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Brush Up On Your Drug Calculation

Skills
Please read

Brush up on Your Drug

about my new

Calculation Skills

book

Louise Diehl, RN, MSN, ND, ACNS-BC, NP-C


Nurse Practitioner - Owner
Doctor of Naturopathy
Lehigh Valley Wellness Center
Many nurses are weak with drug calculations of all sorts. This article
will help to review the major concepts related to drug calculations,
help walk you through a few exercises, and provide a few exercises
you can perform on your own to check your skills. There are many
reference books available to review basic math skills, if you find that
you have difficulty with even the basic conversion exercises.

Common Conversions:
1 Liter = 1000 Milliliters
1 Gram = 1000 Milligrams
1 Milligram = 1000 Micrograms
1 Kilogram = 2.2 pounds

Methods of Calculation
Any of the following three methods can be used to perform drug
calculations. Please review all three methods and select the one that
works for you. It is important to practice the method that you prefer to
become proficient in calculating drug dosages.
Remember: Before doing the calculation, convert units of
measurement to one system.

This is a powerful
antioxidant therapy which I. Basic Formula: Frequently used to calculate drug dosages.
has natural ingredients to
combat effects of
oxidative stress
to promote health and
wellness.
D = dose ordered or desired dose
H = dose on container label or dose on hand

V = form and amount in which drug comes (tablet, capsule, liquid)


Example: Order-Dilantin 50mg p.o. TID
Drug available-Dilantin 125 mg/5ml

II. Ratio & Proportion: Oldest method used in calculating dosage.

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other website

Left side are known quantities


Right side is desired dose and amount to give
Multiply the means and the extremes

Example: Order-Keflex 1 gm p.o. BID


Drug available-Keflex 250 mg per capsule

III. Fractional Equation

H
V= D
X
Cross multiply and solve for X.

Example: Order - Digoxin 0.25 mg p.o. QD


Drug Available - 0.125 mg per tablet

IV. Intravenous Flow Rate Calculation (two methods)

Two Step
Step 1 - Amount of fluid divided by hours to administer = ml/hr

One Step

Example: 1000 ml over 8 hrs


IV set = 15 gtts/ml
Two Step
Step 1 - 1000 divided by 8 = 125

Step 2 One Step

IV. How to Calculate Continuous Infusions

B. mcg/min (For example - Nitroglycerin)

C. mcg/kg/min (For example - Dopamine, Dobutamine, Nipride, etc.)

1.

To calculate cc/hr (gtts/min)

Example: Dopamine 400 mg/250 cc D5W to start at 5


mcg/kg/min.
Patients weight is 190 lbs.

2. To calculate mcg/kg/min

Example: Nipride 100mg/250 cc D W was ordered to decrease


your patients blood pressure.
The patients weight is 143 lbs, and the IV pump is set at 25 cc/hr.
How many mcg/kg/min of Nipride is the patient receiving?
5

V. How to calculate mcg/kg/min if you know the rate of the infusion

For example:

400mg of Dopamine in 250 cc D W = 1600 mcg/cc 60 min/hr =


5

26.6 mcg/cc/min
26.6 is the dosage concentration for Dopamine in mcg/cc/min based
on having 400mg in 250cc of IV fluid. You need this
to calculate this dosage concentration first for all drug
calculations. Once you do this step, you can do anything!
NOW DO THE REST!
(If you have a 75 kg patient for example...)

= 3.5 mcg/kg/min (rounded down)


B. How to calculate drips in cc per hour when you know the mcg/kg/min that is
ordered or desired

For example:
400 mg Dopamine in 250 cc D W = 26.6 mcg/cc/min
5

ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO


DOUBLE CHECK YOUR MATH!

For example:

400mg of Dopamine in 250 cc D W = 1600 mcg/cc 60 min/hr = 26.6


mcg/cc/min
5

26.6 is the dosage concentration for Dopamine in mcg/cc/min based


on having 400 mg in 250 cc of IV fluid. You need this to calculate this
dosage concentration first for all drug calculations. Once you do this
step, you can do anything!
NOW DO THE REST!!

(If you have a 75 kg patient for example)

Now do some practice exercises to check what you learned


A. Practice Problems:

1.
2.
3.
4.
5.
6.
7.
8.

2.5 liters to milliliters


7.5 grams to milligrams
10 milligrams to micrograms
500 milligrams to grams
7500 micrograms to milligrams
2800 milliliters to liters
165 pounds to kilograms
80 kilograms to pounds

B. Practice Problems: Use the method you have chosen to calculate

the amount to give.


1. Order-Dexamethasone 1 mg
Drug available-Dexamethasone 0.5 mg per tablet

2. Order-Tagamet 0.6 gm
Drug available-Tagamet 300 mg per tablet
3. Order-Phenobarbital 60 mg
Drug available-Phenobarbital 15 mg per tablet
4. Order-Ampicillin 0.5 gm

Drug available-Ampicillin 250 mg per 5 ml


5. Order-Dicloxacillin 125 mg
Drug Available-Dicloxacillin 62.5 mg per 5 ml
6. Order-Medrol 75 mg IM
Drug Available-Medrol 125 mg per 2 ml
7. Order-Lidocaine 1 mg per kg
Patients weight is 152 pounds
8. Order- 520 mg of a medication in a 24 hour period. The drug
is ordered every 6 hours.
How many milligrams will be given for each dose?
C. Practice Problems:

1. Order-1000 ml over 6 hrs

IV set 15 gtts/ml

2. Order-500 ml over 4 hrs

IV set 10 gtts/ml

3. Order-100 ml over 20 min. IV set 15 gtts/ml


D. Practice Problems:

1. Dopamine 400 mg in 250 cc D W to infuse at 5 mcg/kg/min.


The patients weight is 200 pounds. How many
cc/hour would this be on an infusion pump?
5

2. A Dopamine drip (400mg in 250 cc of IV fluid) is infusing on


your 80 kg patient at 20 cc/hour. How many
mcg/kg/min are infusing for this patient?
3. A Nitroglycerin drip is ordered for your patient to control his
chest pain. The concentration is 100 mg in 250 cc
D W. The order is to begin the infusion at 20 mcg/min. What is
the rate you would begin the infusion on the
infusion pump?
5

4. A Nitroglycerin drip (100mg in 250 cc D W) is infusing on


your patient at 28 cc/hour on the infusion pump. How
many mcg/min is your patient receiving?
5

5. A procainamide drip is ordered (2gms in 250 cc D5W) to


infuse at 4 mg/min. The patient weighs 165 pounds.
Calculate the drip rate in cc/hour for which the infusion pump
will be set at.
6. A Lidocaine drip is infusion on your 90 kg patient at 22
cc/hour. The Lidocaine concentration is 2 grams in 250 cc
of D W. How many mg/min is your patient receiving?
5

Summary

Many nurses have difficulty with drug calculations. Mostly


because they dont enjoy or understand math. Practicing drug
calculations will help nurses develop stronger and more confident
math skills. Many drugs require some type of calculation prior to
administration. The drug calculations range in complexity from
requiring a simple conversion calculation to a more complex
calculation for drugs administered by mcg/kg/min. Regardless of the
drug to be administered, careful and accurate calculations are
important to help prevent medication errors. Many nurses become
overwhelmed when performing the drug calculations, when they
require multiple steps or involve life-threatening drugs. The main
principle is to remain focused on what you are doing and try to not let
outside distractions cause you to make a error in calculations. It is
always a good idea to have another nurse double check your
calculations. Sometimes nurses have difficulty calculating dosages on
drugs that are potentially life threatening. This is often because they
become focused on the actual drug and the possible consequences of
an error in calculation. The best way to prevent this is to remember
that the drug calculations are performed the same way regardless of
what the drug is. For example, whether the infusion is a big bag of
vitamins or a life threatening vasoactive cardiac drug, the calculation
is done exactly the same way.
Many facilities use monitors to calculate the infusion rates, by
plugging the numbers in the computer or monitor with a keypad and
getting the exact infusion titration chart specifically for that patient. If
you use this method for beginning your infusions and titrating the
infusion rates, be very careful that you have entered the correct data to
obtain the chart. Many errors take place because erroneous data is first
entered and not identified. The nurses then titrate the drugs or
administer the drugs based on an incorrect chart. A method to help
prevent errors with this type of system is to have another nurse double
check the data and the chart, or to do a hand calculation for
comparison. The use of computers for drug calculations also causes
nurses to get rusty in their abilities to perform drug calculations. It is
suggested that the nurse perform the hand calculations from time to
time, to maintain her/his math skills.
Answers to Practice Problems
A. Practice Problems
1. 2500 mL
2. 7500 mg
3. 10,000 mcg
4. 0.5 gm
5. 7.5 mg

6. 2.8 L
7. 75 kg
8. 176 lbs
B. Practice Problems
1. 2 tablets
2. 2 tablets
3. 4 tablets
4. 10 mL
5. 10 mL
6. 1.2 mL
7. 69 kg = 69 mg
8. 130 mg for 4 doses
C. Practice Problems

1. 41.6 (42)
2. 20.8 (21)
3. 75
D. Practice Problems

1.
2.
3.
4.
5.

17 cc/hr
6.65 mcg/kg/min
3 cc
186.5 mcg/min
30 cc/hr

6. 3 mg/min

Reference: Dosage Calculations Made Incredibly Easy! by


Springhouse Corporation, 1998

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