NCM 106 Pharmacology

Lecture
 DOSAGE CALCULATION

THE MEDICATION ORDER

• The nurse is legally responsible for ensuring that the correct
client receives the right medication at the right dose, at the
correct time and by the ordered route.
• Proper interpretation of the medication order is essential.
Abbreviations
• The nurse must follow the institution’s policy regarding
the use of abbreviations in the medical record.
• Medication errors may occur as a result of a misinterpretation of
an abbreviation.
 DOSAGE CALCULATION
Metric System
• The major system of weights and measures used in medicine
is the metric.
• Conversions between units in the system are accomplished
by simply moving a decimal point.
• The three basic units of the metric system are:
—meter (length),
—gram (weight), and
—liter (volume).
• The same prefixes are used with all three measures listed
above.
 DOSAGE CALCULATION
Metric System
• The prefixes also change the value of each of the basic units by
the same amount.
• Four main prefixes:
—Kilo, which identifies a larger unit of measure than the
basics.
—Centi, which identifies a smaller unit than the basic.
—Milli, which identifies a smaller unit than the basic.
—Micro, which identifies a smaller unit than the basic.
• When administering medications, convert units of measure
within the metric system, for example, g to mg, and mg to g.
 DOSAGE CALCULATION
Metric System
• Four metric weights commonly used in medicine (from
highest to lowest value) are as follows:
—k = kilogram
—g = gram
—mg = milligram
—ug = microgram
• Two units of volume in the metric system are as follows:
—l = liter
—ml = milliliter
 DOSAGE CALCULATION

Metric System
• Each of these units differs in value from the next by 1000.
—1 kg = 1000 g
—1 g = 1000 mg
—1 mg = 1000 g
—1 l = 1000 ml (1000 cc)
 DOSAGE CALCULATION
Conversion Rules for Metric System:
• Conversion between the units is a matter of moving the decimal
point three places because each of the units differs from the next
by 1000.

• If you are converting from a larger unit of measure to a smaller

unit of measure, the quantity must get larger, so move the decimal
three places to the right (Example: 0.5 g 500 mg).

• In metric conversions from smaller units to larger units of

measure, the quantity will get smaller. Move the decimal
three places to the left (Example: 450 mg 0.45 g).
 DOSAGE CALCULATION
Common conversions to remember
❑ 1g = 0.001 mg
❑ 1 mg = 0.001 g
❑ 1000 mg = 1 g

• To prevent medication errors, fractional dosages should be

transcribed with a zero in front of the decimal point and unnecessary
zeros are to be eliminated from dosages.
Examples:
▪ 125ug=_____mg (0.125)
▪ 0.25 mg = _____ ug (250)
▪ 100 mg = _____ g (0.1)
 DOSAGE CALCULATION

The Apothecary and Household Measures

• The apothecary and household are the oldest of the drug measurement
systems
• If a drug label contains an apothecary dosage, it will usually also
contain a metric dosage equivalent
• The apothecary system of weights is based on the grain (gr), which is
the smallest unit in the system
• Common medications that may be ordered or labeled in grains are
nitroglycerin, atropine, codeine, morphine, and aspirin
• gr 1 = 60 mg
• gr 15 = 1000 mg
 DOSAGE CALCULATION

Apothecary measures
• There are three apothecary measures for volume:
Liquids:
❑ minim (m, min)
❑ dram (dr)
❑ ounce (oz)
1 ounce = 30 ml
1 dram = 4 ml
1 minim = 1 drop approximately or 0.06 ml (1/16 of a dram)
15 minim = 1 ml approximately
 DOSAGE CALCULATION

Household measures
• Common household measures which may be used in
medication calculations are as follows:
❑ Tablespoon (T or tbs) 1 T = 15 ml
❑ Teaspoon (t or tsp) 1 tsp = 5 ml
❑ Drop (gtt) 60 gtt = 1 tsp
 DOSAGE CALCULATION
Conversions from Apothecary to Metric
• When a medication dose is ordered using an apothecary or
household measures, it should be converted to metric.
• Use the equivalent: gr 1 =60 mg.
Example: 1
𝑔𝑟 = ______𝑚𝑔
3
𝑔𝑟 1 𝑔 1/3
=
60 𝑚𝑔 𝑥 𝑚𝑔
60
𝑥 =
3
𝑥 = 20
 DOSAGE CALCULATION
Conversions from Apothecary to Metric
• Remember, if you have less than 60 mg, the grain
amount will be expressed as a fraction instead of a
decimal number.
Example:
15 𝑚𝑔 = 𝑔𝑟 _______ 60 𝑥 = 15
15
𝑥=
60
𝑔𝑟 1 𝑔𝑟 1/3 1
= 𝑥 = 𝑔𝑟
60 𝑚𝑔 𝑥 𝑚𝑔
4
 DOSAGE CALCULATION

Conversion from Household to Metric

• Examples to remember:
—1 T = _____ ml (Answer: 15)
—1 oz = _____ ml (Answer: 30)
—1 t = _____ ml (Answer: 5)
 DOSAGE CALCULATION

Ratio and Proportion Method

• A ratio consists of two numbers, which have a significant
relationship to each other.
• While a ratio is an expression of a significant relationship
between two numbers, a proportion takes this one step
further, and is used to show the relationship between two
ratios.

• Example: The physician has ordered 10 mg of a medication.

The nurse has a solution containing 8 mg/1 ml.
 DOSAGE CALCULATION

Ratio and Proportion Method

Check sequence of measurement units.
Drop the measurement units
Cross-multiply, keeping x on the left of the equation.
Remove the number on the left side of your equation by dividing 10
by the number in front of x.
Reduce the numbers by their highest common denominator—2.
Divide the final fraction.
The x in the original proportion was ml, so the answer is 1.25 ml.
 DOSAGE CALCULATION
Ratio and Proportion Method
The ordered dosage of 10 mg is contained in 1.25 ml.
• It should be routine to check your math twice in dosage
calculations.
• It is also necessary to assess each answer to determine if it seems
logical. If 1 ml contains 8 mg, you will need a larger
volume than 1 ml to obtain 10 mg. The answer obtained,
1.25 ml is larger, and, therefore, it is logical.

• You can prove that the proportion is true and your calculation is
correct by substituting your answer for x in the original proportion.
 DOSAGE CALCULATION
Ratio and Proportion Method
Solve this dosage calculation problem:

The physician orders digoxin (Lanoxin) 0.125 mg p.o. daily.

The medication available is digoxin (Lanoxin) 0.5 mg/2 ml.
What is the quantity of medication that the nurse should
administer?
Answer:
0.5 𝑚𝑔 0.125 𝑚𝑔
=
2 𝑚𝐿 𝑥 𝑚𝐿
0.5 𝑥 = 0.25
𝑥 = 0.5 𝑚𝐿
 DOSAGE CALCULATION
Converting Different Units of Measure to One Unit of Measure
• Doctor’s order: Give 0.15 g of medication. The dosage
strength available is 200 mg/ml. You have to convert the
different units of measure to one unit of measure.
• Convert the 0.15 g to mg by moving the decimal point three
spaces to the right. 0.15 g 150 mg. Then solve for x.

The ratio and proportion method can solve all

problems of fractional dosages. (Answer: 0.75 ml)
Solve this dosage calculation problem:
Remember to change to one unit of measure before calculating the
dose.
 DOSAGE CALCULATION
Converting Different Units of Measure to One Unit of Measure

𝐷𝑒𝑠𝑖𝑟𝑒𝑑 𝑂𝑟𝑑𝑒𝑟
𝑋 𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦
𝑆𝑡𝑜𝑐𝑘 𝑜𝑛 𝐻𝑎𝑛𝑑

• The physician orders ampicillin (Principen) 0.5 g p.o. q 6

hour. The medication available is ampicillin (Principen)
125 mg/5 ml.
• What is the quantity of medication that the nurse should
administer?
Change 0.5 g to 500 mg and then solve for x. (Answer: 20 ml)
 DOSAGE CALCULATION

CONCENTRATION- Strength of the solution that contains the drug.

Example: a vial contains 2.5mg of a drug in 5ml solution.

a. What is the concentration of the drug in mg per ml?
b. How many milligrams of drug are there in 1 litre?
c. EXAMPLE: THE CONCENTRATION OF A DRUG IS 250MG/ML.
How many grams are there in 100 ml?
 DOSAGE CALCULATION

Converting pounds to kilograms

• There are 2.2 lbs in 1 kg
• To convert from lb to kg divide by 2.2
• Since you are dividing, the answer in kg will be smaller than the lb
you are converting
• Answers are expressed to the nearest 10th.
Solve this dosage calculation problem:
Convert the weight of a 150-lb adult to kg.
Answer: 150/2.2 68.18 68.2 kg
 DOSAGE CALCULATION

Dosage Calculation Based on Body Weight

• Individual dosages may be calculated in terms of g/kg, mg/kg, or
mg/lb/d
• The total daily dosage may be administered in divided
doses, for example every 6 hours (4 doses), every 8 hours
(3 doses) or every 12 hours (2 doses).
 DOSAGE CALCULATION

Recommended Daily Dosage Range

Two-step procedure:
• Calculate the total daily dosage range.
• Divide the total daily dosage by the number of doses per day to
obtain the actual dose administered at one time.
• Dosage discrepancies are much more critical if the dosage range
is low, for example 4–6 mg, as opposed to high, for example 250
mg.
• To check the safeness of a dose ordered by the physician,
calculate the correct dosage and compare it with the dosage
ordered.
 DOSAGE CALCULATION

Recommended Daily Dosage Range

Solve this dosage calculation problem:
The physician orders amoxicillin (Amoxil) for a 50-lb child.
The child is to receive this medicine p.o. tid. The usual dose
range is 20–40 mg/kg/d in divided doses.
a. 50 lb = _____ kg
b. What is the lower daily dosage? ______
c. What is the upper daily dosage? ______
d. What is the lower dose for one dose? ______
e. What is the upper dose for one dose? ______
 DOSAGE CALCULATION

Recommended Daily Dosage Range

f. The dosage range is ______ mg to ______ mg per dose q
8 hours.
g. If the order is to give 400 mg q 8 hour, is this a safe dose?
Why?
Answer:
• First, determine how many kg the client weighs: 50 lb/2.2
kg = 22.7 kg.
• Second, use 20 mg as your lower daily dosage and multiply that by
22.7 kg = 454 mg/d.
 DOSAGE CALCULATION

Recommended Daily Dosage Range

• Third, use 40 mg as your upper daily limit and multiply that by 22.7 kg=
908 mg/d.
• Fourth, using the 454 mg/d, divide by 3 to obtain the lower limit for one
dose =151.3 mg per dose.
• Fifth, using the 908 mg/d, divide by 3 to obtain the upper limit for one
dose = 302.6 mg per dose.
• Sixth, you have determined that 151.3–302.6 mg is the safe dose range
for this client.
• Seventh, 400 mg/8 hours is not a safe dose range for this client
 DOSAGE CALCULATION

Temperature Conversion
• To convert Celsius to Fahrenheit: multiply by 1.8 and add 32. (Or
multiply by 9/5 and add 32)
• To convert Fahrenheit to Celsius: subtract 32 and divide by 1.8 (Or
subtract 32, and multiply by 5/9).
Solve these problems:
37 ℃ = _____ ℉ (Answer: 98.6)
34 ℃ = _____ ℉ (Answer: 93.2)
107.6 ℉ = _____ ℃ (Answer: 42)
105.8 ℉ =_____ ℃ (Answer: 41)
 DOSAGE CALCULATION

Steps to Decrease Interpretation Errors:

• Always place a zero before a decimal expression less than one.
• Never place a decimal point and zero after a whole number, because the
decimal may not be seen and result in a 10-fold overdose.
• Avoid using decimals whenever whole numbers can be used as
alternatives. Example: 0.3 g should be expressed as 300 mg
• Whenever possible, use the metric system rather than grains, drams, or
minims.
 DOSAGE CALCULATION

Dosage Calculation: IV Flow Rate

• Most institutions require the use of an infusion controller or pump to assist
with the delivery of intravenous infusions.
• However, there will be many times when the nurse will be responsible for
calculating ml/hr or ml/min to safely administer intravenous medications or
fluids.
• The size of the fluid drop is determined by the specific intravenous set
being used.
• Macrodrip sets will vary among manufacturers and will deliver between
10–20 gtt/ml.
• Microdrip sets deliver 60 gtt/ml.
 DOSAGE CALCULATION

❖ Administer 1 g of a drug at a rate of 10 mg/kg/hr. The bag

contains 1 g in 100 ml. If the patient weighs 80 kg,
then: a) what is the drop rate for a standard giving set?
b) how long should the infusion last?
 DOSAGE CALCULATION

Information Needed to Calculate Intravenous Flow Rate

• The volume of solution to be infused
• The length of time of the infusion: converted to minutes:
i.e., 1 hour 60 minutes
• The drop factor of the infusion set being used: i.e., 15
gtt/ml
 DOSAGE CALCULATION

Formula to Calculate Flow Rates

𝒗𝒐𝒍𝒖𝒎𝒆 𝒎𝑳 𝒙 𝒅𝒓𝒐𝒑 𝒇𝒂𝒄𝒕𝒐𝒓
𝒈𝒕𝒕𝒔/𝒎𝒊𝒏 =
𝒕𝒊𝒎𝒆 (𝒎𝒊𝒏)
Solve this rate calculation problem:
• The physician orders an IV to infuse at 150 ml/hr.
Calculate the drops per minute rate for a set with a drop factor of 10
gtt/ml.
• Do not forget to convert the hour to minutes.
Answer:
150𝑚𝐿 𝑥 10𝑔𝑡𝑡/𝑚𝐿
60 𝑚𝑖𝑛
Answer 25 gtt/min
 DOSAGE CALCULATION

Formula to Calculate Flow Rates

The physician orders 1000 ml D5 1⁄2 NS to infuse over 8hours.
• The nurse has an infusion set that delivers 15 gtt/ml.
• How many milliliters should the nurse administer per hour?
• How many drops per minute should the nurse administer? Solve this rate
calculation problem:

Answer:
1000 ml/8 hours 125 ml/hour
125𝑚𝐿 𝑋 15𝑔𝑡𝑡𝑠/𝑚𝐿
𝐹𝑙𝑜𝑤 𝑅𝑎𝑡𝑒 =
60 𝑚𝑖𝑛𝑠.
Answer: 31 gtt/min
 DOSAGE CALCULATION

Changing the infusion rate

Example:
2L bag of 0.9% saline is infused at a rate of 125ml/hr for the first 6 hours
and then increased to 150 ml/hr until the bag is consumed. How long will
the infusion last?
 Week 7 Topic:

DRUGS AFFECTING THE

BODY SYSTEM

Intended Learning Outcome : Provide appropriate health education related to

drug therapy.
Drugs affecting the body system, that is often referred to as
pharmacological agents also known as medications, play a
pivotal role in the field of healthcare and medicine.
These substances are designed to interact with various
physiological systems within the human body to achieve
therapeutic effects, manage diseases, alleviate symptoms, or
promote overall well-being.
Understanding on how these drugs affect the body system is
crucial for healthcare professionals, including nurses, to provide
safe and effective care to patients.
Reproductive System:
Ovaries – the female sexual glands

Testes - male sexual glands

-respond to follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) - released from the anterior pituitary in response
to stimulation from gonadotropin-releasing hormone (GnRH)
released from the hypothalamus.
Female Reproductive System
- consists of two ovaries
- two fallopian tubes
- uterus
- accessory structures, including the vagina, clitoris, labia,
and breast tissue.

Hormones - estrogen and progesterone

Ovaries - almond-shaped organs located on each side of the
pelvic cavity
- store the ova, or eggs (ovum = egg).
Ovum - contained in a storage site called a follicle - act as
endocrine glands producing the hormones estrogen and
progesterone - prepare the body for pregnancy and to maintain
the pregnancy until delivery. Very near to each ovary is a
fallopian tube.
fallopian tube - muscular tube with a ciliated lining that is
constantly moving - propels the ovum released into the abdomen
down the fallopian tube and into the uterus, or womb, for the
developing embryo and fetus.

Uterus – a muscular organ, develops a blood-filled inner lining, or

endometrium - allows for implantation of the fertilized egg and
supports the development of the placenta, which provides
nourishment for the developing fetus and acts as an endocrine
gland producing the hormones needed to maintain the active
metabolic state of the pregnancy.
The muscular walls of the uterus are important for expelling the
developed fetus
through the vagina at delivery.

External genitalia—clitoris, labia, and vagina—are sites of

erogenous stimulation
and entry way for sperm to reach the uterus to allow
conception and the exit path for the developed fetus at birth.
Breast tissue - a secondary sex characteristic, is controlled
by the female sex hormones and is necessary for
producing milk for the nourishment of
the baby
 Hormones

Estrogen - produced by the ovaries including estradiol,

estrone, and estriol.
-enter cells and bind to receptors within the cytoplasm to
promote messenger RNA
(mRNA) activity, which results in specific proteins for cell
activity or structure
 Effects of Estrogen

• Growth of genitalia (in preparation for childbirth)

• Growth of breast tissue (in preparation for pregnancy and lactation)
• Characteristic female pubic hair distribution (a triangle)
• Stimulation of protein building (important for the developing fetus)
• Increased total blood cholesterol (for energy for the mother as well
as the developing fetus) with an increase in high-density-lipoprotein
levels (“good” cholesterol, which serves to protect the female blood
vessels against atherosclerosis)
 Effects of Estrogen

• Retention of sodium and water (to provide cooling for the heat
generated by the developing fetus and to increase the diffusion of
sodium and water to the fetus through the placenta)
Inhibition of calcium resorption from the bones (helps to deposit calcium in
the fetal bone structure; when this property is lost at menopause,
osteoporosis, or loss of calcium from the bone, is common)
• Alteration of pelvic bone structure to a wider and flaring pelvis (to
promote easier delivery)
• Closure of the epiphyses (to conserve energy for the fetus by halting the
growth of the mother)
 Effects of Estrogen

• Increased thyroid hormone globulin (metabolism needs to be increased

greatly during pregnancy, and the increase in thyroid hormone facilitates
this)
• Increased elastic tissue of the skin (to allow for the tremendous stretch of
the abdominal skin during pregnancy)
• Increased vascularity of the skin (to allow for radiation loss of heat
generated by the developing fetus)
• Increased uterine motility (estrogen is high when the ovum first leaves
the ovary, and increased uterine motility helps to move the ovum toward
the uterus and to propel the sperm toward the ovum)
 Effects of Estrogen

• Thin, clear cervical mucus (allows easy penetration of the sperm into
the uterus as ovulation occurs; used in fertility programs as an
indication that ovulation will soon occur)
• Proliferative endometrium (to prepare the lining of the uterus for
implantation with the fertilized egg)
• Anti-insulin effect with increased glucose levels (to allow increased
diffusion of glucose to the developing fetus)
• T-cell inhibition (to protect the non–self cells of the embryo from the
immune surveillance of the mother)
 Hormones

Progesterone - released into circulation after ovulation

- many effects that support the early development of the fetus
- effects on body temperature are monitored in the “rhythm method” of
birth control to indicate that ovulation has just occurred.
• Decreased uterine motility (to provide an increased chance that
implantation can occur)
• Development of a secretory endometrium (to provide glucose and a
rich blood supply for the developing placenta and embryo)
• Thickened cervical mucus (to protect the developing embryo and
keep out bacteria and other pathogens; this is lost at the beginning of
labor as the mucous plug)
 Effects of Progesterone
• Breast growth (to prepare for lactation)
• Increased body temperature (a direct hypothalamic response to
progesterone, which stimulates metabolism and promotes activities for
the developing embryo; this increase in temperature is monitored in the
“rhythm method” of birth control to indicate that ovulation has occurred)
• Increased appetite (this is a direct effect on the satiety centers of the
hypothalamus and results in increased nutrients for the developing
embryo)
• Depressed T-cell function (again, this protects the non–self cells of the
developing embryo from the immune system)
• Anti-insulin effect (to generate a higher blood glucose concentration to
allow rapid diffusion of glucose to the developing embryo)
Interaction of the hypothalamic,
pituitary, and ovarian hormones
that underlies the menstrual cycle.
Dotted lines indicate negative
feedback surge.
CNS, central nervous system;
FSH, follicle-stimulating hormone;
GnRH, gonadotropin-releasing
hormone; LH, luteinizing
hormone.
 Sex Hormones

estrogens and the progestins - the endogenous female hormone

progesterone and its various derivatives.
Estrogens that are available for use include estradiol (Estrace, Climara,
and others),
Conjugated estrogens (Premarin),
Esterified estrogen (Menest), and estropipate (Ortho-
Est, Ogen).
Progestins include drospirenone (Yasmin, Yaz), etonogestrel
(Implanon), levonorgestrel (Mirena), medroxyprogesterone
(Provera), norethindrone (Aygestin), norgestrel (Ovrette),
progesterone (Progestasert and others), and desogestrel (found in
many contraceptive combinations).
 THE FEMALE REPRODUCTIVE SYSTEM
Hypothalamus, Pituitary Gland, and Ovary -
Regulation of the female reproductive system is
achieved by hormones.
Hypothalamus > secretes GnRH
Pituitary > stimulate the secretion of FSH and LH
day 14 of the ovarian cycle - surge of LH secretion
causes one follicle to expel its oocyte, a process
called ovulation
Hormonal changes during
the ovarian and uterine
cycles
Ovarian follicles mature > secrete the female sex hormones
estrogen and progesterone.
Estrogen : estradiol, estrone, and estriol
-responsible for the maturation of the female reproductive organs
-appearance of secondary sex characteristics
- metabolic effects on nonreproductive tissues, including the brain,
kidneys, blood vessels, and skin.
- estrogen decreases the levels of LDL ; increases the amount of
HDL
- help lower the risk of myocardial infarction (MI) in
premenopausal women
-causes bones to grow longer and stronger in younger women
corpus luteum > secretes a progestins, most abundant of is
progesterone.
- The combination of estrogen, and progesterone promotes breast
development
- regulates the monthly changes of the uterine cycle
- uterine endometrium becomes vascular and thickens in preparation
for receiving a fertilized egg
- The final third of the uterine cycle provides negative feedback to
shut off GnRH, FSH, and LH secretion
- Without stimulation from FSH and LH, estrogen and progesterone
levels fall sharply, the endometrium is shed, and menstrual
bleeding begins.
- pharmacologic use of the female sex hormones is to prevent
pregnancy
- treat dysfunctional uterine bleeding
-severe symptoms of menopause
-certain neoplasms.
Negative feedback control of
the female reproductive
hormones
Facts in Female Reproduction
■ There is a wide range of ages at which women reach
menopause: 8 of 100 women will stop menstruating before age
40, and 5 of 100 women will continue to age 60 and beyond.
■ About 90% of dysfunctional uterine bleeding occurs due to lack
of ovulation.
■ It is estimated that approximately 10% to 15% of all sexually
active women use no birth control, contributing to the almost 50%
unintended pregnancy rate.
■ Over 10% of sexually experienced women aged 15 to 44 have
used emergency contraception (Plan B).
■ Oral contraceptives confer benefits besides contraception,
including the following:
Reduced risk for colorectal, ovarian, and endometrial cancer
Decreased risk for benign breast disease, ovarian cysts, primary
dysmenorrheal, and iron-deficiency anemia
Improvement in acne and bone mineral density
 ORAL CONTRACEPTIVES

- drugs used in low doses to prevent pregnancy.

- “the pill”
- prevent fertilization by inhibiting ovulation.

Estrogens and Progestins as Oral Contraceptives:

- common estrogen used for contraception is ethinyl estradiol
- most common progestin is norethindrone
 ORAL CONTRACEPTIVES

- hormonal contraception is nearly 100% effective

- administration of an OC begins on day 5 of the menstrual cycle
and continues for 21 days. During the other 7 days of the month,
the woman takes a placebo. placebos contain iron, which replaces
iron lost due to menstrual bleeding
- reason for treatment failure (pregnancy), is forgetting to take the
medication daily
 ORAL CONTRACEPTIVES

Estrogen–Progestin OCs:
monophasic - delivers a constant dose of estrogen and progestin
throughout the 21-day treatment cycle.
biphasic agents – the amount of estrogen in each pill remains
constant, but the amount of progestin is increased toward the end
of the treatment cycle to better nourish the uterine lining.
triphasic formulations - amounts of both estrogen and progestin
vary in three distinct phases during the treatment cycle.
four-phase OC – first, Natazia contains estradiol valerate, a
synthetic estrogen, and dienogest, a progestin this is the first drug
containing this specific combination.
SELECTED ORAL CONTRACEPTIVES