When administering oral medications in TABLET form the formula to use is: Amount/number of tablets (or capsules) = Dose

ordered Stock strength The 'dose ordered' is the amount of medication that has been prescribed. The 'stock strength' is the amount available. The medication might be located in the Drug/Imprest cupboard, or on the med trolley, or in the patients own medication cupboard. Heres an example A patient is prescribed 25mg of Tenormin mane. The stock you have available is Atenolol 50mg tablets. How many tablets should the patient be given? Number of tablets = 25mg = 1/2 tablet

50mg In this example, the patient would be given 1/2 a tablet. Note: Atenolol is the generic name for Tenormin. What does 'mane' mean? Additional notes: Some medications come in variable dosages but some do not. Remember you can always check the availability of differing strengths in the E-MIMs and/or with the pharmacist. If you're not sure about a particular medication - always ask! It's always advisable to not break a tablet into sections such as halves. If it is absolutely necessary to do this, make sure that the tablet is scored to allow easier breakage. If it has been decided to crush a tablet so that it can be administered mixed in some food or liquid, remember that tablet forms such as enteric coated tablets are not suitable for this. If you are not sure what 'scoring' means, or what an enteric coated tablet is, refer to the relevant chapter in your text more information.

When administering oral medications in LIQUID form, the formula to use is: Volume to be given = Dose ordered X Volume of the Stock Solution Stock strength The dose ordered is the amount of medication (in mg, mcg or g) that has been prescribed. The stock strength is the amount of drug (in mg, mcg or g) that is contained in a given amount of solution. This is sometimes referred to as the 'drug concentration'. The volume of the stock solution refers to the given volume of solution that contains a stipulated amount of drug - not the total volume available in the bottle. Heres an example -

A patient is prescribed Largactil Syrup 35 mg. In the ward is Largactil Syrup 25mg/5 mL. How much should the patient be given? Volume (mLs) to be given = 35mg X 5mL 25mg Thus, in this example, the patient would be given 7 mL of Largactil Syrup. Additional notes: You must ensure at all times that both the 'dose ordered' and the 'stock strength' are in the same units of measurement. If one is in mg and the other is in mcg we suggest that you change the 'dose ordered' units into the 'stock strength' units before working out the volume to be administered. Also remember that liquid medications come in various forms, eg. syrups and suspensions. Depending on the form of the drug, there are certain things that may need to be included in its preparation for administration to a patient. If you need more info on this, refer to the relevant chapter in your text. = 7mL

Paediatric administration of medication is based on the childs body weight. It is therefore important to use a formula that accounts for weight (in kgs), for example: Paediatric Single Dose = (mg / kg / day) x child's body weight (kgs) Number of prescribed doses per day You'll notice here that the recommended dosage for a child is usually expressed as mgs/kg/day. When a medication needs to be given in 'divided doses', ie. in a number of doses during the day, the dosage per administration needs to be calculated using a formula such as the one above. An example: A patient is ordered Clamoxyl syrup (amoxicillin) 30mgs/kg/day TDS. The patient weighs 9 kg, and the stock supply of Clamoxyl surup is 125 mg in 5 mls. The completed formula will read like this:

Required dose =

30 mg/kg/day X 9 kgs 3

= 90 mg per dose Asthe medication is to be administered in mls, then the volume to begivenwill need to be calculated further. This formula is: Required volume = 90 mgs X 5 mls 125 mg x 1 = 3.6 mls per dose

When administering medications in INJECTABLE form, the formula to use is: Volume to be given = Dose ordered X Volume of the stock solution Stock strength The dose ordered refers to the amount of drug that has been prescribed for the patient. The stock strength refers to the amount of drug that is contained in the solution that you have available. The volume of stock solution refers to the total volume of solution in the vial/ampoule, eg. 1 mL, 2 mL etc. Heres an example: A patient is prescribed 75 mg of Pethidine. Stock on hand is Pethidine 100 mg in 2 mL. How much should be drawn up? Volume (mL) to be given = 75 100 In this example the patient would be administered 1.5 mL of Pethidine. Additional notes:

2 mL =

1.5 mL

Injectable meds should not be kept in a patients medication cupboard. Storage of Schedule 8 medications is, of course, subject to the relevant sections of the Poisons Regulations (1996). For more info on this, refer to the Study Tools - Legal and Professional Requirements (use the link in the menu bar on the left) and go to the Health (Drugs and Poisons) Regulations document. Injectable drugs that are not stable as liquids are presented in powder form in a vial. Antibiotics are a good example of such medications. In this situation diluent (liquid) must be added to the vial to reconstitute the drug into liquid form. The type of diluent required for a particular drug is recommended by the manufacturer (additional resources are the MIMs and the "Australian Injectable Drugs Handbook" published

the Society of Hospital Pharmacists of Australia (SHPA) - now available in many wards). The amount of diluent that should be added to achieve a particular drug concentration is specified in the manufacturers instructions. Read and follow these carefully. Here's an example: Amoxycillin sodium is dispensed in vials containing 500mg and 1G of drug as a dry powder for reconstitution. It is recommended that for, IM injection, each 500mg of Amoxycillin sodium should be reconstituted with 2.6mL of water for injection. If you were using the 500mg vial, the resulting 3 mL of solution contains 500mg of Amoxycillin. Thus, stock strength of this reconstituted Amoxycillin is 500mg/3mL.

IV Injections (Bolus) When administering medications as IV bolus injections (via a port, cannula or tap) the formula to use for calculating the required volume of medication is:

Volume (mls) to be given =

Dose ordered X Stock strength

Volume of the stock solution

This formula is, of course, the same as that used for the calculation of liquid meds given via the oral route and injectable meds given IM, SC or ID. As before, the dose ordered refers to the amount of drug that has been prescribed for the patient. The stock strength refers to the amount of drug that is contained in the solution that you have available. The volume of stock solution refers to the total volume of solution in the vial/ampoule, eg. 1 mL, 2 mL etc. Heres an example: An elderly patient with pulmonary oedema requires rapid diuresis. Frusemide is indicated and oral administration is not possible. The patient is prescribed IV Frusemide 40 mg stat, to be repeated after 20 minutes if necessary until urine output is adequate. The Lasix ampoules on hand contain 20mg/2mL. How much should be drawn up? Volume (mLs) to be given = 40mg 20mg In this example, the patient would be administered 4 mL of Lasix (2 of the stock ampoules would be needed). Additional notes: X 2 mL = 4 mL

When performing an "IV Push" it is absolutely essential that the medication prescribed has been recommended to be given as a "push". This will be outlined in the manufacturers recommendations and the MIMs. The "Australian Injectable Drugs Handbook" (published by the Society of Hospital Pharmacists of Australia) is another useful resource that is referred to by many ward nurses. Take particular note of the time period over which to administer particular drugs by IV bolus injection - this is usually not less than 2 minutes. The decision to push or not to push a drug is based on a number of factors including the patients condition, the urgency of the situation, the desired therapeutic effect and the drugs chemical makeup, particularly its pH level. Nurses feedback about the ongoing health status of patients, and the condition of their veins, are also important factors in decisions about administering a drug as an IV bolus. As for IM meds, some drugs may only be available in powder form and, thus, need to be reconstituted before use. The same general considerations apply but be sure to carefully check the amount of diluent to be used when administering a drug via the IV route. Top

IV therapy (without an infusion control device)

For IVT without an infusion control device that regulates the flow in mL/min you need to calculate a flow rate in drops/min to set your drip chamber appropriately. The formula to use is: Top Rate (dps/min) = Volume to be given X drops/mL (drop factor)

Time in hrs 60 (mins per hr) The mL/hr is calculated by dividing the volume of fluid prescribed (in mL) by the time over which it is to be given (in hrs). Drops per mL refers to the drop size that is set by manufacturers for particular drip chambers. It is also called the drop factor. The 2 most common sizes in Australia are the macrodrip (20 dps/mL) and the microdrip (60 dps/mL). Heres an example: Lets say that a patient has been prescribed 1 litre of Dextrose 4% in 1/5 NS to run 8th hourly. Assuming that you are using a macrodrip set, at what rate should this infusion drip?

Rate (dps/min) =

1000 mL 8 hr

20 drops/mL = 60 mins

42 dps/min

The exact answer to this calculation is 41.66 (recurring). For administration purposes, however, you would round up this figure to 42 drops per minute. Additional notes: Rounding-off rule: If the calculated answer has more decimal points than warranted, the answer is rounded off as appropriate, ie. to the nearest whole number or nearest decimal point. As an example, when rouding off to the nearest whole number is warrented, and the decimal point is .4 or below, round the amount down to the nearest whole number. If the decimal point is .5, or above, round up to the nearest whole number.