 30. If you're wrong, you just cal ins, nbd.

As for tsp, NO. Never use tsp. It's a horrible practice. Every time I get an Rx for myself with the dosage listed in tsp, I see red! Tsp to a patient means "pick a spoon from the drawer and use it." You should ALWAYS give EVERY patient a measuring device in mL. Always use mL in the sig. No exceptions.