Chapter 4 Conversions and Calculations Used by Pharmacy Technicians

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1

Introduction
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The ability to manipulate conversions is a required competency of pharmacy technicians It is a foundation for filling orders and calculating dosages in the pharmacy All transcribing calculations need to be checked by a pharmacist

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2

Introduction (Continued)
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Pharmacy measurements come from different regions of the world The four most common types of calculation systems are: 
Metric

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system 

Household

measurements  Apothecary system 
Avoirdupois

system

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3

Introduction (Continued)
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A good way to become familiar with common pharmacy measurements is to start with what you know and then slowly build on that knowledge The pharmacy technician must translate the doctor¶s orders into lay terms You must make the instructions easy enough for a child to understand

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4

Objectives
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Describe the differences among the following measurement systems: 
Apothecary

system  Avoirdupois system  Metric system  Common household measurements

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5

Objectives (Continued)
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Convert Arabic numbers into Roman numerals. Demonstrate the ability to convert among the following measurement systems commonly used on prescriptions:
system  Apothecary system  Household system 
Metric
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Objectives (Continued)
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Use mathematical calculations to determine dosage: dosage: 
Ratios/proportions  Fractions  Percentages

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7

Objectives (Continued)
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Demonstrate the ability to set up equations and solve problems for the following: 
Determining

day¶s supply  Pediatric dosages  Drip rates  Alligation  Percent dosages
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Metric System
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Used throughout pharmacy because of its accuracy Metric units include: 
Milliliters,

cubic centimeters, and liters for

volume  Kilograms, grams, milligrams, and micrograms for weight  Millimeters and meters for distance
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Metric System (Continued)
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There is a 1000-unit difference between 1000each measurement Most Common Metric Measurements kg______g________mg________mcg kg______g________mg________mcg 1000x 1000x 1000x

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10

Metric System (Continued)
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The use of millimeters is reserved for drug calculations based on body surface areas Knowing the basics for volume and weight conversions is adequate

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11

Household Measurements
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The most common measurement system still used in the United States is the household system Measurements come in a variety of units Volume refers to liquids Weight refers to dry ingredients Length refers to distance Most common measurement is the teaspoon

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12

Common Household Measurements
Household Measurements (Volume) 1 teaspoon 1 tablespoon 1 cup 1 pint 1 quart 1 gallon Metric (Volume) 5 ml or cc* 15 ml or cc 240 ml or cc 480 ml or cc 960 ml or cc 3840 ml or cc or 3.84 L Household 1 teaspoon 3 teaspoons 8 ounces 2 cups 4 cups 16 cups

*Remember that 1 ml and 1 cc contain the same amount of liquid.

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13

Apothecary System
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Originated in Europe Units used in this system are grains and scruples for dry weight Drams and minims for liquids More common measurements include ounces and pounds

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14

Apothecary Weights
Dry Weight 1 grain 15 grains 20 grains 1 dram 1 ounce = 60 mg = = = = = = = = = = = = 1 gram 1 3 8 or 24 gr 480 31.1 grams 16 ounces 96 288 gr 5760 454 grams Fluid Weight 1 dram 8 drams 3 scruples* = 60 = 480 =1

1 pound

*Scruples and minims are not commonly used units
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Conversion Table: Apothecary/Metric/Household
Apothecary Volume 1 4 2 1 ½ Apothecary Weight 1 4 2 gr 60 gr 30 Metric Volume 30 ml 15 ml 7.5 ml 4 ml 2 ml Metric Weight 30 g 15 g 7.5 g 4g 2g Common Household 2 tbsp 1 tbsp ½ tbsp 1 tsp ½ tsp

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16

Avoirdupois System
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Originated in England Similar to the apothecary system because it also uses grains, ounces, and pounds for weight For avoirdupois and metric equivalents, refer to Table 4-3 4-

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17

Important Differences Among Systems
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The metric system is used for compounding drugs There are differences among manufacturer¶s products and their weights Conversions with these variances are approximate A pint can be 473 ml, 480 ml, or 500 ml 1 pound = 454 g in metric, but only 373 g in the apothecary system
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Writing Units Using Each System
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All four systems will be used in writing prescriptions, but pharmacies primarily use the metric system Regardless of what system is used in a prescription, it must be converted to the household system

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19

Writing Units Using Each System (Continued)
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Metric measurements
cc and ml can be used interchangeably  Dry weights use mcg, mg, g, and kg  Liquid volumes use ml and L 

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20

Writing Units Using Each System (Continued)
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Apothecary measurements
Dry weights use pounds, ounces, drams, scruples, and grains  Liquid volume weights use gallons, pints, fluid ounces, fluid drams, and minims 

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21

Writing Units Using Each System (Continued)
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Avoirdupois measurements 
Dry

weights using pounds, ounces, and grains

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22

Conversions
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Metric system slide 
When

converting metric measurements from one unit to another you need to move the decimal either to the right or to the left changes of the metric system involve either dividing or multiplying by tens unit is a multiple of 1000 

All 

Each

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23

Conversions (Continued)
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By moving the decimal three spaces (to the right or left), you can change between these units Remember the difference between 1 kg, 1 g, 1 mg, and 1 mcg is 1000

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24

Conversions (Continued)
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Method A for determining metric conversions

Left Right Largest Smallest 1________1_______1_________1_______ ________1_______1_________1 1000 kg 1000 g 1000 mg mcg
1 kg
mcg

1000 g

1,000,000 mg

1,000,000,000

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25

Conversions (Continued)
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Decimals are not placed at the end of a number unless there is a fraction, such as 1.1 kg Decimals and periods have been the main source of mistakes in pharmacies

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26

Conversions (Continued)
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Method B: Large number to small number 
Don¶t

divide² divide²multiply  When converting from large to small, you multiply  When converting from small to large, you divide

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27

Conversions (Continued)
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Fractions 
There

is a two-step process for converting twofractions into percentages  Percentage is always a portion of 100  To convert a decimal into a percentage you simply multiply by 100

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28

Conversions (Continued)
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Percentages
Represent a portion of a whole (100)  Used in compounding  Used to calculate markup on prices, payment discounts, net profits, gross profits 

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29

Conversions (Continued)
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Ratio/proportion or formula method
Ratios can be considered as parts or fractions  A concentration of 1:1000 means there is 1 part to 1000 parts or 1 g of drug in 1000 ml of solution 

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30

Conversions (Continued)
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90% of the orders you will encounter in the pharmacy will be ratio/proportion equations This is three-step process: three Filter  Find  Set

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out the unnecessary information

what strength you have in stock and what strength you need up an equation and double-check the doublecalculations
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Conversions (Continued)
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Two methods: 


Method A: (have = need or ratio/proportion) Method B: D / H x Q = Medication to give D = desired dose H = have in stock Q = quantity needed

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See Examples 4-2 to 4-6 44Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32

Pediatric Dosing
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When the strength of the medication needed cannot be measured with a teaspoon or is an odd amount, droppers must be used The pharmacist, not the technician, should show the parent of the patient how to measure the correct amount

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33

Common Liquid Measuring Devices

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34

Determining Weight
Because all manufacturers provide proper dosing regimens based on kilograms, it is necessary to convert pounds into kilograms z There are 2.2 pounds per kilogram z 16 ounces = 1 lb 2.2 pounds = 1 kg z To determine how many kg in 1 lb, divide z To determine how many lbs in 1 kg, multiply
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Drip Rates
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Hospital pharmacy technicians deliver a 24-hour supply of IV solutions to 24nursing units daily Most IV piggybacks are smaller IV solutions that are given over 30 to 60 minutes Large volume medications need to be given at a slow rate because the veins can only handle a small volume
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Drip Rates (Continued)
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For large volume drips, pharmacy technicians must be able to calculate the volume needed to last over a certain amount of time, or they might need to calculate how much longer a currently hanging IV solution will last

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37

Intravenous (IV) Drip System
Slide clamp 100 ml VolumeVolumecontrol chamber Microdrip chamber Roller clamp

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38

Drip Rates (Continued)
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Calculations involve the following: 
The

right amount of drug that is to be given over time  The amount of time left until an IV runs out  The amount of drug needed to last a certain amount of time

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39

Drip Rates (Continued)
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Basic conversions are as follows: 
Time:

1 hour = 60 minutes, 24 hours = 1 day  Volume: 5 mL = 60 gtt

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40

Drip Rates (Continued)
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Steps involved in determining drops per minute: 
What  What  What  What

is the drop factor? will be the milliliters per hour? will be the milliliters per minute? will be the drops per minute?

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See Examples 4-12 to 4-14 44-

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41

Alligation
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Alligation is used when you need to prepare (compound) percent strength that you do not have in stock

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42

Roman Numerals
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The number system commonly used in the United States is the Arabic system, consisting of numbers 1, 2, 3, and so forth Many physicians use Roman numerals to indicate the quantity of tablets or capsules to be filled or to order the strength of medication

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43

Roman Numerals (Continued)
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When working with Roman numerals, remember that if a larger number is placed in front of a smaller one, you must add both to determine the value However, if a smaller number is placed before a larger number, then you must subtract

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44

International Time
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In hospital settings, international time, also known as military time, is used exclusively Orders are written 24 hours a day and all medicalmedical-related caretakers must understand exactly when the order was written and when the medication or treatment is to take place

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45

International Time (Continued)
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The system is based on 100 Starting with the first hour of the day, the clock begins at 0100 (1 AM) through 2400 or 12 midnight By using this system there is never any question as to when an order was written or which order supersedes another

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46

Military Time Clock

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47

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