Dosage Calculations Dosage Calculations

Chapter5 Chapter5
PharmACOLOGY
O To determine the correct dose of a drug,
consider patients sex, weight(include Body
Surface Area BSA), age and physical
condition, as well as other drugs the patient
is taking.
O oing mathematical calculations to determine
what should given is the responsibility of the
prescriber, who orders the drug, the pharma-
cist who dispenses, and the nurse who
administers the drug.
O !repackaged system drugs in unit-dose
form and the nurse may solely rely on this
prepackaged system.
O The nurse is legally and professionally
responsible for any error that might occur.
O The practicing nurses must know how to
convert drug dosing orders into approp-
riate doses of available forms of a drug to
ensure right dosage.
easuring systems easuring systems
O Four different systems that are currently
used in drug preparation and delivery:
metric, the apothecary, the household and
avoirdupois systems.
In an effort to decrease the dependence on
so many different systems, in 1995, the U.S.
Pharmacopeia Convention established the
standards requiring all prescriptions, regard -
less of the system used, include the metric
measure for quantity & strength of drug.
lossary of Key Terms lossary of Key Terms
O apothecary system old system of
measure that was developed by apothecaries
or pharmacists; uses the minim as the basic
unit of liquid measure & grain as basic unit of
solid measure. It uses roman numerals after
unit of measure, 15 grain =gr xv
O avoirdupois system- another older system
used by pharmacists when they compound
medications. Uses ounces & grains but differ
-ent from apothecary & household systems.
Seldom used by prescriber.
continued continued
O Household system is the measuring system
found in recipe book. The system uses teaspoon
as the basic unit of fluid measure and the pound
as the basic unit of solid measure. Flatware tea-
spoon and drinking cup vary in volume. A flat-
ware teaspoon could hold up to two measuring
teaspoons of quantity.
O other systems- milliequivalents(mEq)-are used
for electrolytes measures(K+, Na+, Ca, Fluoride
)- refers to ionic activity of drug, international
unit used to measure vitamins & enzymes.
Continued other systems Continued other systems
O Some drugs are measured in units other
than those already discussed. A unit
usually reflects the biological activity of
the drug in 1 ml of solution.
O The unit is unique(specific) for the drug it
measures; a unit of heparin is not compar
-able to unit of insulin.
Continued lossary Continued lossary
O etric system is the most widely
used system; based on the decimal
system; all units in the system are
determined as multiples of 10; uses the
gram as the basic unit of solid measure
and liter as the basic unit of liquid
measure.
etric system Apothecary system Household system
Solid measure
1 kg 2.2 lb
454 g
1 gm=1000 mg 15 grain(gr xv)
1.0 lb
60 mg 1 gr (gr i)
30 mg gr (gr ss)
Liquid measure
1 L= 1000 ml About 1 qt
240 ml 8 f oz(f oz viii) 1 c
30 mL 1 f oz(f oz i) 2 tbsp
15-16 mL 4 f dr (f dr iv) 1 tbsp= 3 tsp
8 mL 2 f dr (f dr ii) 2 tsp
4-5mL 1 f dr (f dr i) 1 tsp = 60 gtt
1 mL 15-16 min(min xv-
min xvi)
0.06 ml 1 min (min i)
Conversion between systems Conversion between systems
O Ratio and proportion an equation in
w/c a ratio containing 2 known equivalent
amounts is one side and a ratio containing
the amount desired to convert and its
unknown equivalent is on the other side.
O %o do this, it is necessary to check a table
of conversions to determine the equiva-
lent measure in 2 systems you are using.
Conversion Between Systems Conversion Between Systems
O The simplest way to convert measurements
from one system to another is to set up a
ratio and proportion equation.
O to do this first check a table of conversion to
determine the equivalent measure in the two
systems you are using. Second, the ratio
containing 2 known equivalent amounts is
placed on one side, and the ratio containing
the amount you wish to convert and its
unknown equivalent is placed on the other
side.
Continued conversion Continued conversion
O Convert 6 f oz to the metric system, in table
5.2, 1 f oz is = to 30mL
O 1 f oz = 6 f oz
30 mL X
1 f oz( known ratio) = 30 mL is on one side of
equation; the other side of equation 6 f oz is the
amount to convert, and X the unknown(metric
system). Because the fluid ounce is in the
numerator on the left, fluid ounce must be in the
numerator in the right side of equation.
The equation is read as: one f oz is to 30 milli-
liters as 6 fluid oz is to how many
milliliters?
Continued conversion Continued conversion
O The first step is to cross multiply(multiply the
numerator from one side of equation by the
denominator from the other side, & vice versa.
O 1 f oz = 6 f oz 1 (f oz)(x) (6 f oz)(30 ml)
O 30 mL X
O 1 (f oz)X = 180(f oz)(mL)
O Next rearrange the terms to let the unknown quantity
stand alone on side of equation:
O X = 180(mL)(f oz) X = 180 mL
O 1 f oz
O Cancel out the numbers as well as units of measure.
So you are left w/ appropriate amt. & unit of measure
ral Drugs ral Drugs
O ral drugs
O %he tablets or capsules for oral adminis-
tration are usually not in exact dose that
has been ordered.The easiest way is to
set up a ratio and proportion equation.
The ratio containing 2 known equivalent
amounts is put on one side of equation
and the ratio containing the unknown
value is put on other side.
Calculating dose Calculating dose
O The known equivalent is the amount of drug
available in one tablet or capsule; the
unknown is the number of tablets of capsules
needed for prescribed dose.
amt. of drug available=amt of drug presc
one tablet /capsule # of tablets to give
An order written for 10 grains of aspirin(gr x)
How many tablets should give the nurse give?
O Set up the equation:
5 gr = 10 gr 3(gr)x 10 (gr)(LableL)
one tablet X
O #earrange and cancel like units and numbers
X= 10 (gr)(tablets) X= 2 tablets
5 gr
There are times that the desired dose is equivalent to a
fraction of a tablet or capsule. Many tablets come in
matrix that allows for slow steady & release of the
active drug and cannot be cut, crushed or chewed.
O If the only way to deliver the correct dose
to a patient is by cutting one of these pre
O -parations, a different formulation of the
drug, a different drug, or a different
approach in treatment of patient should
be tried. Many of the drugs used in pedia
and for adults who have difficulty swall-
owing a pill/tablet are prepared in liquid
form.
O If the patient is not able to swallow a
tablets or capsule, check for other avail-
able forms and consult the pharmacist for
possibility to prepare drug in liquid form
of suspension or a solution. The same
principle used to determine the number of
tablets needed to arrive at a prescribed
dose can be used to determine the
volume of liquid that will be required to
administered the prescribed dose.
O An order has been written for 250 mg of
sulfisoxazole. The bottle states that the
solution contains 125 mg/5mg which is the
amount of drug available. How much of the
liquid should you give? The phrase "amount
of drug must appear in the numerator of
both ratios, the volume to administer is the
unknown (X).
O Amt of drug available =amt of drug prescribed
O volume available X unknown volume to give
O 125 mg = 250 mg
O 5 mL X
O Cross-Multiply:
O 125(mg) X = (250 x5)(mg)(mL)
continued continued
O Cross multiply:
125 (mg)X = (250 x 5)(mg)(mL)
O Simplify :
O X = 1250(mg)(mL)
125(mg)
O cancel out like units and numbers
O X = 10 mL
!arenteral !arenteral Drugs Drugs
O All drugs administered parenterally must be
given in liquid form. The person admi-
nistering the drugs need to calculate the
volume of the liquid that must be given to
administer the prescribed dose. The same
formula for determining the dose of liquid
can be used for determination of parenteral
dose.
O amt of drug available =amt. of drug prescribed
O volume available volume to administer
continued continued
O An order for 75 mg of meperidine to be
given intramuscularly(IM). The vial
contains meperidine, 1.0 mL= 50.0 mg.
O 50mg = 75 mg
O 1 mL X
O 50(mg)X = (75x 1)(mg)(mL)
O X= 75(mg)(mL) X= 1.5 mL
O 50 (mg)
ntravenous Solutions ntravenous Solutions
O Intravenous(IV) Solutions are used to
deliver a prescribed amount of fluid,
electrolytes, vitamins, nutrients or drugs
directly into blood stream.
O Most IV delivery system have standard
control called microdrip, each mL = 60 drops
O Macrodrip = 15 drops/mL, ratio to determine
drops of fluid to administer per minute
O they are used for large volume must be delivered quickly.
O Always check the packaging of the IV
tubing to see how many drops/mL are
delivered by the particular device.
O (mL of solution prescribed/hour)
O drops = (drops delivered/mL)
O minute (60 min)/(1 hour)
continued continued
O An order for a patient to receive 400mL of
5% 5W for a period of 4 hours in stand-
ard microdrip(60gtts/mL). Calculate the
correct setting(drops/minute).
O X =(400 mL/4 h)(60drops/min)
O (60 min)/(1 hr)
O X= (100 mL/h)(60 drops/min)
O X = 6000 drops/h X = 100 drops/min
O (60min)/1 hr
continued continued
O Now calculate the same order for an IV
set that delivers 15 drops/ml:
O X= (400 mL/4 h)(15 drops/min)
O (60min)( 1 hr)
O X = (100 mL/h)(15 drops/min)
O (60min)/(1 hr)
O X = 1500 drops/h
O (60 min)/(1 hr)
O X = 25 drops/min
continued continued
O If a patient has an order for IV drug, the same
principle can be used to calculate the speed of the
delivery. For example, patient to receive 50 mL of an
antibiotic over 30 minutes. IV set dispenses 60
drops/min. Calculate how fast the delivery:
O X= (50mL/0.5 h)(60drops/min)
O 60 min)(1 hr)
O X= (100mL/h)(60 drops/min)
O (60 min)/(1 hr)
O X = 6000 drops/h
O (60 min)(1 hr)
O X = 100 drops /min
!ediatric Considerations !ediatric Considerations
O A childs body handle drug differently in all
aspect of pharmacokinetics-
Absorption, distribution, metabolism and
excretion.The responses of childs organs to
the effects of the drug vary due to
immaturity of the organs. Most of the time
child requires a smaller dose of a drug to
achieve comparable critical concentration as
that for an adult. There are times when no
recommended dose for a child is available in
drug guide but that drug is needed.
continued continued
O Today, nomogram using body surface area
is commonly used due to its accuracy. The
body surface area of childs body is used
to determine the approximate dose. The
height and weight are taken into
consideration.
O Childs dose = Surface area(m2)x ave. adult dose
O 1.73
O One must have nomogram available to determine
the surface area.
illigrams/Kilograms of BW illigrams/Kilograms of BW
O The orders for drug dose, when a safe
and effective pediatric dose has been
determined are often written in
milligrams/ kilograms(mg/kg).