Week 4 Discussion – OTC Medications and Introduction to Calculations

Career Relevancy
Across the healthcare industry, healthcare professionals have to juggle different roles including dosage calculation. You’ll have to calculate the proper dosages of drugs for individual patients, and in those calculations, you’ll consider a variety of metrics, from drug quantity and duration to patient’s age and body weight. To prepare you for these basic equations, you’ll need a base knowledge of the different types of metrics and units and how to perform key formulas. You’ll also need to understand and accurately interpret prescription orders, which include information about the dose, type of medication, and administration route. Because there are many medications, and many are not manufactured in exact doses or they contain concentrations that differ from what is required, you’ll need to know how to mathematically modify medication amounts for any number of on-the-job scenarios.

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Monique, our trusted authority on all things pharmacology, is finishing up the orientation training she’s building for new employees at her hospital. She’s covered the drug fundamentals, from some biochemical basics to drug interactions to privacy and safety policies. She’s hoping to give her new colleagues the tools to provide medically sound, ethical care, especially when it comes to medications.

How can she wrap it all up? What else do her colleagues need to know on day one? As Monique is brainstorming how to bring everything together, she realizes there’s a big, important chunk that she hasn’t covered. Remembering her pharmacology training from many years ago, she recalls that there is some basic math, some equations, and calculations that can get any new employee up to speed on medication administration at her hospital.

But she wants to ease them into that. First, she decides to cover some fundamental, math-free information: common over-the-counter drug classes.

What are over-the-counter medications?

Over-the-counter, or OTC, drugs, Monique explains, are not prescribed by a doctor and do not have to be recommended by a clinician. These drugs are used as a form of self-treatment and do not require the supervision of a healthcare professional. A patient can purchase them at their discretion.

There are many classes of over-the-counter drugs, and they can be used to treat a variety of conditions and symptoms, from allergies to nausea. Medical professionals do not need to know all of them, but they should be familiar with some because of how often they’re used. Monique explains that her audience members will become increasingly familiar with many over-the-counter drugs as they continue to work with patients in the hospital.

Allergy treatment
Cold and cough medication
Nonsteroidal anti-inflammatory drugs
Antacids
Contraceptives
Topical treatments
Various classes of OTC medications can help streamline the care process. They are conveniently and quickly accessible, and can easily help patients alleviate their symptoms. They also reduce the burden on the healthcare system because patients do not need to go to an urgent care facility or hospital to help themselves feel better.

What does math have to do with medications?

Having oriented her audience in the basic classes of OTC drugs, she thinks they’re ready for some simple math. After all, they’ll need to perform some basic calculations every day to ensure their patients are receiving the correct dosages of their medications. Because medications can have toxic effects if misused, caregivers’ computations need to be accurate. Otherwise, a patient may experience poor or dangerous outcomes and the employee, or organization, may face charges.

The truth is, Monique explains, physicians write prescriptions for doses that are not premeasured. There might be a request for 3 ml of insulin, one 350 mg tablet of ibuprofen, 1 teaspoon of cough syrup, or 5 mg of morphine, to be provided intravenously. Medical assistants and other professionals must be able to use mathematical functions to accurately calculate dosages for each patient for each situation, using key numerical info such as body weight, medication type, and different units and systems of measurements.

So, what are some of the key metrics and calculations that they’ll need to do? The general methods of calculating dosages involve using several mathematical units: fractions, decimals, percentages, ratios, and proportions. Monique decides it’s best to give her audience a quick arithmetic refresher.

Fractions: Fractions represent the number of parts to the whole. For instance, ½ is a fraction that represents half. In the medical field, fractions can be used to identify the portion of a medication that should be used, such as ½ of a pill.
Fraction terms: A fraction is made up of the numerator, which is the number on top, and the denominator, which is the number below. For instance, with the fraction ¼, 1 is the numerator and 4 is the denominator. The denominator represents the whole, and the numerator represents a part of that whole. So, in ¼, there are 4 parts that make up the whole, and the 1 represents the part. Fractions are read based on the denominator; in other words, ¼ is one-fourth, and 1/10 is one-tenth.
Types of fractions: There are several types of fractions that appear on the job in medical facilities. In some cases, they require being manipulated before they can be applied to calculations.
Proper fractions: In these fractions, the numerator is smaller than (<) the denominator. For instance, ¼ is a proper fraction since the 1 < 4.
Improper fractions: In these fractions, the numerator is larger than (>) the denominator. For instance, 5/4 is improper since 5 > 4.
Whole fractions: A fraction is considered whole when the numerator is equal to the denominator. For instance, 4/4 is a whole fraction because 4=4.
Decimals: Decimals are like fractions in that they represent part of a whole. But a decimal can be an easier method of reflecting an amount that is more than one. This is because a decimal is technically a combination of a whole number and a fraction with a dot in between. That dot in the number is characteristic of the decimal, it’s a dead giveaway that you’re looking at a decimal. On the left-hand side are the whole numbers. On the right-hand side, there will be a “fraction” represented by powers of ten. The numbers on that side of the point are referred to as tenths, hundredths, thousandths, etc.
For example, take the decimal 3.4. The 3 is the “ones” position. So, the fraction component would be the .4, in which .4 technically means 4/10. It is written in lieu of the fraction, however, and a zero is added based on the number of digits after the decimal. In this case, there is only one digit: 4.
When it comes to medication, medical professionals of all kinds will encounter decimals regularly. Although sometimes they require translation, because writing a 500 mg dosage is clearer than writing a 0.5 grams dosage, even if they’re the same.
Percentage: Percentages are another way to represent part of a whole, and they are expressed as a ratio of 100. Therefore, 5% is equivalent to the fraction 5/100. It can also be represented by a decimal as .05, and that fraction can be reduced further to 1/20. The term percent refers to “per hundred.” In other words, all percentages will be expressed as a ratio or fracture of X out of 100. This could be used when trying to determine the amount of a drug in a patient’s bloodstream.
Ratios: A ratio is a calculation used to show the relation between 2 values. It indicates how many times the one contains or is contained in the second. For example, you might need to add water to a medical solution. A ratio will tell you how much water to add per quantity of concentrate. Ratios can be written in several formats.
Using a colon (:). For example, you’d write 1:4.
Using a slash (/). For instance, you can use the above examples of 1/5 and 4/5. (As a decimal, 1/5 is .2 and 4/5 is .8. And as a percentage, 1/5 is 20%. Dividing fractions and multiplying decimals and fractions will likely be a regular task you’ll have to take on.)
How to manage medication orders?

Monique decides to wrap up this section with some practical applications. She’s just thrown some mathematical ideas at her audience, and she wouldn’t want to lose their unwavering attention now. She decides to get back into the people part of the program, hoping to help her audience see how these calculations work in action. Monique explains that every day, medical professionals must administer medications for specific patients, who may be children or adults, with specific needs and contexts that must be considered. Medication orders will depend on these considerations.

These orders can fall into various categories: immediate, as needed, single orders, verbal, or standard, or timed order. This language and terminology are used to help medical professionals understand and process information regarding medications, such as type, dosage, administration, route, and reactions, as well as communicate findings and recommendations that support the patient’s care. For any of these orders, a clinician will ask their medical support staff to process the order. They’ll mention a medication by name, the form it should be delivered in (probably in an abbreviated form), the administration route (abbreviated, such as IM or ID), the timeline (q 4 hours), and the dose to give.

Monique dives into some examples. A medication order that states that a patient should receive 5 mg of aspirin daily with no timeline means that this order is for an oral form of aspirin that is in effect every day until discontinued. If it is only a one-time administration, this is a single order. Or, perhaps an order is urgent; if it’s needed immediately, it’s written as STAT. If it’s prescribed on an as-needed basis. Such as if a patient has chest pain, it’s identified as PRN (an abbreviation of the Latin phrase, pro re nata, which means “as needed). Caregivers also give and receive verbal orders. If a medical assistant is receiving a verbal order, for instance, they need to repeat it to ensure that there was no miscommunication or misinterpretation.

Resources and References

F.A. Davis. (n.d.) Pediatric dosage calculations. Davis’s Drug Guide. Retrieved from https://www.drugguide.com/ddo/view/Davis-Drug-Guide/109514/all/Pediatric_Dosage_Calculations (Links to an external site.)

Grissinger, M. & Proulx, S. (2008). Let’s get to the point! U.S. Pharmacist. Retrieved from https://www.uspharmacist.com/article/lets-get-to-the-point (Links to an external site.)

Math is Fun. (n.d.). Decimals, fractions, and percentages. Retrieved on October 23, 2019, from https://www.mathsisfun.com/decimal-fraction-percentage.html (Links to an external site.)

Werdo, B. (n.d.). 12 medicine cabinet essentials (Home pharmacy). Emedicine Health. Retrieved from https://www.emedicinehealth.com/home_pharmacy/article_em.htm (Links to an external site.)

Prompt
Although often, your medication calculations will apply to prescription drugs, sometimes you’ll need to modify or regulate over-the-counter medications. This is particularly true when it comes to working with pediatric patients because they’re often more vulnerable than adults.

For this prompt, you’ll imagine the following scenario: Your friend Susan is babysitting her 9-year-old nephew when he complains of a headache. After searching the medicine cabinet, she can only find adult acetaminophen. She figures that because her nephew is almost as tall as she is, she can give him the full adult dosage. But before she does anything, she decides to check. Luckily, she knows you are in school and calls you for your advice. As a healthcare professional how would you educate Susan on factors that would impact the use of an over the counter medication in a 9-year-old.

For your citation, you might use articles that discuss how to adjust medication dosage amounts for younger patients. You can also find articles from experts that discuss the specific risks, or real-life consequences, of giving a child an adult’s dosage of a medication, even just and over-the-counter one.

You will also complete two peer responses. In each peer response, you will reply to your peers’ posts with thoughtful, substantive ideas. Consider answering some of these questions: Is there anything your peer missed or overlooked? Are there other ideas to consider? Is there a current event or episode that you can bring into the conversation? Expand and deepen the discussion—introduce new concepts or controversies, add thoughtful and insightful questions, and make new connections to your own experiences or the material.

Your initial and reply posts should work to develop a group understanding of this topic. Challenge each other. Build on each other. Always be respectful but discuss this and figure it out together.

Reply Requirements
You must submit:

1 main post of 150+ words with 1 in-text citation and reference (follow the Institution Writing Guidelines)
2 follow-up posts (replies) of 50+ words
Responses can be addressed to both your initial thread and other threads but must be:

Your own words (no copy and paste)
Unique (no repeating something you already said)
Substantial in nature, which means there has to be some meat to the reply, not something like: “Good job, Rasha, your post is excellent.” A substantial post will do one of the following:
Extend the conversation deeper,
Challenge the post being responded to, or
Take the conversation in a career-relevant tangent
Remember that part of the discussion grade is submitting on time and using proper grammar, spelling, etc. You’re training to be a professional—write like it.

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