CALCULATING MEDICATION

DOSAGES AND INTRAVENOUS

THERAPIES

France Allan M. Cavite

Learning Outcomes:

Upon completion of this lesson, you will be able to:

 Describe the measuring systems that can be used in drug
calculations.
 Convert between different measuring systems when given drug
orders and available forms of the drugs.
 Calculate the correct dose of a drug when given examples of
drug orders and available forms of the drugs ordered.
 Discuss why children require different dosages of drugs than
adults.
 Explain the calculations used to determine a safe dose of a
drug across the lifespan..
Conversions:

 1 liter (L) = 1000 ml (milliters)

 1 gram (g) = 1000 mg (milligrams)
 1 mg (milligrams) = 1000 mcg (micrograms)
 1 gram (g) = 15 grain (gr)
 1 grain (gr) = 60 mg (milligrams)
 1 dram (dr) = 4 ml (milliters)
 1 ounce (oz) = 30 ml (milliters)
 1 tsp (teaspoon) = 5 ml (milliters)
Conversions:

 1 tbsp (tablespoon) = 15 ml (milliters)

 1 kg (kilogram) = 2.2 lbs (pounds)
 1 inch = 2.54 cm (centimeters)
 16 ounces (ozs) = 1 lb (pound)
 1 cup = 8 ounces (oz)
 1 ml (milliter) = 15 minims
 1 drop (gtt) = 15 minims
Conversion Rule

 Rule 1: To convert a quantity in the metric

system to a larger metric unit (e.g., mg to g),
move the decimal point to the left.
-Smaller to larger (S to L) = Right to left (R to L)

Example: 2.0 mg ------- 0.002 g

Conversion Rule

 Rule 2: To convert a quantity to a smaller

metric unit, move the decimal point to the right.
-Larger to smaller (L to S) = Left to Right (L to R)

Example: 2.4L ---------- 2400.0 mL

Client Rights:

 Right PATIENT  Right TO REFUSE

 Right PRESCRIPTION  Right APPROACH
 Right DRUG  Right PHYSICIAN
 Right DOSAGE  Right PRINCIPLE OF
 Right TIME and CARE
FREQUENCY  Right EVALUATION
 Right ROUTE  Right EDUCATION
 Right NURSE  Right DOCUMENTATION
 Right ASSESSMENT
Recommended Volume for
Administration Per Sites:

 Intradermal = 0.1 ml (example PPD, allergy

testing)
 Subcutaneous injection = 0.5-1.0 ml per site
 Intramuscular injection = 3.0 ml per site
(1 ml in the deltoid)
 IV injection (IV push) = 1-60 ml
Steps in Problem Solving

1. Understand the problem.

– What facts are given?
– What is asked?
– What operation or formula will solve the problem? Is there
a need to convert?
2. Plan.
– What equation will solve the problem?
3. Solve.
4. Look back. Ask yourself these questions:
– Did I use a correct operation? Does the anwer make
sense?
Methods of Calculating Dosages

Basic Formula
 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).
Basic Formula

Formula
D
xV= Amount to Administer
H
Practice Question 1:

 The physician orders Ampicillin 500mg q6h

orally (po). Ampicillin is available: 250mg
capsule (cap). How many capsules would
you administer q6h?

*check answer:
2 capsules
Practice Question 2:

 The physician orders Lanoxin 0.25mg IM

every day. Lanoxin is available: 0.5mg per
2 ml. How much Lanoxin would you
administer IM ?

*check answer:
1 ml
Practice Question 3:

 The physician orders Theophylline 160mg

q6h orally (po). Theophylline available:
80mg per 15 ml. How much Theophylline
would you administer q6h?

*check answer:
30 ml
Practice Question 4:

The physician orders Morphine 5mg IM q4h.

Morphine is available: 1grain per 5 ml. How
much Morphine would you administer?
1 grain = 60mg
Morphine available: 60mg per 5 ml

*check answer:
0.42 ml
Practice Question 5:

 The physician orders Morphine 1/100 grain

(gr) IM q6h for abdominal pain. Morphine
available: 0.5 mg per 0.5 ml. How much
would you administer?
1/100 grain = 0.01 grain = 0.6mg

*check answer:
0.6 ml
Practice Question:

 Conversions:
15 ml = _____teaspoons (tsp)
45 ml = _____ounces (oz)
8 ounces (oz) = _____ml
76 kilograms (kg) = ______lbs (pounds)
60 inches = _____centimeters (cm)
Calculating Medication Dosages

 Ratio and Proportion or Calculation of

Fractional Doses
 Conversion Between Systems of
Measurement
 Calculation of Dosages Based on Weight
 Pediatric Dosage Calculations
Ratio and Proportion

 The ratio and proportion method is

considered the oldest method used for
calculating dosage problems.
 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).
Ratio and Proportion

 The equation looks like this:

H : V :: D : x
 Once the equation is set up, multiply the
extremes (i.e., H and x) and the means (i.e.,
V and D). Then solve for x.
Ratio and Proportion

Important Considerations:
1. The numerators must have the same units.
2. The denominators must have the same
units.
3. Three of the four parts must be known.
The Apothecary System

 The Apothecary System uses Roman

Numerals and three symbols:
– “gr” – grains
– “ “ or “dr” – dram
– “ “ or “oz” for ounce
– Small letter “f” - fluid
Apothecary System of Weights

 Based upon the grain (gr), which is the

smallest unit in the system.
 The origin of the grain is uncertain, but it is
believed that at one time solids were
measured by using grains of wheat as the
standards.
 15 grains = 1 gram
 The unit is written first followed by the
quantity.
The Apothecary System

Common Rules for the Apothecary System

 Lowercase Roman Numerals are used to
express whole numbers
3 = iii
6 = vi
The Apothecary System

Common Rules for the Apothecary System

 Arabic Numbers are used for larger
quantities (except for 5, 20, & 30) or when
the amount is written out.
12 or twelve drams
The Apothecary System

Common Rules for the Apothecary System

 The apothecary abbreviation always goes
before the quantity.
gr x = grains 10
viii – eight drams
The Apothecary System

Common Rules for the Apothecary System

 Fractional units are used to express
quantities that are less than one (gr. 1/3).
The symbol ss or ṡṡ is used for fraction1/2.
The Apothecary System

Common Rules for the Apothecary System

 To change units within the same system:
determine the equivalent values, write down
what you know followed by what you
desire, in fraction or colon format, and solve
for x.
Apothecary System of Weights

 Convert 15 milligrams to grains

1
 The physician orders 7 2
grains of
aminophylline po for a client. On hand are
the aminophylline tablets 500mg. How many
tablets are required for one dose?
1
 How many mg of nitroglycerine are in one 150
gr tablet of the drug
Calculation of Fractional Doses

 The physician orders 1,000,000 units of

Penicillin G for a client. The Pen G on hand
available as a solution containing 250,000
units/mL.
 The physician orders 250 mcg of
cyanocobalamin (Vit B) IM daily. Available on
hand is labeled 1,000 mcg/mL. How many
mL should be given to the client?
Calculation of Fractional Doses

 The fractional equation method is similar to ratio and

proportion, except it is written as a fraction:
H D
V
= X
 The formula consists of cross multiplying and solving
H D
for x: = X into Hx = DV
V

DV
X= H
Calculation of Dosages Based on
Weight

 The recommended dosage for a drug might

be 5mg/kg/24 hours. This information can be
utilized by the nurse to:
1. Calculate the dose for a given client
2. Check on doses ordered that are suspected to
be significant over- or underdoses.
Practice Problem:
Calculation of Dosages Based on
Weight

 The physician orders thiabendazole

chewable tablets for a 110-pound child.
The recommended dosage for is
20mg/kg per dose. How many 500mg
tablets should be given to this client for
each dose?
Calculation of Dosages Based on
Weight

 Step 1: convert the client’s weight to kilogram

by proportion.
 Step 2: calculate the total daily dose using
the recommended dosage information: 20
mg/kg.
 Step 3: calculate the number of tablets
needed to supply 1,000 mg per dose. The
concentration of tablets on hand is 500
mg/tablet/
Calculation of Dosages Based on
Weight

 The recommended dose of meperidine is

6mg/kg/24 hours for pain. It is given in
divided doses every 4-6 hours. How many
mL of meperidine injection (50 mg/mL)
should be administered to a 33-pound child
as a single dose every 6 hours?
Calculation of Dosages Based on
Weight

 The recommended dose of cefamandole

nafate (Mandol) for a pediatric client is
50mg/kg/day. How many mg must be given
daily to a 60-pound child?
 A recommended dose for the administration
of streptomycin sulfate is 10mg/lb/day. How
many mg of this drug must be administered
daily to a 63kg adult?
Calculating Rate of Flow

 Standard Drop or Drip Factor: 10gtts/mL;

15gtts/mL; 20gtts/mL or 60gtts/mL
 The number of drops needed to deliver 1 mL
of fluid.
 Drop factors vary among manufacturers.
Regulating Flow Rate

1. Calculating the infusion time

2. Calculating milliliters per hour (mL/hr)
3. Calculating drops per minute (gtt/min) for IV
sets (DF of the tubing is needed)
4. Regulating the number of drops entering the
drop chamber by using the roller clamp on
the tubing to adjust the rate of flow
5. Setting the infusion rate for electronic
regulation in mL/hr.
 IV Sets

• A spike to pierce the rubber

stopper or port on the IV
container
• A drip chamber for trapping air
and adjusting flow rate
• A control clamp for adjusting flow
rate or shutting down the flow
• Flexible tubing to convey the fluid
IV Sets

• A needle adapter for

attaching a needle or a
catheter
• A catheter, or tube, may
be implanted into the
patient and fixed with
tape to avoid having to
repuncture the patient
each time an infusion is
given
 IV Sets
• The most common IV
drop sets are
– 10 (10 gtt/mL)
– 15 (15 gtt/mL)
– 20 (20 gtt/mL)
– 60 (60 gtt/mL)

• An opening that provides 10,

15, or 20 gtt/mL is commonly used
for adults
• An opening that provides 60 gtt/mL
is used for pediatric patients and is
called a mini-drip set
Calculating Infusion Time

Total Volume
 = infusion time (round off
mL/hr
minutes to nearest whole
numbers)
Practice Problem::

 The patient is to receive 1000 mL of D5Water

solution at 75 mL/hr.
Calculating Infusion Time

 Rule: to calculate infusion time when mL.hr is

unknown, you would: convert gtt/min to
mL/min, convert mL/min to mL/hr, and use
the previous formula.
Practice Problem:

 The physician prescribed 1000mL of PLR to run at

30 gtt/min, using a drop factor of 15 gtt/mL.
Step 1: Convert gtt/min to mL/min:
 15 gtt : 1mL :: 30 gtt : x mL
15 X x = 1 x 30
15x = 30 x=2mL

Step 2: Convert mL/min to mL/h:

2mL/min X 60 min = 120 mL/h

Step 3: Use the formula and substitute. What is your answer?

Calculating Milliliters per Hour for
Manual or Electronic Regulation

 Rule: To calculate milliliters per hour, you

would use this formula:
Total Volume Ordered (mL)
 = milliliters per hour
Total Time (hours)
Practice Problem:

 A patient to receive 1000 mL of PLR over 6-

hour period. The patient would receive ____
mL/hr?
Calculating Milliliters per Hour for Manual or
Electronic Regulation when the Infusion is
less than 1 hour

 When infusion time is less than 1 hour, total

time in minutes needs to be used with ratio
and proportion to solve for x (mL/hr)
 Rule: To calculate milliliters per hour, when
total time is less than 1 hour, you would use
this formula:
mL
Total Volume x ( hr )
 =
Total Time (𝑚𝑖𝑛) 60 mins
Practice Problem:

 A patient is to receive 1 gram of Rocephin in

50mL of NSS over 30 minutes.
Calculating Drops per Minute For
Manual Regulation

 To calculate drops per minute, you need

three pieces of information:
1. The total volume to be infused in mL.
2. The drop factor of the tubing you will use.
3. The total time for the infusion, in minutes
The Standard Formula

Total Volume X Drop Factor

 = Drops per minute
Total Time in minutes
(gtt/min )= Flow rate
Practice Problem:

 Administer 1000 mL of PNSS every 8 hours.

The drop factor is 15 gtt/mL.
 Administer 500 mL of PLR over 6 hours. The
Drop Factor is 20 gtt/mL
 Administer 500 mL of D5LR over 30 minutes.
The DF is 10. Calculate the FR in gtt/min.
The Quick Formula

mL
Milliliters per Hour Hr X Drop Factor
 = gtt/min
Time (60 mins)
 Requires that you know the volume (mL/hr),
DF, and time in minutes. Frequently, the
Physician’s order indicates total volume, not
mL/hr. Therefore, you would need to use the
following to get mL/hr:
Total Volume (mL)
= mL/Hr
Total Time (Hours)
Practice Problem:

 Give 1 Liter of a drug over 10 hours. The

Drop factor is 20.
 Administer 250 mL of PNSS over 5 hours.
The DF is 60 gtt/mL.
The Quick Formula with Constant
Factor

milliliters per hour (mL/hr)

 = gtt/min
constant factor
 Constant Factor depends on the Drop Factor
– DF 10: the constant factor is 6 (60÷10)
– DF 15: the constant factor is 4 (60÷15)
– DF 20: the constant factor is 3 (60÷20)
Practice Problem:

 Administer 1000 mL of LR over 10 hours.

The DF is 15 gtt/mL.
Practice Problem:

 The Physician prescribed 1000mL of LR to

infuse over 12 hours. You would give ______
mL/hr.
Practice Problem:

 You are to give 500 mL of NSS over 4 hours.

You would give _____ mL/hr.
 Administer 800 mL over 10 hours. The DF is
20 gtts/mL. You would give ________
gtt/min.
 You are to give 1000 mL of IV to infuse over
6 hours. The drop factor is 15 gtts/mL. You
would give ______ gtt/min.
Practice Problem:

 Administer 500 mL of solution over 24 hours.

The DF is 6o gtt/mL. You would give _____
gtt/mL.
 You are to give 600 mL of solution over 12
hrs. The DF is 20 gtt/mL. You would give
_____ gtt/min.
Practice Problem:

 A patient is to receive 1200 mL of LR to run

over 12 hours. The DF is 20 gtt/mL. The
nurse would give _____ mL/hr and gtt/min.
Intravenous Therapies: Critical-
Care Applications

 mcg/kg/min
 mcg/min
 mg/min
 mg/hr
Calculating Drug dosages and FR
Using the Formula Method
mcg or mg
D (Desired amt in dose
time (min or Hr)
x Q (quantity in IV bag) = x
H (have available in IV Bag)

X = mL/min or mL/Hr
Steps

1. Convert to like units

2. Calculate mcg/min or mL/hr
3. Calculate mL/min or mcg/h or min using
formula
4. Calculate mL/h
Practice Questions:

 Dopamine 400 mg in 250 mL D5W has been

increased to 10 mL/hr to maintain a SBP of
100 mmHg in a patient weighing 115 lbs.
How many mcg/kg/min should be infusing?
Practice Questions:

 Fentanyl 4 mg in 250 mL D5W is titrated to a

4 mL/hr to control pain. How many mcg/h is
currently infusing?
Practice Questions:

 Primacor 50 mg in 250 mL D5W is

prescribed to run at 0.375 mcg/kg/min in a
patient weighing 58 kg the infusion pump
should be set at _____ mL/hr.
Practice Questions:

 Esmolol 2500 mg in 250 mL D5W is infusing

at 21.6 mL/h in a patient weighing 72 kg.
How many mcg/kg/min should the patient
receive?
Fin.