Dosage Calculations

Objectives: Demonstrate competency in calculating drug dosages using the following formulas: Basic Ratio and proportion Fractional equation Dimensional analysis Demonstrateedit Master subtitle style to the metric system of Click to competency in converting measurement Apply appropriate use of abbreviations used in drug orders and calculation Note: As a safety issue for future experiences with patients, students are required to successfully pass a drug dosage calculation exam at 100% within three scheduled tries to continue in the course and the nursing program. Each exam will be different. 4/13/12

Abbreviations-Routes of Drug Administration

NGT au = Both ears A.U., = Nasogastric tube O.D., od = Right ID= Intradermal eye O.S., os = Left eye IM = Intramuscular O.U., ou = Both IV = Intravenouseyes PO, po Intravenous IVPB = = By mouth Piggyback SL, sl, Keep Sublingual KVO =subl =vein open TKO = To L = Left keep open Vag = Right R = Vaginal

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AC, ac = before meals Ad lib = as desired

Abbreviations-Times of Administration

B.i.d., b.i.d. = Twice a day c = with NPO = Nothing by mouth PC, pc = after meals PRN, p.r.n. = whenever necessary, as needed Stat = Immediately

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q = every qAM = Every morning qPM = Every evening qh = Every hour q2h = Every 2 hours q4h = Every 4 hours q6h = Every 6 hours q8h = Every 8 hours s = without SOS = once if necessary: if there is a

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Cap = capsule gtt = drops Dr = dram Elix = elixir G, GM, g, gm = gram gr= grain

Abbreviations-Drug Measurements and Drug Forms

kg= kilogram L, l = liter m2 = square meter mcg = microgram mEq =

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mg= milligram mL= milliliter m, min = minim oz= ounce pt=pint qt= quart

ss= one half Supp = suppository Susp = suspension T.O. = Telephone order

T Tbsp = SR = Sustained tablespoon release 4/13/12

Systems of Measurement

Although most health care related measures are in the metric system, two other systems are in use in the United States, and each student must be familiar with these, and know the conversions of them into the metric system.

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Metric System

Organized into units of 10a decimal system. Basic units are meter, liter, and gram. Deci = 1/10 or 0.1 Centi = 1/100 or 0.01 Milli = 1/1000 or 0.001
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Volume = liter (liters, milliliters) Weight = gram (kilogram--kg, milligram--mg, microgrammcg) Meds may be ordered by weight and given in volume. (20 mg codeine in an elixir form. It comes labeled 10 mg/5mL. The nurse would give 10 mL of codeine elixir.)
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Apothecaries System

Grain=weight of 1 grain of wheat. Measured with Roman numerals following: gr ii (2 grains) 1/60 grain = 1 mg 1 gr = 60 mg 15 grains = 1 gram Minim= volume of water = to the wt of 1 grain of wheat Scruple=almost never used
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Dram = 4g (grams)

Metric

1 kg = 1000 g 1 mg = 0.001 g 1 mcg = 0.001 mg

1000 g = 1 kg 1000mg = 1 g 1000 mcg = mg

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HouseholdApothecaryM etric EquivalentsVolume

1 tsp 1C 1 pt 1 qt 1 gal 60 gtt oz 8 oz 16 oz 32 oz 5 mL 1 Tbs 15 mL 250mL 500 mL 1 liter

128 oz 3840-4000 mL

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Weight Equivalents

4 g = 1 dram 30 g = 1 oz 1 kg = 2.2 lb

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Conversions

Objective: Accurately convert weights, volumes, and measures among and between the systems of metric, apothecaries and household.

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Medication order is to give morphine gr . The medication is available labeled only in milligrams (mg). 1 mg = 1/60 gr 60 mg = 1 gr X mg = gr (O.25 gr) X = (60 X 0.25) 1 X = 15 mg

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To change from mg to g move the decimal 3 places to the left: 500 mg = ? g Move the decimal 3 places to the left = 0.5 g It is important to put the 0 in front of the decimal so it is not mistaken for 5. 4/13/12

To convert from g to mg multiply the number of g by 1000 or move the decimal point three places to the right. 0.006 g = ? Mg 6 mg.

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Basic Formula

D=Desired Dose H=Dose on Hand V=Vehicle (tablet, liquid, etc) Formula= D X V = amount to administer H
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Example: Order: Erythromycin 500 mg On Hand: 250 mg in 5 ml D = 500 mg H = 250 mg V = 5 mL 500 mg X 5 mL = 2500 = 10 mL 250 mg
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250

Example: Order: Phenobarbital gr ii On Hand: Phenobarbital 30 mg tablets Must convert into one system of measure. 2 gr = 120 mg D = 120 mg H = 30 mg V = tablet
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120 mg X 1 tablet = 4 tablets

Ratio and Proportion

H:V::D:x Multiply the extremes (H and x) and the means (V and D). Then solve for x.

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Example: Order: Keflex 750 mg On Hand: Keflex 250 mg tablets H=250 mg: V= 1 tablet:: D= 750 mg:x 250:1::750:x 250x=750 x=3 tablets
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Example: Order: Apirin gr 10 On Hand: Aspirin 325 mg tablets Convert unit of measurement 1 gr = 60 mg 10 gr = 600 mg H = 325 mg: V= tablet:: D=600 mg:x Multiply extremes 325x = 600
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x = 1.8 = 2 tablets

Fractional Equation Method

H = D V x

Cross multiply and solve for x Hx = DV X = DV H

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Example: Order: Lanoxin 0.25 mg On Hand: Lanoxin 0.125 mg tablets

H=D V x

0.125 mg = 0.25 0.125x=0.25 1 tablet

Cross multiply

x tablets 0.125

Solve for x
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0.125x = 0.25 0.125

Example Order: Atropine gr 1/100 On Hand: Atropine 0.4 mg/mL Convert unit of measurement 1 gr = 60 mg 1/100 gr = 0.6 mg 0.4 mg = 0.6 mg = 1.5 mL 1 mL x mL 0.4x = 0.6 x

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Dimensional Analysis

Useful when there are different units of measurement that need converted. It puts it all into one formula. (C = conversion factor) V X V X C(H) X D H X C(D) X 1 (Drug label) X (conversion) X (drug order) 4/13/12

Example: Order: Valsartan 120 mg On Hand: Valsartan 40 mg tablets On left side of the equation put the form of the drug on hand --- x tablets On the right side of the equation put the information of how the drug comes ---40 mg into a fraction --- 1 tablet (information matching x) 40 mg
(information

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x tablet = 1 tablet X 120 mg 40 mg X 1 x = 120 40 x=3 tablets

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Order: Erythromycin 25 mg oral suspension On Hand: Erythromycin oral suspension 25 mg per 5 mL Determine number of teaspoons the nurse will administer. x tsp. = 5 mL X 1 tsp X 25 mg 25 mg X 5 mL X 1 x = 1 tsp
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Order: Tylenol gr xv On Hand Tylenol 325 mg tablets x tablets = 1 tab X 60 mg X 15 gr 325 mg X 1 gr X 1 x tablets = 60 X 15 = 900 325 X 1 325 x = 2.76 = 3 tablets since a tablet cannot be accurately cut into 0.76 4/13/12

Calculating dosages per body weight

1.

Convert pounds to kilograms

2. Determine the drug dose per body weight by multiplying drug dose X body weight X frequency 3. Choose a method of drug calculation to determine the amount of medication to administer.

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Order Keflex, 20 mg/kg/day in three divided dosed. Patient wt = 20 pounds On Hand Keflex oral suspension 125 mg per 5mL 1. Convert pounds to kilograms 20 2.2 = 9kg 2. Multiply drug dose X body wt X frequency 20 mg X 9 kg X 1 day = 180 mg/day 180 3 divided doses = 60 mg/dose

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Misc. Information

Capsules cannot be cut. If order and dosage available in capsules cannot be reconciled, must call physician and get change of order. If reconstituting a medication, read how much diluent to use, and then read what the concentration per mL will be.
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When more than one dose is ordered of a medication, read carefully the orders If a total dose per day is ordered, but it needs to be given in divided doses, dont forget to divide the total so that you are giving a portion of the total in each dose.

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Practice Problems

Order: doxycycline hyclate (VibraTab), po, initially 200 mg; then 50 mg, po bid. Drug available: 100 mg tabs. How many tablet(s) would the nurse give as the initial dose? How many tablets would the nurse give for each dose after the initial dose?

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Answer

100 mg/1 tab = 200mg/x tabs 1 x = 200/100 = 2 tabs initial dose 100 mg/1 tab = 50 mg/x tabs 100x = 50 X = 50/100 = 0.5 or tab
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Order: Diazepam (Valium) 2 mg Drug available: Valium 5 mg scored tablet Correct dosage = 5 mg/1 tab = 2 / X tab 5 X = 2 or 2.5 X = 2.5/5 = 0.5 or tablet
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Order: amoxicillin/clavulanate potassium (Augmentin) 0.5 g, po, q8h. Drug available: Augmentin 250 mg/5mL How many mL should the patient receive per dose? 0.5 g = 500 mg 250 mg/5 mL = 500 mg/X mL
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250 X = 2500

Order: valproic acid (Depakene) 10 mg/kg/day in three divided doses (tid) po. Patient weighs 165 pounds. How much Depakene should be administered? To convert pounds to kilograms divide by 2.2 165/2.2=75kg 10mg/1kg = x/75 kg 1 x = 10 times 75

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