Dosage Forms

Routes of Administration

Dosage Calculations

Dosage Calculations Conversions

Drug Dosage Calculations Formula

Types of dosage Forms

Metric System

General Dosage Rounding Rules

IV Flow Rates (mL/hr & gtt/min)

Practice questions

FAMZ NURSING NOTES

Depending on the route of administration, dosage forms come in several
different types. The most popular route of administration is oral, however,
in some medical situations this route is unavailable, ineffective or
associated with a high number of adverse reactions. That is why patients
may receive drugs through parenteral means (this includes: subcutaneous,
intramuscular, intraosseous, intravenous, etc.). Moreover, some drugs are
only given topically – they're applied directly onto the skin or eye, into the
rectum or vagina, or as an inhalation.
You should know that the route of administration of a drug dramatically
influences its dosage and efficacy. You should thus always check if you are
administering the appropriate drug to the appropriate person through the
appropriate route in the appropriate dose!

What is an appropriate dose?

When treating a patient, or just taking a medication by yourself, we always
need to wonder what is the exact dose of the drug we choose. And the
truth is that we dose (or should dose) nearly everything in our life, from
cooking dinner to taking medications! However, regarding drugs, there are
certain different kinds of dosing that depend on the specific drug and/or
the patient.

One dosage Different, fixed dosages

Drugs with one fix dosage are the The dosage of these drugs is
easiest to use; you just take it and usually set by the doctor
forget about it (e.g., vaccines). You according to the patient's needs
don't need to use any dosage or age (e.g., hypotensive drugs).
calculation formulas! In this case, you also don't have
to worry about medical dosage
calculations!
Different, variable dosages Blood concentration-
dependent dosages
In this case, the doctor usually
This is a relatively small group of
suggests the patient a sample
drugs. The doses are different
dosage; the patient then modifies it
depending on the concentration
according to his/her needs and the
of the drug's active compound in
situation (e.g., insulin).
the serum (e.g., vitamin K
antagonists, lithium, etc.).

The dosage of the drug depends on the patient's body weight

The dose of the drug depends on the weight of the patient. It means that
two patients with the same disease may receive a different amount of the
same drug!

Calculating medication dosage by weight

Medical dosage calculations that consider a patient's weight are very
common in obese patients and on pediatric wards. It's easy to imagine that
the weight of the body of an adolescent may be 40 times larger than that of
a newborn baby, so we hope you can see the need to dose drugs accurately.
Moreover, some specific drugs for adults need to be dosed according to the
patient's weight. These include heparin, antibiotics, and muscle relaxants.

How to calculate drug dosage?

If you want to find what the appropriate dosage of a drug is for your body
weight, you need to follow these steps:
1.Determine the dosage of the medication. Let's say the appropriate dosage
of the active substance is 2 mg/kg of body weight.
2.Weigh yourself. Let's assume you weigh 80 kg.
3.Multiply these two values to get the dose of medication in mg: 2 * 80 =
160 mg. You need to take 160 mg of active substance.
4.What if your medication is liquid? Type the concentration into the
proper box. Let's say the concentration of your medicine is 2 mg/ml.
5.Divide the dose by the medicine concentration to obtain the liquid dose:
160 / 2 = 80 ml.
Routes of administration refer to the different ways in which medications,
drugs or other substances are introduced into the body. There are several
routes of administration for medications, including oral, topical,
inhalation, injection, transdermal, rectal, and vaginal. The choice of route
of administration is based on various factors such as the patient's medical
history, age, condition being treated, the type of medication, and the
desired speed and duration of the medication's effect. Understanding the
different routes of administration is important for proper medication
management and adherence to treatment plans.

Oral Topical
Oral medications are among the Topical medications are applied to
most common and convenient the skin or mucous membranes,
routes of administration. The such as creams, ointments, or
medication is taken by mouth and patches. These medications can
absorbed through the digestive act locally, at the site of
system. This can include pills, application, or they can be
capsules, tablets, or liquid absorbed into the bloodstream
medication. The medication must and have systemic effects. The
pass through the digestive system, main advantage of topical
so it can take longer to take effect, medications is that they can
and there is some variability in the deliver a high concentration of
amount of medication absorbed the drug to a specific area with
due to differences in metabolism fewer side effects compared to
and absorption in the gut. oral or injectable medications.
 Inhalation Injection
Inhalation medications are Injectable medications are
delivered through the mouth or delivered directly into the
nose, such as inhalers, nebulizers, bloodstream, muscle, or tissue.
or aerosol sprays. Inhalation The three most common types of
medications are typically used to injection routes are intravenous
treat respiratory conditions such (IV), intramuscular (IM), and
as asthma, bronchitis, or COPD. subcutaneous (subQ). IV injections
The medication is delivered are used when immediate effects
directly to the lungs and can act are required and the medication
quickly, providing rapid relief of must be delivered rapidly. IM
symptoms. injections are slower to take effect,
but they can deliver a larger
Transdermal volume of medication. SubQ
injections are used for smaller
Transdermal medications are volumes of medication, such as
delivered through the skin, insulin injections.
typically through a patch. The
medication is absorbed slowly over Rectal
time, providing a continuous dose
of medication. Transdermal Rectal medications are
patches are often used for chronic administered through the rectum,
conditions such as pain such as suppositories or enemas.
management, hormone Rectal medications are typically
replacement therapy, or smoking used for local conditions such as
cessation. hemorrhoids, inflammation, or
constipation.
Vaginal
Vaginal medications are
administered through the vagina,
such as creams or suppositories.
These medications are typically
used to treat vaginal infections,
inflammation, or dryness.
 Abbreviations Commonly Used in Dosage
Abbreviation Term Tips for Correct Calculations:
po by mouth (or orally) Make sure that all measurements are in the same units. If necessary,
convert
susp suspension between units.
pm • In most cases, it is best to convert a larger unit to smaller units (e.g.
as needed
convert
tab tablet grams to milligrams). This conversion uses multiplication and most
often keeps the
cap capsule
calculation in whole numbers.
q every • Always check for reasonableness of your answer. Does the drug
dosage make
bid twice a day sense? (Amounts less than half a tablet or greater than 3 tablets are not
tid three times a day common,
but still possible.)
qid four times a day

Formula: D/H * Q=X Desired/Have * Quantity=X

Term Symbol Meaning Example

"Give 500 milligrams" "

Dosage ordered The amount of medication Give grains/v" "
D
or desired dose that the physician prescribed Give 1.2 milliliters"

Dosage strength The amount of drug in a 250 milligrams

or supply on H specific unit of measure Grains/v
hand (what is available; in stock)

Unit of measure The unit of measure for the per 2 milliliters

or quantity of Q specific dosage strength or per capsule
unit supply on hand per tablet

Unknown The dosage you are

S Not applicable
Dosage trying to calculate
1 kg = 2.2 lb 1 lb = 16 oz 1 mg = 1,000 mcg
1 gallon = 4 quart 1 tbsp = 3 tsp 1 cm = 10 mm
1 tsp = 5 mL 60 minute = 1 hour 1 tbsp = 15 mL
1 inch = 2.54 cm 1 cc = 1 mL 1 cup = 8 fl oz
1 L = 1,000 mL 2 pints = 1 qt 1 pint = 2 cups
1 kg = 1,000 g 8 oz = 240 mL = 1 glass 12 inches = 1 foot
1 oz = 30 mL = 2 tbsp 1 tsp = 60 gtt 1 L = 1.057 qt
1 g = 1,000 mg 1 pt = 500 mL = 16 oz 1 oz = 30 mL

Unit Conversions
Mass: Converting lb to kg and kg to lb
→ → →
mcg mg g kg ( ÷ by 1,000 ) lb = kg × 2.2
← ← ←
mcg mg g kg ( x by 1,000 ) kg = lb ÷ 2.2
→
lb kg ( ÷ by 2.2 ) Converting mL to L and L to mL
←
lb kg ( x by 2.2 ) mL = L × 1,000
Volume: L = mL ÷ 1,000
mcL → mL → L → kL ( ÷ by 1,000 ) Converting mg to g, g to mg, mg to mcg,
mcL ← mL ← L ← kL ( x by 1,000 ) and mcg to mg
Time: mg = g × 1,000
min → hr ( ÷ by 60 ) g = mg ÷ 1,000
min ← hr ( x by 60 ) mcg = mg × 1,000 mg = mcg ÷ 1,000

Figuring IV flow rate, infusion time, and total volume

flow rate (mL/hr) = total volume (mL) ÷ infusion time (hr)
infusion time (hr) = total volume (mL) ÷ flow rate (mL/hr)
total volume (mL) = flow rate (mL/hr) × infusion time (hr)
Example: if you must administer 1 L (1,000 mL) of fluid over 4 hours, use the first
formula to calculate the flow rate, like so:

flow rate (mL/hr) = total volume (mL) ÷ infusion time (hr)

flow rate (mL/hr) = 1,000 ÷ 4

flow rate (mL/hr) = 250

The flow rate is 250 mL/hr.
 Dosage By Weight Mass for Mass
Formula: Formula:
Weight in Kg * Dosage Per Kg = Y Ordered \ Have
(Required Dosage) = Y (Tablets Required)

Mass/Liquid For Liquid IV Fluid

Formula: Formula:
Ordered \ Have x Volume Per Have Volume (mL) \ Time (min) x Drop Factor
= Y (Liquid Required) (gtts/mL) = Y (Flow Rate in gtts/min)

Volume/Time - IV mL Volume/Time - IV Drop

Formula: Formula:
Volume (mL) \ Time (hr) Concentration % \ 100 x Volume (mL)
= Y (Flow Rate in mL/hr) = Y (Dosage Amount in g)

Volume/Time - IV mL Volume/Time - IV Drop

Formula: Formula:
Volume (mL) \ Time (hr) Volume (mL) \ Time (min) x Drop Factor
= Y (Flow Rate in mL/hr) (gtts/mL) = Y (Flow Rate in gtts/min)

Fluid Maintenance

Weight Range Required Daily Fluid

0-10 kg 100 mL per kg

10-20 kg 1,000 mL + 50 mL per each kg above 10 kg

20-70 kg 1,500 mL + 20 mL per each kg above 20 kg

Over 70 kg 2,500 mL (adult requirement)

If you want to calculate the dose of a medication, you need to use the following
equation:
Dose=Weight × Dosage
Where:
Weight — Patient's weight, expressed in kg or lb. It is very important that you
input an accurate result;

Dosage — Prescribed amount of drug in mg per kg of body weight. You can

usually find this number on the medicament box or on the prescription; and

Dose — Total amount of medication you need to take.

The situation gets more complicated if your medicine is in liquid form. After all,
how are you supposed to know how many ml of your drug you are meant to take
to ingest, for example, 50 mg of the active substance? Our dosage calculator can
help you with this as well. All you have to do is use the following formula:

Liquid dose=Dose/Medicine concentration

Where:

Medicine concentration — Amount of active substance per a given volume of

your drug. It can be expressed in mg per ml.

This function of our dosage calculator is especially useful when giving fluid
drugs (e.g., syrup) to children and in hospitals, where many drugs are given to
the patient not only orally but intravenously. Conversion from mg to ml is
essential in situations like these!

Difference between dose and dosage

A dose is the amount of a drug/medicine taken at once. A dosage is a bit
more — it's the dose, plus when and how often to take it.
Dose refers to a measured portion or a quantity of a medicine or a
substance that must be taken at a time.
Dosage refers to the duration or frequency at which the medicine must be
taken or administered.
 Classification
Physical state

Route of Administration
Based on
Site of Application

Uses

Based on Physical state

SOLID SEMI-SOLID LIQUID GAS

1. Monophasic liquid:
1. Unit solid:
Syrup
tablets
solution
capsules
2.Biphasic liquid:
2. Bulk dosage emulsion
form: suspension
powder
Inhaler
dusting powder
aerosols

Cream
paste
gel
suppositories
 Based on Physical state

Oral Parenteral Rectal Trans dermal

Powders Solutions Suppositories Ointments
Tablets Suspensions Enemas Powders

Capsules Emulsions Ointments Creams

Solutions Vaginal Solutions Pastes

Suspensions Suppositories Intranasal Lotions

Emulsions Tablets Solutions Plasters

Syrups Ointments Sprays Intra ocular

Elixirs Creams Inhalations Solutions

Magmas Douches Intra respiratory Ointments

Gels Sublingual Aerosols Suspensions
Cachets Tablets Conjuntival --
Pills Lozenges Ointments --

Site of Application Uses

1. Skin- Ointments, creams, lotions, liniments 1. Internal – all
2. Eye- Solutions, ointments, creams preparations except
3. Tooth- Tooth powder, tooth paste external
4. Hand- Hand creams, lotions, hand washings 2. External – Ointments,
5. Foot- Creams, ointments, dusting powders lotions, creams,
6. Hair- Hair cream, hair lotions, shampoos, hair powders, solutions,
fixing liniments, paste, hair
7. Nasal- Solutions, sprays, inhalations dyes, hair colorants
 9 KEY FACTS
WEIGHT VOLUME
Kilogram (kg) Liter (L)
Killo-graham-cracker Liter-of-cola
In the metric system ,the gram (g/gm) is In the metric system, the liter (L) is
used to describe weight. 1 kilogram (kg)= used to describe volume.1 liter =
1,000 grams (g). 1,000 milliliters (mL).
Gram (g/gm)
Graham-cracker Milliliter (mL)
In the metric system, the gram (g/gm) is Millionaire-liter-of-cola
used to describe weight. 1 gram (g) = 1,000 In the metric system, the liter (L) is
milligrams (mg). used to describe volume. 1 liter =
Milligram (mg) 1,000 milliliters (mL).
Millionaire-graham-cracker
In the metric system, the gram (g/gm) is
used to describe weight. 1 milligram (mg) = LENGTH
1,000 mcg.
Microgram (mcg) Meter (m)
Microphone-graham-cracker Meter-Pan
In the metric system, the gram (g/gm) is In the metric system, the meter is used
used to describe weight. 1,000 microgram to describe length.
(mcg) = 1 milligram (mg).

CONVERTING
Larger to Smaller: Multiply
Large Metro Car Turned into a Small Metro Car by Multiplying
The metric system applies the idea that units within the system get larger or smaller by
a power of 10. Conversions between the units in the metric system can be done by
multiplying or dividing by 1,000. To convert larger to smaller, multiply by 1,000, or
move the decimal point 3 places to the right.
Smaller to Larger: Divide
Small Metro Car Turned into a Large Metro Car by Dividing
The metric system applies the idea that units within the system get larger or smaller by
a power of 10. Conversions between the units in the metric system can be done by
multiplying or dividing by 1,000. To convert smaller to larger, divide by 1,000 or move
the decimal point 3 spaces to the left.
use the same rounding rules applied to adult medications depending on
type.

Calculating Dosage
⦁ Round to the nearest tenth. i.e.: 5.35mg = 5.4mg
Calculating Weight
⦁ Kilograms – round to the nearest tenth.
⦁ Body Surface Area – round to the nearest hundredth.

Other Rules
To prevent error, all calculations must have:
⦁ Leading zeros –
If the calculated dose is a decimal number that is not preceded by a whole
number, a zero must precede the decimal point.

Example:
Answer = 0.75 mL (correct); Answer = .75 mL (incorrect)

⦁ No trailing zeros -
If the calculated dose is a decimal number that ends in zero, the zero
holding no value must be omitted.

Example:
Answer = 1.5 mL (correct); Answer = 1.50 mL (incorrect)

⦁ Labels –
All calculated doses must be labeled with proper units of measure.

Example:
Answer = 7.5 mcg (correct); Answer = 7.5 (incorrect)
 Tablets/Capsules – Liquid (Oral) –
round to the nearest whole tablet. round to the nearest tenth. i.e.:
Round up or down depending on the 10.3ml of cough syrup may be given.
calculated dose i.e.: 1.1 – 1.4 tablets, Pour 10 mL into medicine cup; draw
give 1 tablet; 1.5 – 1.9 tablets, give 2 up the 0.3 mL in a 3 mL syringe and
tablets. add to the medicine cup.
Scored tablets may be broken in
half. If scored, tablets should be Liquid (Injectables) –
rounded to the nearest half tablet.
Example: 1.45 scored tablets = 1 ½ round to the tenth or hundredth
tablets (depending on volume).
*Capsules are not scored. Milliliters
⦁ Volumes less than 1 - round to
the nearest hundredth i.e.: =
Intravenous (Basic
0.75mL
Fluid/Piggyback Infusions) ⦁ Volumes greater than 1 – round
to the nearest tenth i.e.: 1.25mL –
– round to the nearest whole 1.3mL
number. This applies to flow Syringes
rates calculated in drops/min or ⦁ Use a 3 mL syringe for any dose
mL/hr i.e.: 15.4 drops/min = 15 between 1 and 3 mL. Round to the
drops/min nearest tenth.
⦁ Use a 1 mL (tuberculin) syringe
for doses < 1 mL. Round to the
nearest hundredth.

Intravenous (Medicated/Dose-
Based Flow Rates)
– round to the nearest tenth. i.e.:
0.45mg/min = 0.5mg/min, 0.69
milliUnits/min = 0.7 milliUnits/min
IV (intravenous) flow rates are used to determine the rate at which
medication or fluids are delivered through an IV line. The flow rate can be
expressed in milliliters per hour (mL/hr) or drops per minute (gtt/min),
depending on the type of IV administration set being used.
The flow rate is calculated based on several factors, including the total
volume of fluid to be infused, the length of time over which it will be
infused, and the drop factor of the administration set. The drop factor is the
number of drops per milliliter (gtt/mL) that the administration set delivers.
To calculate the flow rate in mL/hr, the total volume of fluid to be infused is
divided by the length of time over which it will be infused:

To calculate the flow rate in mL/hr, the total volume of fluid to be infused is
divided by the length of time over which it will be infused:
Flow rate (mL/hr) = Total volume (mL) ÷ Infusion time (hours)
For example, if a patient requires 1000 mL of IV fluids over 4 hours, the flow
rate would be:
Flow rate (mL/hr) = 1000 mL ÷ 4 hours = 250 mL/hr
To calculate the flow rate in gtt/min, the following formula is used:
Flow rate (gtt/min) = Volume to be infused (mL) x Drop factor ÷ Infusion
time (minutes)
For example, if a patient requires 500 mL of IV fluids over 2 hours, and the
administration set has a drop factor of 15 gtt/mL, the flow rate would be:
Flow rate (gtt/min) = 500 mL x 15 gtt/mL ÷ (2 x 60 min) = 31.25 gtt/min
(rounded to the nearest whole number)

It's important to monitor the IV flow rate regularly to ensure that the
patient is receiving the appropriate amount of fluid or medication at the
appropriate rate. Changes in the patient's condition, such as changes in
blood pressure or urine output, may require adjustments to the flow rate.
Nurses and healthcare professionals must be trained to monitor IV flow
rates and make adjustments as needed to prevent complications such as
fluid overload or inadequate delivery of medications.
 1. A patient is prescribed 500mg of medication to be taken twice daily. The
medication comes in 250mg tablets. How many tablets should the
patient take per dose?
2. A child weighing 22lbs is prescribed a medication at a dosage of
8mg/kg/day. The medication comes in a concentration of 2mg/mL. How
many mL of the medication should the child receive per day?
3. A patient is prescribed 1g of medication to be taken once daily. The
medication comes in a vial of powder that must be reconstituted with
10mL of sterile water. How many mL of the reconstituted medication
should be administered to the patient?
4. A patient is prescribed 2mg/kg of a medication to be given
intravenously over 30 minutes. The patient weighs 154lbs. The
medication comes in a concentration of 4mg/mL. How many mL of the
medication should be administered?
5. A patient is prescribed 0.5mg of a medication to be taken three times
daily. The medication comes in a concentration of 1mg/mL. How many
mL of the medication should the patient take per dose?

ANSWERS
1. The patient should take 2 tablets per dose, as each tablet contains
250mg of the medication and the prescribed dose is 500mg.
2. First, we need to convert the weight of the child from pounds to
kilograms. 22lbs ÷ 2.2 = 10kg. Then, we can calculate the total daily
dosage: 8mg/kg/day x 10kg = 80mg/day. Finally, we can calculate
the total volume of medication needed per day: 80mg/day ÷
2mg/mL = 40mL/day.
3. The powder must be reconstituted with 10mL of sterile water,
which will create a total volume of 10mL of the reconstituted
medication. Since the prescribed dose is 1g, or 1000mg, the patient
should be administered 10mL of the reconstituted medication.
First, we need to convert the weight of the patient from pounds to
kilograms. 154lbs ÷ 2.2 = 70kg. Then, we can calculate the total dosage
needed: 2mg/kg x 70kg = 140mg. Next, we need to calculate the
volume of the medication needed, using the medication concentration
and the total dosage needed: 140mg ÷ 4mg/mL = 35mL. Finally, we can
administer the medication over 30 minutes, which means we should
administer the medication at a rate of 1.17mL/minute (35mL ÷ 30
minutes).
The patient should take 0.5mL of the medication per dose, as each mL of
the medication contains 1mg and the prescribed dose is 0.5mg.
INTRESTING FACTS ABOUT DOSAGE CALCULATIONS
1. Dosage calculations are used to determine the appropriate amount of
medication a patient needs based on their weight, age, medical history,
and other factors.
2. Medical professionals use different units of measurement for medication
dosages, including milligrams (mg), micrograms (mcg), grams (g), and
units (U).
3. There are several different methods for calculating medication dosages,
including ratio and proportion, dimensional analysis, and the formula
method.
4. Inaccurate dosage calculations can have serious consequences for patient
health and safety, including medication errors, adverse drug reactions,
and even death.
5. Dosage calculations are an important part of nursing and pharmacy
education and are often tested on licensure exams.
6. Medication dosages may need to be adjusted for patients with renal or
hepatic impairment, as well as for pediatric and geriatric patients.
7. In some cases, medication dosages may need to be adjusted based on the
patient's response to the medication or changes in their medical
condition.
8. Electronic medical record systems and pharmacy automation technology
have made dosage calculations more accurate and efficient, but human
error remains a risk factor
9. The development of personalized medicine and precision dosing
techniques has the potential to improve patient outcomes and reduce
medication-related adverse events.
10. The World Health Organization (WHO) has established guidelines for safe
medication dosing and has launched initiatives to improve medication
safety worldwide.