Considerations for Determining

Correct Drug Dosages

• Sex
• Weight
• Age
• Physical condition
• Other drugs that the patient is taking
 Persons Responsible for
Accurate Dosage Calculations
• The pharmacist who dispenses
the drug
• The prescriber who orders the
drug
• The nurse who administers the
drug
Types of Systems Used in Drug
Measurement

• Metric system
• Apothecary system
• Household system
• Avoirdupois system
 Metric System
 Most widely used system of measure.
 Based on the decimal system,
 All units are determined as multiples of
10.
 Used worldwide & makes the sharing
of
 Metric System

• Basic units of measure

• For solid = gram

• For liquid = liter
 Metric System
• Solid measure: Gram (g)
– 1 milligram (mg) = 0.001 g
– 1 microgram (mcg) = 0.000001 g
– 1 kilogram (kg) = 1000 g

• Liquid measure: Liter (L)

– 1 milliliter (mL) = 0.001 L
– 1 mL = 1 cubic centimeter = 1 cc
 Apothecary System
• Is a very old system of measure that was
specifically developed for use by apothecaries or
pharmacist.

• Uses the minim as the basic unit of liquid

measure, and the grain as the basic unit of solid
measure.

• Uses Roman numerals placed after the unit of

measure to denote amount, for example 15
grains would be written “gr xv”
 Apothecary System
–Solid measure: Grain (gr)
• 60 gr = 1 dram (dr)
• 8 dr = 1 ounce (oz)
–Liquid measure: Minim (min)
• 60 minim = 1 fluidram (f dr)
• 8 f dr = 1 fluidounce (f oz)
 Household System
• Pts need to be advised that flatware
teaspoons & drinking cups vary
tremendously in the volume that they
contain.

• Important to clarify that the measures

indicated in the instructions of liquid
medication refer to a standardized
measuring device.
 Household System
– Solid measure: Pound (lb)
• 1 lb = 16 ounces (oz)
– Liquid measure: Pint (pt)
• 2 pt = 1 quart (qt)
• 4 qt = 1 gallon (gal)
• 16 oz = 1 pt = 2 cups (c)
• 32 tablespoons (tbsp) = 1 pt
• 3 teaspoons (tsp) = 1 tbsp
• 60 drops (gtt) = 1 tsp
 Household System

• Measuring system found in recipe

books.

• Uses the teaspoon as the basic unit

of fluid measure and the pound as
the basic unit of solid measure.
 Avoirdupois System

• Uses ounces & grains but they measure

differently than those of the apothecary &
household systems.

• Seldom used by prescriber but may be used for

bulk medications that come directly from the
manufacturer.
 Other Systems
• Some drugs are measured in units
reflecting the chemical activity or biological
equivalence.

• One of these measures is the unit (U).

– A unit usually reflects the biological activity of
the drug in 1 mL of solution.
– The unit is unique for the drug it measures; a
unit of heparin would not be comparable to a
unit of insulin.
• Milliequivalents (mEq) are used to measure
electrolytes (example K, Na,).
– Milliequivalent refers to the ionic activity of the drug in
question; the order is usually written for a number of
milliequivalents instead of a volume of drug.

• International units (IU) are sometimes used to

measures certain vitamins or enzymes. These
are also unique to each drug & can’t be
converted to another measuring form.
 Conversion among Metric,
Apothecary & Household System
Metric system Apothecary System Household System
Solid measure
1 kg 2.2 lb
454 g 1.0 lb
1 g= 1000 mg 15 gr (gr xv)
60 mg 1 gr (gr i)
30 mg ½ gr (gr ss)
Liquid measure
1 L – 1000 mL About 1 qt
 Conversion among Metric,
Apothecary & Household System
Metric system Apothecary System Household System
240 ml 8 f oz ( 8 oz viii) 1c
30 ml 1 f oz ( f oz i) 2 tbsp

15-16 ml 4 f dr ( f dr iv) 1 tbps= 3 tsp

8 mL 2 f dr ( f dr ii) 2 tsp
4-5 mL 1 f dr ( f dr i) 1 tsp= 60 gtts
1 mL 15-16 min ( min xv or
min xvi)
0.06 mL 1 min (min i)
 Methods of Calculations
Formula method:
• D/H x Q = X
• D - dosage desired or ordered
H - what is on hand (available)
Q - unit of measure that contains the available
dose.
• When using solid products (tablets, capsules) Q
is always 1 and can be eliminated. Q varies
when using liquid measures.
X - the unknown dosage you need to administer
 Example
Order: Potassium Chloride 20 mEq added to
the IV.
Available: 40 mEq per 10cc.
How much potassium will you add?
D = 20 mEq      H = 40 mEq   Q = 10 cc
20 mEq   X 10 cc = X   
40 mEq
0.5 X 10  = X  = 5 cc
 Methods of Calculations
• Ratio-proportions
• Ratios indicate a relationship between
two numbers with a colon between the
numbers. The colon represents division.
For example 3:4 = 3/4.
• Proportions are equations containing
ratios of equal value.
For example 3:4 = 6:8.  This may also be
written as fractions, 3/4=6/8.
 Ratio-proportions
• Means are the two inner numbers, in this case 4 & 6.
Extremes are the two outer numbers, 3 and 8.
•    3 : 4 = 6 : 8
• The product of the means (4 X 6) must equal the product
of the extremes (3 X 8).
• Therefore when you do not know one value (x), you can
determine it, if the other three values are known.. When
setting up a ratio, the known factor (on hand) is stated
first, the desired is stated second.  H = D x
• 3 : 4 = x : 8          multiply the means and
4x = 3 X 8             the extremes
4x = 24            
x= 24 ¸ 4 = 6
 Fractional Formula
3 = x                          
4    8                          
4x = 3 X 8 = 24          
x = 24 ÷ 4 = 6
• cross multiply to obtain the product of the
means and extremes
 Example
Ordered:   600,000 units of penicillin po q6h
              Available:   400,000 units per scored tablet
              How many tablets will you administer?
• 400,000 units : 1 tablet =  600,000 units : x   
600,000 = 400,000x                        (multiply means
600,000 = x = 1.5 tablets                 & extremes)
400,000
• OR set it up as a fraction
• 400,000  =  600,000
      1               x
• 400,000x  = 600,000
• x  = 600,000 = 1.5 tablets
       400,000
 Ratio for Converting Drug
Dosages (Tablets)

amount of drug available = amount of drug prescribed

one tablet or capsule # of tablets or capsules to give
 Ratio for Converting Drug
Dosages (Liquids)

amount of drug available = amount of drug prescribed

volume available volume to administer
Ratio to Determine Amount of Drops
of Fluid to Administer per Minute

drops/minute = mL of solution prescribed per

hour x drops delivered per mL
60 minutes/hour
 Formula for calculating IV flow rate

• V1  X  V2 = gtt/min       V1 - volume to infuse

T1       T2                     T1 - time to infuse (hours or
minutes)
                                   V2 - drop factor
                                   T2 - time in minutes - this
number is always
                                    60 (minutes/hour)
unless you are
                                   going to infuse for less
            than 60 minutes
Medical prescription: 250 ml 5% D/W to
infusion over 10 hours. Drip factor is 60.

Total fluid = 250 mL(cc)

Drip factor = 60 gtts/min
Infusion time in minutes = 600 min
 Fried’s Rule for a Child Younger
Than 1 Year
• This rule assumes that an adult dose would
be appropriate for a child who is 12.5 years
(150 months) old

child’s dose (age <1 year) = infant’s age (in months)

150 months x average adult dose
 Young’s Rule for Children 1 – 12
Years Old

child’s dose (age 1–12 years) =

child’s age in years
child’s age in years + 12 x average adult dose
 Clark’s Rule
• Uses the child’s weight to calculate the
appropriate dose and assumes that the
adult dose is based on a 150-lb person

child’s dose = weight of child in pounds

150 pounds x average adult dose

 Using Child’s Surface Area to
Determine Dosage
• Determine the child’s surface area with
the use of a nomogram (the height and
weight of the child are taken into
consideration in this chart)

child’s dose = surface area in square meters

1.73 x average adult dose
Sample Nomogram
 Basic Drug Calculation Practice
Problems
• 1. Ordered: Trilafon 24 mg po bid.
Available: Trilafon concentrate labeled 16
mg/5 ml.
How many ml will you administer?   
 Answer
• Ratio-proportions:
• 24 mg : x  =  16 mg : 5 ml
16 x = 24 X 5 = 120
x = 120 ¸ 16
x = 7.5 ml
• Formula method:
• D/H X Q = X
• 24  X  5  = X
16
1.5 X 5 = 7.5 ml
 Basic Drug Calculation Practice
Problems
• 2. Ordered: SoluMedrol 100 mg IM q8h
Available: Vial 1 ml in size labeled 125 mg
SoluMedrol/3 ml

How many ml will you administer?

What size syringe is best to administer this
dose?
 Answer
• Ratio-proportion method:
• 100 mg : x = 125 mg : 3 ml
125 x = 300
x = 300 ¸ 125
x = 2.4 ml
• You would need to use a 3 ml syringe.  A 5 ml syringe
would not give you the decimal point.
• Formula method:
• D/H X Q = X
• 100 ¸ 125 X 3 ml = x
0.8  X  3 = x
2.4 ml = x
 Basic Drug Calculation Practice
Problems
• 3. The physician orders Lasix 20 mg IV
stat for a child weighing 34 lbs.

The pediatric handbook states that 1 mg/kg

is a safe initial dose.  Should you give this
dose?    
 Answer
• 34 lbs. X   1kg/2.2 lbs = 15.5 kg

• 15.5 kg X 1 mg/kg = 15.5 mg

• The does is too high, you need to call the

physician.
 Basic Drug Calculation Practice
Problems
• 4. Ordered: Infuse 2 L of Lactated Ringers
solution in 24 hours.  The administration
set has 12 gtts/ml.  How many gtts/min will
you administer the IV?  
 Answer
• 2000 ml   X  12 gtts/ml   = x   
  24 hr           60 min/hr

24000 = x
1440
• 16.7 gtts/min or 17 gtts/min = x
 Definition of Drug Interaction
• The pharmacological result, either
desirable or undesirable, of drugs
interacting with themselves or with other
drugs, with endogenous chemical agents,
with components of the diet, or with
chemicals used in or resulting from
diagnostic tests.