Drug Calculations

Inver Hills Community College

Paramedic Program
I. Kevin J ohnson, AS,BS, NREMT-P
The new system of
weights and measures
will be a stumbling block and the
source of difficulties for
several generations
Its just tormenting the people with
trivia!!
Napoleon I
Converting from one
System to Another
Units of Weight
Metric Apothecary
60 Milligrams (mg) = grains (gr) 1
1 gram (g) = grains (gr) 15
Units of Volume
Apothecary Metric Household
1 minum = 1 gtt
1 ml = 15 - 16 m = 15 gtts
5 ml = 1 dram = 1 teaspoon
30 ml = 1 ounce = 1 ounce
Converting mg to Grains
Convert 300 mg to grains
We want to cancel the mg and end up with grains
?mg
?gr
mg 300
Since 60 mg = gr 1, the fraction is:
mg
gr
60
1
5
60
300
60
1
300 gr
gr
mg
gr
mg = =
The Metric System
1000 g = 1 mg
1000 mg = 1 g
1000 g = 1 kg
1000 mL = 1 L
1000 L = 1 kL
1 mL = 1 cc = 1 cm
3
To convert from one multiple to the other, move the
decimal point 3 places in the direction indicated.
Kg g mg g
3 3 3
Converting lbs to kg
Convert 200 lb to kg
Known = 1kg = 2.2 lb
kg
lbs
kg
lbs 9 . 90
2 . 2
200
2 . 2
1
200 = =
Two AM Rule:
Divide the weight in pounds by 2
Multiply by 10%
Subtract the % from the quotient
100 2 200 lb
10 % 10 100
kg 90 10 100 =
Finding the Ordered Dose
The Doctors Order
amount of medication and the route
Concentration
how much drug is in a given amount of fluid
worded as on Hand
Break it down to per mL values
100mg/5mL =20mg/mL
What are You looking For?
Identify unit of measurement to be administered to the
patient
The Key
Organization
identify key components of problem
The Order
Whats on Hand
Looking for:
Find the Ordered Dose
Dr. Kool orders 2 mg of Valium IV to a patient with seizure
activity. You have a 5 mL vial that contains 10 mgs of
Valium. (10mg/5mL). How many mLsare you going to
draw up into a syringe?
Order:
Order: 2 mg Valium IV
On Hand
On Hand: 10 mg/5 mL Valium
Looking for:
Looking for: mL to be given
Ordered Dose
Formula Method
(mg) ion concentrat
dose ordered hand on
) ( given be to volume

=
volume
X
mg
mg mL
X
10
2 5
=
ml X
10
10
=
mL X 1 =
Ordered Dose
Ratio & Proportion Method
On the left side of the proportion, put the known ratio:
10 mg : 5 mL ::
On the right side, put the ration that is unknown:
10 mg : 5 mL :: 2 mg : X mL
Multiply the extremes then multiply the means
10 X = 5 x 2
10 X = 10
X = 1 mL
Titrated Drugs
Specific dose of Drug given in small
increments to effect
Dose usually repeated Q 3 5 minutes
Example
2- 10 mg Versed for seizure control
2 10 mg MS for pain and B/P >100
Example of Titrated Med
Standing orders:
2 10 mg Versed IV for seizure control
On Hand:
10mg in 2 mL or 5 mg/mL
Problem
How to give 2 mg increments accurately IVP
Answer
Dilute to 10 mL of solution
2 mL of Versed with 8 cc of NS = 1 mg/mL
Find the Units per Kilogram
Recognize the order is based upon weight
Utilize the Key = Organization
Solve the problem
Convert Pounds to Kilograms
Order by Weight to a Basic Order
Find the Ordered Dose
Units per Kilogram
You are to give 10 mg/kg of Bretyliumto 198 pound patient
You have premixed syringes with 500 mg/10 mL.
How many mLswill you administer?
Order:
Order:
10 mg/kg
10 mg/kg
On Hand:
On Hand:
500mg/10
500mg/10
mL
mL
Looking For:
Looking For:
mL
mL
Pt
Pt

s Weight:
s Weight:
198 lbs
198 lbs
Organize your pertinent Information
Units Per Kilogram
Step 1- Convert lbs to Kg
Step 2- Convert to Basic Order
Step 3- Find the ordered Dose
kg lb 90 2 . 2 198 =
1kg
) weight(kg dose ordered
= X
kg
kg mg
X
1
90 10
= mg X 900 =
500mg :10mL :: 900mg : XmL
500X = 9000
mL X
500
9000
=
X = 18 mL
Concentration
Goal
to find out how many mg, mcg, or grams of a
drug there are in 1 mL of solution
usually mg/mL
Formula
X =
Solute (grams or milligrams of drug)
Solvent (liters or milliliters of volume)
Calculating Concentration
Formula Method
One gram of lidocaine has been added to a 250 mL bag of
Normal Saline. What is the concentration?
Step 1 - set up the formula
X =
Solute (grams or milligrams of drug)
Solvent (liters or milliliters of volume)
X
g
=
1 lidocaine
250 mL D5W
Step 2 - Convert grams to milligrams
X
mg
mL
=
1000
250
Step 3 - Do the math
X
mg
mL
mg
mL
mg mL = = =
1000
250
250
250
4
1
4 /
Calculating Concentration
Ratio & Proportion Method
One gram of lidocaine has been added to a 250 mL bag of
Normal Saline. What is the concentration?
Step 1 - Place known concentration on the left
1000mg : 250 mL ::
Step 2 - Place unknown concentration on the right
1000mg : 250mL :: (X)mg : 1mL
Step 3 - Multiply the Means and Extremes
250 1000 X =
X mg = =
1000
250
4
Step 4 - Write as: 4:1
Calculate an IV Drip Rate
To determine how many drops per minute
are needed to infuse a desired volume of IV
solution over a given time period
Example:
how many gtts/min are needed to infuse 1000
mL of NS over 2 hrs using a Macro IV set?
Formula
gtts/ min=
volume to be infused drip set rate
infusion time in minutes

IV Drip Rate Calculation

Dr. Feelgoodorders 2 L of D5W1/2NS to be infused over
4 hours. Using a Macro tube drip set of 15gtts/mL, how many
gtts/min will you adjust your IV set to deliver?
Step 1: Set up the formula
hrs 4
15gtt/mL 2L
= gtts/min

Step 2: Convert to Proper Units & solve
gtts/ min=
2000 15
240

=

= =
200 5
8
1000
8
125gtt / min
3
3
IV Drip with Medication
Usually ordered to administer a certain
number of mgs or mcgsor drug per minute.
May involve drawing up medication from a
vial and injecting it into a bag of solution.
You need to figure how much drug is
contained in 1 mL of the solution
IV Drip Rate
Dimensional Analysis
You are to administer lidocaine at a rate of 2 mg/min to a
patient with an arrhythmia. You have a vial of Lidocaine
that contains 1 g in 5 mL. You also carry a 250 mL bag of
Normal Saline. Your administration set is a microdripwith a
rate of 60 gtts/mL. How many drops/min will you set your
IV set to drip?
Step 1: Organize the information.
Order: 2 mg lidocaine/min IV
On Hand: 1 g lidocaine/5 mL
Bag: 250 mL NS
Adm set: 60 gtt/mL
Looking for: gtt/min
IV Drip Rate
Formula
mL 1
set(gtt) adm
min 1
ordered mg
Bag in Drug
) volume(mL bag IV
= X
mL
gtt mg
mg
mL
x
1
60
min 1
2
1000
250
=
mL
gtt
X
1
60
min 1
2
10
25
=
min / 30
min 10
300
gtts
gtt
X = =
IV Drip Rate
Rule of Fours
Using the same problem, we calculate the following:
4mg=1mL
& 60gtt = 1 mL
4 mg
2 mg
1 mg
3 mg
60
30
15
45
Gtts/min
Desired Dose
IV Drips based on Patient Weight
Order: 10mcg/kg/min
On Hand 200 mg/10mL
Bag: 250 cc NS
Adm. Set 60 gtts
Pts Weight: 176 lbs
Looking for: gtts/min
Example:
An order is given to administer 10 mcg/kg/min of Dopamine.
You have a vial that contains 200mg/10mL. Of Dopamine.
You also have a 250 cc bag of NS & a microdripIV set. Your
Patient weighs 176 pounds. How will you set your drip rate?
IV Drips based on Patient Weight
Calculation
Step 1: Convert the patients weight to kg & calculate dose
176
1
1
22 1
800
lb kg
lb
mcg
kg
=
.
10
mcg/ min
Step 2: Calculate Drip Rate
X
mL
mcg
mcg gtt
mL
=
250
200000
800
1
60
1 min
X gtts = =
120
2
60 / min
IV Drips based on Patient Weight
Calculation Alternative
Step1:Calculate the concentration
200 mg = 200000mcg
200000mcg : 250mL :: Xmcg; 1 mL
250 X = 200000
X mcg mL = =
200000
250
800 /
Step 2: Convert lbs to Kg
176/2.2 = 80kg
Step 3: Calculate Drip rate
X =
Kg ordered Dose gtt set
concentration of drip
X gtt =

=
80 10 60
800
60 / min
Solutions
A solution given as a percentage always
refers to this concentration
Grams of drug in 100 mL of solution
Therefore:
D5W =
5% Dextrose solution
5 grams of Dextrose for every 100 mL solution
500 mL bag = 25 grams of Dextrose
Solutions (continued)
Example #2
2% Lidocaine
2 grams of Lidocaine in 100 mL solution
2000 mg in 100 mL solution
20 mg/mL
Example #3
20% Lidocaine
20 grams in 100 mL
20000 mg in 100 mL
200 mg.mL