Pharmacology

DRUG CALCULATION
 NURSES’ RIGHTS WHEN
ADMINISTERING
MEDICATIONS
These rights provide an additional
layer of safety by ensuring that the
nurse has what is needed to
provide safe medication
administration
 NURSES’ RIGHTS WHEN
ADMINISTERING
MEDICATIONS
1. The right to a complete and clear order.
2. The right to have the correct drug,
route (form) and dosed dispensed
3. The right to have access to information
 NURSES’ RIGHTS WHEN
ADMINISTERING
MEDICATIONS
4. The right to have the policies in guide safe
medication administration
5. The right to administer medication safety
and to identify the problems in the system.
6. The right to stop, think and be vigilant
when administering medications.
 Guidelines on Medication

• 1.Administer medicines as
prescribed & according to the
manufacturer’s instruction.
 Guidelines on Medication

• 1.Follow safety procedure

• Never give drug prepared by someone
else.
• Never allow the medication cart/tray
out of your site after you prepare the
dose
 Guidelines on Medication

•Never leave the drug at the bedside,

watch the patient swallow the drug.
• Never return unwrapped or prepared
drugs to the stock supply, instead
dispose the medication & notify the
pharmacist.
 Guidelines on Medication

•Keep the medication supply

secure at all times.
• Follow standard precautions as
appropriate.
 Guidelines on Medication

•3 Monitor the patient for therapeutic

effects, regularly evaluate the serum drug
level & results of relevant laboratory tests.
 Guidelines on Medication

•4 Evaluate the patient for adverse

reaction & notify the practitioner &
intervene if necessary
 Guidelines on Medication

5 Provide patient teaching essentials to

proper medication administration.

6 Consider legal aspects associated with

drug therapy.
 ASSIGNMENT
• CALCULATE THE FOLLOWING:
Your patient weighs 200 lb and the order
is to infuse 250 mg dobutamine in 500 ml
NS
at 10 mcg/kg/min. How many milligrams
of dobutamine will infuse per hour?
 ASSIGNMENT
• CALCULATE THE FOLLOWING:

1500MG/500 MG X 1 CC=3CC
 Drug Calculations
1. Determine the basic formula, the ratio-and proportion
method, fractional equation, or dimensional analysis for
calculating drug dosages.
2. Convert all measures to the same system and same unit
of measure within the system before calculating drug
dosage
3.Calculate drug dosage using one of the general formulas.
 OBJECTIVES
1. Determine the basic formula, the ratio-and
proportion method, fractional equation, or dimensional
analysis for calculating drug dosages.
2. Convert all measures to the same system and same
unit of measure within the system before calculating
drug dosage.
3. Calculate drug dosage using one of the general
formulas.
 Metric System

❖ The metric system is logically organized into

units of 10; it is a decimal system.
❖ Basic units can be multiplied or divided by 10
to form secondary units.
 Metric System

❖ Multiples are calculated by moving

the decimal point to the right, and
division is accomplished by moving
the decimal point to the left
 Metric System
❖ Basic units of measurement are the meter, the
liter, and the gram.
❖ Liter and gram are the only metric system used
in drug administration.
❖ The kilogram (kg) is the only multiple of the
gram used, and the milligram (mg) and
microgram (mcg) are subdivisions
 Metric System

❖ Multiples of the liter are usually

expressed as liters or milliliters, for
example, 2.5 liters or 2,500 mL.
 Metric System

❖ In nursing practice it is important to

understand the difference between
weight and volume. A drug dosage may
be ordered by weight (i.e., grams, mg,
mcg), but administered by volume (mL).
 Metric System

❖ For example, a health care provider

prescribes 20 mg (weight) of codeine in
an elixir (liquid) form. The codeine elixir
bottle is labeled 10 mg per 5 mL.
❖ The nurse administers 10 mL (volume)
of codeine elixir
 Apothecary System
• Very old system of measurement that was specifi cally developed for use by
apothecaries or pharmacists.
• The apothecary system uses the minim as the basic unit of liquid measure
and the grain as the basic unit of solid measure .
• This system is much harder to use than the metric system and is rarely seen
in most clinical settings. Occasionally, a prescriber will write an order in this
system, and the dose will have to be converted to an available form.
Table 3. Metric, Apothecary and Household Measurements
 Household System
• The household system is the measuring system that is found in recipe books.
• This system uses the teaspoon as the basic unit of fluid measure and the
pound as the basic unit of solid measure .
 Converting Units of Weight

❖ A milligram is smaller than a grain

(1 mg = 1/60 grain and 1 grain= 60
mg).
 Converting Units of Weight

❖ Divide by 60 if converting from milligrams

to grains.
❖ Multiplies by 60 if converting from grains
to milligrams.
1. 2 g = _________ mg 5. 500 mg = ______ g
2. 1.2 kg =________ g 6. 10,000 mcg =____mg
7. 2400 mg = ______ g
3. 5 mg = _______ mcg
8. 1500 mL = ______L
4. 2.5 L = _______ mL
 Converting Units of Weight

❖ Small units (mg) to large units (grains) = a

smaller number
❖ Large units (grains) to small units (mg) =
a larger number
 Converting Units of Weight

❖ Example 3,000 mg
_______ =50 grains

60

50 grains x 60 =3,000 mg
 Converting Units of Weight

❖To convert kilograms (kg) to pounds (lb),

multiply kg by 2.2

❖To convert pounds (lb) to kilograms (kg),

divide lb by 2.2
Converting Units of Weight
Example
1. Maria gave birth to an alive baby whose weight is 8 lbs. what
is the weight in kilograms?

8
___= 3. 63 kg
2.2
Example
1. Order: fluorouracil (5-FU), 12 mg/kg/day IV, not to exceed 800
mg/day. The adult weighs 132 lb.

a. Convert pounds to kilograms by dividing the

number of pounds by 2.2
(1 kg = 2.2 lb).
132÷ 2.2 = 60 kg
Example
1. Order: fluorouracil (5-FU), 12 mg/kg/day IV, not to exceed 800
mg/day. The adult weighs 132 lb.

b. mg × kg = patient’s dose
12×60 = 720mgIV/day
Answer: Fluorouracil 12 mg/kg/day = 720 mg
2. Order: cefaclor (Ceclor) 20 mg/kg/day in three
divided doses. The patient weighs 31 lb.
Available
a. Convert pounds to kilograms.

• 31÷ 2.2 = 14 kg

b. 20 mg × 14 g = 280 mg/day
280mg÷ 3 divided doses = 93mg/dose

D 93 463 5mL ×93mg 465

c. BF= -__ : x V= ----- x 5 = ----- = 3.7 ml or DA ml= ----------------= = 3.7ml
• H: 125 125 125mg×1 125
 Methods of Calculating Dosage
• The basic formula for calculating drug dosages is commonly
used and easy to remember:
D -desired dose (i.e., dose ordered by primary care provider)
H -dose on hand (i.e., dose on label of bottle, vial, ampule)
V -vehicle (i.e., form in which the drug comes, such as tablet or
liquid).
• Example

Order: Erythromycin 500 mg

On hand: 250 mg in 5 mL
D = 500 mg H = 250 mg V =5 mL
❖ Order: Phenobarbital gr ii
On hand: Phenobarbital 30 mg tablets

❖ Note: Before doing the drug

calculation, the nurse needs to
convert to one system and unit of
measurement. In this case, the nurse
converts the grains (order) to the
measurement on hand (mg):
2 gr =120 mg
D =120 mg, H -30 mg, V =tablet
❖ Start cefuroxime 300 mg IV q8 hr IVTT
ANST.
❖Stock on hand 500mg reconstituted 5ml?
How many cc/ml you will administer?
 Ratio and Proportion Method
• The equation is set up with the known quantities on
the left side (i.e., H and V). The right side of the
equation consists of the desired dose (i.e., D) and the
unknown amount to administer (i.e., x).
• The equation looks like this:
H:V=D:X
• the multiply the extreme H:V=D:X
Example
Order: Keflex 750 mg
On hand: Keflex 250 mg capsules
H =250 mg : V =1 capsule :: D =750 mg : x
• 250 : 1 :: 750 : x
• Multiply the extremes (i.e., H and x) and the means (V and D):
• 250x= product of extreme
• 25=products of means
• 250x=25 is the equation
• 250x 25
250 250
• = 3 capsules
• Order: Aspirin gr 10
• On hand: Aspirin 325 mg tablets

• Note: Before doing the drug calculation, the nurse needs to convert to
one system and unit of measurement. In this case, the nurse converts
the grains to milligrams:
• 1 gr =60 mg
• 10 gr =600 mg
• H = 325 mg : V = tablet : : D = 600 mg : x
325 : 1 :: 600 : x
Multiply the extremes (i.e., H and x) and the means
(V and D):
•X=1.8=2 tablets since a tablet
cannot be accurately cut into 0.8.
• Suppose you had a medication with a dosage
strength of 50 mg per 1 mL, and the prescriber
orders a dosage of 25 mg. A ratio and proportion
may be used to determine how many milliliters to
administer.
• H=50 mg D=25 mg V=1 ml
50 mg: 1 ml= 25 mg: X
50 mgX=25 mg
= 0.5 ml
• Order: 1 g p.o. of an antibiotic
• Available: 500 mg capsules. How many
capsules will you administer?
 Fractional Equation Method

❖The fractional equation method is similar to ratio

and proportion, except it is written as a fraction:

H D
V X
 Fractional Equation Method

• The formula consists of cross multiplying and

solving for x:
•
 Fractional Equation Method
• Order: Lanoxin 0.25 mg
• On hand: Lanoxin 0.125 mg tablets
• 0.125 mg 0.25 mg
• ______ = _______
1 tablet x tablets
•
•Cross multiply:
0.125 x = 0.25
Solve for x:

=2 tablets
Example Requiring Conversion

• Order: Atropine gr 1/100

• On hand: Atropine 0.4 mg/mL
• Note: Before doing the drug calculation, the nurse
must convert from two systems to one system and
unit of measurement. In this case, because the
dosage on hand is in milligrams, the nurse converts
the grains to milligrams
 • Cross multiply:
0.4 x =0.6

1 gr = 60 mg
1/100 gr =0.6 mg Solve for x
0.4 x 0.6
0.4 mg 0.6 mg
_____ = ___
1 ml xml
0.4 0.4

X= 1.5 ml
Dimensional Analysis(also called Factor-Label
Method or the Unit Factor Method)
The dimensional analysis method is often used in
the physical sciences when a quantity in one unit
of measurement is converted to an equivalent
quantity in a different unit of measurement by
cancelling matching units of measurement.
•Is a problem-solving method that uses
the fact that any number or expression
can be multiplied by one without
changing its value.
 Dimensional Analysis
• The three components (D, H, and V) are still needed to solve
the problem. However, when the units of measurement differ
for D and H, the dimensional analysis method includes the
conversion factor in the equation. The formula is as follows;
• (drug label) x (conversion) x(drug order)
where V -vehicle, H - on hand, D -desired, and C
-conversion factor.

• If D and H are of the same unit of measurement, the

conversion factor is not included in the equation.
•
Order: Valsartan 120 mg
On hand: Valsartan 40 mg tablets
1.On the left side of the equation, put the drug form [V] (e.g.,tablet,
capsule, mL) of x. For example: x tablet =.
2.On the right side of the equation, put the information related to the
drug label. This information is put in the equation as a fraction. The
information that matches the x quantity must be put in the numerator.
The information about the numerator is placed in the denominator.
Order: Valsartan 120 mg
On hand: Valsartan 40 mg tablets
• 3. Place the information about
the conversion factor on the
right side of the equation. In
this example, the units are the
same and there is no need for a
conversion factor in the
equation.
 Order: Valsartan 120 mg
On hand: Valsartan 40 mg tablets
• 4. Next, find the information
that matches the information in
the denominator of the fraction.
That is, the desired dose. In this
case, that is milligrams and the
order is for 120 mg. Add this
information to the right side of
the equation.
Example Using a Conversion Factor
Order: Dofetilide 0.5 mg
On hand: 125 mcg capsules
 Calculations of Intravenous Fluids

❖ Intravenous (IV) fluid therapy is used to

administer fluids that contain water,
dextrose, vitamins, electrolytes, and drugs.
 Calculations of Intravenous Fluids

❖ The number of drugs that are administered

by the IV route for direct absorption and fast
action are currently increasing
 Calculations of Intravenous Fluids

❖ Drugs are given by IV push is called bolus.

❖ Many drugs administered IV irritate the veins, so
these drugs are diluted in 50 to 100 mL of fluid.
 Calculations of Intravenous Fluids

Some drugs are delivered in a large volume of fluid

over a specific period, such as 4 to 8 hours
Methods used to administer IV fluids and drugs:

1. Continuous IV infusion –This is to replace

fluids loss, maintain fluid balance and serves
as a vehicle for drug administration
Methods used to administer IV fluids and drugs:

2.Intermittent IV infusion- is used primarily to

give IV drugs.
 The nursing functions and responsibilities
during drug preparation
1. Knowing IV sets and their drop factors
2. Calculating IV flow rates
3. Mixing and diluting drugs in IV fluids
4. Gathering equipment
5. Knowing the drugs and the expected and
untoward reactions
 CONTINUOUS INTRAVENOUS
ADMINISTRATION

❖ The health care provider orders the type and

amount of IV solution in liters over a 24-hour
period or in milliliters per hour if IV solutions
are required.
 CONTINUOUS INTRAVENOUS
ADMINISTRATION

❖ The nurse calculates the IV flow rate

according to the drop factor, the amount of
fluids to be administered, and the time
period.
 Intravenous Sets

❖ Drop factor is the number of drops per milliliter,

and it is normally printed on the packaging cover
of the IV set (marketed by Abbott, Cutter,McGaw,
and Travenol)
 Intravenous Sets

❖ Macrodrip set is a set that delivers large drops per

milliliter (10 to 20 gtt/mL). This set is use if the IV rate
is to infuse at 100 mL/h or more.
❖ Microdrip (Minidrip) set- one that delivers small drops
per milliliter (60 gtt/mL). Use if the infusion rate is less
than (<) 100 mL/h or the patient is a child.
Intravenous Sets
Intravenous Sets
 Intravenous Sets

❖ Keep vein open (KVO) or to keep open (TKO)-are IV

fluids given at a slow rate. This rate is ordered if there is a
suspected or potential emergency situation for rapid
administration of fluids and drugs, and the need for open
line to give IV drugs at specified hours.
❖ Microdrip set ( 60gtt/ml ) and a 250 ml IV bag may be
used and usually regulated to deliver at 10ml/hr.
Calculating Intravenous Flow Rate
Calculating Intravenous Flow Rate
Calculating Intravenous Flow Rate
 EXAMPLE

❖ Order: 1000 mL of 5% dextrose in water (D5W) with

potassium chloride (KCl) 20 mEq in 8 h
❖ Available: 1000 mL of 5% dextrose in water.
Potassium chloride 40 mEq/20 mL ampule. IV set
labeled 10 gtt/mL
Method I

1. 1000 ml
8 hr = 125 ml/hr

2. 125ml/hr
= 2.0-2.1 ml/hr
60 min
2.1 x 10 = 21 gtt/ml
Method II

1. 1000 ml ÷ 8 hr = 125 ml/hr

2. 125 ml x 10gtt/ml 125gtt
꞊
60 min 6min
꞊ 20-21 gtt/min
1000 ml x 10 gtt/ ml
8h x 60 min

1000
꞊ 20 or 21 gtt/min
48
For the KCL,use the basic formula, the ratio-and proportion
method, fractional equation, or dimensional analysis if
needed.
 Volume/Time –IV ml Rate Question
❖ Given a certain amount of a liquid and a time period,
what is the necessary IV flow rate in ml/hr? Measurement
used when IV regulated electronically by infusion pump.
❖ FORMULA
Volume (ml)
X ( Flow rate in ml/hr
Time (hr)
 Volume/Time –IV ml Rate Question
Volume (ml)
X ( Flow rate in ml/hr
Time (hr)
Example: Infuse 250 ml over the next 120 minutes by
infusion pump.
 Example: Infuse 250 ml over the next 120
minutes by infusion pump.

Volume (ml)
X ( Flow rate in ml/hr
Time (hr)
Convert 120 minutes to hours.
Minutes divide by 60 250 ml
125 ml/hr
120 divide by 60= 2 hrs 2hrs
Ordered 1000 ml D5LR IV to infuse 10 hrs by
infusion pump
Volume
Hour
1000 ml
10 hrs
= 100 ml /hr
• https://www.youtube.com/watch?v=NmNBiTRtPFY&t=182s
A 20 gtts/min set is to be used to infuse an IV
at a rate of 90 mL/hr. Calculate the gtt/min
flow rate.
• Set it up: 90 mL/hr x 20 gtt/mL = ____ gtt/min
60 min

•Answer: 30 gtt/min
Calculate the gtt/min flow rate to administer an
IV at 100 mL/hr using a set calibrated at 15
gtt/mL.

• Set it up:
100 ml/hr x 15 gtt/mL = ___________gtt/min.
(1hr) 60 minutes

Answer: 25 gtt/min
• Unit factors may be made from any two terms that describe the same or
equivalent "amounts" of what we are interested in. For example, we know
that;
• 1 inch = 2.54 centimeters
(1) How many centimeters are in 6.00 inches?

(2.) Express 24.0 cm in inches.

Order: Erythromycin 25 mg oral suspension
On hand: Erythromycin oral suspension 25 mg per 5 mL
Determine the number of teaspoons the nurse will administer
Order: Tylenol gr xv
On hand: Tylenol 325 mg tablets
• Suppose you had a medication with a dosage
strength of 50 mg per 1 mL, and the prescriber
orders a dosage of 25 mg. A ratio and proportion
may be used to determine how many milliliters to
administer.
• H=50 mg D=25 mg V=1 ml
50 mg: 1 ml= 25 mg: X
50 mgX=25 mg
= 0.5 ml
 Clark’s rule
• A method of determining the correct drug dose for a child based on the
known adult dose (assumes that the adult dose is based on a 150-lb person);
it states
child’s dose= weight of child (lb) x average adult dose
150 lbs.
• Used to calculate the amount of medicine to give to a child aged 2-17
 EXAMPLE
• If an adult dose of medication calls for 30mg and the child weighs 30lbs.
Divide the weight by 150 (30/150) to get 1/5. Multiply 1/5 times 30mg to
get 6mg
• X= 30 Ibs x 30 mg
150 lbs
= 0.2 x 30 mg
x= 6mg
 Fried’s rule
• Method of determining a pediatric drug dose for a child younger than 1 year
of age, based on the child’s age and the usual adult dose (assumes that an
adult dose would be appropriate for a 12.5-year-old child); it states
child’s dose (age 1yr) =weight of child (months) x average adult dose
150 months
 example
• The doctor orders an adult dose of Ibuprofen 500mg PO PRN. Calculate the
dose for a child who is 24 months old.
• Pediatric dose = 24 months x 600 mg
150 months
= 0.16 x 600 mg
= 96 mg
 Young’s rule
• Method for determining pediatric drug dose based on the child’s age
(calculates doses for children 1 to 12 years of age) and the usual adult dose; it
states
child’s dose (age 1– 12 y) = child’s age (y) X average adult dose
child’s age (y) 12
 EXAMPLE
• The pediatric dose for a 9-year old child who weighs 63lbs needs to be determined. You
learn that the adult dose for the same drug is 200mg. Using Young’s rule, what dose should
the child be given?
• = 9 yr x 200 mg
9 yr+ 12
= 9 x 200 mg
21
= 0.42 x 200 mg
= 85.7 0r 86 mg
 Body Surface Area
• The surface area of a child’s body may also be used to determine the
approximate dose that should be used.
• To do this, the child’s surface area is determined with the use of a
nomogram
• The height and weight of the child are taken into consideration in this chart.
 Body Surface Area
• The following formula is then used:
child’s dose = surface area (m2 ) x average adult dose
1.73
• This method is more precise than the formula methods, but you have to have
a nomogram available to determine the surface area
 NOMOGRAM

•The nomogram that uses body surface

area is more accurate for determining
doses
0.17