Brush up on Your Drug Calculation Skills

Many nurses are weak with drug calculations of all sorts. This article will help to review the major concepts related to drug calculations, help walk you through a few exercises, and provide a few exercises you can perform on your own to check your skills. There are many reference books available to review basic math skills, if you find that you have difficulty with even the basic conversion exercises.

Means Extremes III. IV. V. Left side are known quantities Right side is desired dose and amount to give Multiply the means and the extremes HX = DV X= DV H

Common Conversions: 1 Liter = 1000 Milliliters 1 Gram = 1000 Milligrams 1 Milligram = 1000 Micrograms 1 Kilogram = 2.2 pounds

Example: Order-Keflex 1 gm p.o. BID Drug available-Keflex 250 mg per capsule VIII. IX. X. D=1 gm (note: need to convert to milligrams) 1 gm = 1000 mg H=250 mg V=1 capsule 250 : XI. 1 :: 1000 : X

Methods of Calculation Any of the following three methods can be used to perform drug calculations. Please review all three methods and select the one that works for you. It is important to practice the method that you prefer to become proficient in calculating drug dosages. Remember: Before doing the calculation, convert units of measurement to one system. I. Basic Formula: Frequently used to calculate drug dosages. XIII. D (Desired dose) H (Dose on hand) V (Vehicle-tablet or liquid) D x V = Amount to Give H D = dose ordered or desired dose H = dose on container label or dose on hand V = form and amount in which drug comes (tablet, capsule, liquid) Example: Order-Dilantin 50 mg p.o. TID Drug available-Dilantin 125 mg/5ml D=50 mg H=125 mg V=5 ml

250X = 1000 1000 250

X=

XII. Fractional Equation

X = 4 capsules

H D = V X XIV. Cross multiply and solve for X. H D = V X HX = DV X= DV H

50 250 x5= = 2 ml 125 125 II. Ratio & Proportion: Oldest method used in calculating dosage. Known H : V :: Desired D : X

Example: Order - Digoxin 0.25 mg p.o. QD Drug Available - 0.125 mg per tablet D=0.25 mg H=0.125 mg 0.125 0.25 = 1 X XX. 0.125X = 0.25 V=1 tablet

mcg/min (For example .X= 0.000 = = 2.Lidocaine.) To calculate cc/hr (gtts/min) Solution cc x 60 min/hr x kg x mcg/kg/min = cc/hr Drug mcg Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min.Nitroglycerin) Solution cc x 60 min/hr x mcg/min = cc/hr Drug mcg Drug mcg x cc/hr = mcg/hr Solution cc x 60 min/hr Rule of Thumb NTG 100 mg/250 cc amount of fluid x drops/milliliter (IV set) hours to administer x minutes/hour (60) Example: 1000 ml over 8 hrs IV set = 15 gtts/ml Two Step 1000 = 125 8 1 cc/hr = 6.5 mcg/kg/min 250 cc x 60 min x 65 kg 975. mcg/kg/min (For example . X = 2 tablets Intravenous Flow Rate Calculation (two methods) Two Step Step 1 .25 0. How to Calculate Continuous Infusions mg/min (For example .6 mcg/min NTG 50 mg/250 cc 1 cc/hr = 3.000 = = 31. How to calculate mcg/kg/min if you know the rate of the infusion . Pronestyl) Solution cc x 60 min/hr x mg/min = cc/hr Drug mg Drug mg x cc/hr = mg/hr Solution cc x 60 min/hr Rule of Thumb Lidocaine. 1.Amount of fluid divided by hours to administer = ml/hr ml/hr x gtts/ml(IV set) Step 2 = gtts/min 60 min One Step D.125 3 mg = 22 cc/hr 4 mg = 30 cc/hr XXII.500. Nipride. How many mcg/kg/min of Nipride is the patient receiving? 100.3 mcg/min Step 1 Step 2 - G.Dopamine. Pronestyl 2 gms/250 cc D5W 1 mg = 7 cc/hr 2 mg = 15 cc/hr 4. etc.4 x 5 mcg/kg/min = 16.2 cc/hr 400. XXI.000 mcg 125 x 15 = 31.000 A. The patient¶s weight is 143 lbs. Patient¶s weight is 190 lbs. To calculate mcg/kg/min Drug mcg/ x cc/hr = mcg/kg/min Solution cc x 60 min/hr x kg Example: Nipride 100 mg/250 cc D5W was ordered to decrease your patient¶s blood pressure. and the IV pump is set at 25 cc/hr. 250 cc x 60 min x 86.000 mcg x 25 cc/hr 2.25 (31 gtts/min) 60 One Step 1000 x 15 15. A.25 (31gtts/min) 8 hrs x 60 480 XXIII. Dobutamine.

6 mcg/cc/min 3. Order-Lidocaine 1 mg per kg Patient¶s weight is 152 pounds 8. 2. Order-Phenobarbital 60 mg Drug available-Phenobarbital 15 mg per tablet 4.54 mcg/kg/min Patients¶s weight in kg (75 kg) 400mg of Dopamine in 250 cc D5W = = 26. C. you can do anything! NOW DO THE REST! If you have a 75 kg patient for example. For example: 1600 mcg/cc 60 min/hr N. 2800 milliliters to liters 7.. Order-Dexamethasone 1 mg Drug available-Dexamethasone 0. 1. For example: M.Dosage (in mcg/cc/min) x rate on pump = mcg/kg/min Patient¶s weight in kg B. 26. 26.5 grams to milligrams 3. 400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min x 10 cc on pump = 3. 10 milligrams to micrograms 4. F. Order. The drug is ordered every 6 hours. O. Once you do this step. How many milligrams will be given for each dose? Practice Problems: IV set 15 gtts/ml IV set 10 gtts/ml IV set 15 gtts/ml D.6 mcg/cc/min C. You need this to calculate this dosage concentration first for all drug calculations. 165 pounds to kilograms 8.6 mcg/cc/min x 10 cc on pump = 3. How to calculate drips in cc per hour when you know the mcg/kg/min that is ordered or desired mcg/kg/min x patient¶s weight in kg = rate on pump dosage concentration in mcg/cc/min G..5 mg per 5 ml 6. Order-Dicloxacillin 125 mg Drug Available-Dicloxacillin 62.6 mcg/cc/min = 10 cc rounded up I. Practice Problems: D.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid. 7500 micrograms to milligrams 6. Once you do this step. 3. Practice Problems: 1. 7. Order-Ampicillin 0. .5 liters to milliliters 2. ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE CHECK YOUR MATH! For example: 10 cc x 26. Order-Tagamet 0. Order-Medrol 75 mg IM Drug Available-Medrol 125 mg per 2 ml 7. E. Order-1000 ml over 6 hrs Order-500 ml over 4 hrs Order-100 ml over 20 min. You need this to calculate this dosage concentration first for all drug calculations.54 mcg/kg/min Patients¶s weight in kg (75 kg) = 3.5 mcg/kg/min (rounded down) B.5 mg per tablet 2. 2.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid.6 mcg/cc/min = 3.5 gm Drug available-Ampicillin 250 mg per 5 ml 5.5 mcg/kg/min x 75 kg = 9. J. 80 kilograms to pounds Practice Problems: Use the method you have chosen to calculate the amount to give. 26. For example: 400 mg Dopamine in 250 cc D5W = 26. you can do anything! NOW DO THE REST!! If you have a 75 kg patient for example 26. 1.6 gm Drug available-Tagamet 300 mg per tablet 3. H. 500 milligrams to grams 5. P.86 cc 26.5 mcg/kg/min 75 Kg Dosage (in mcg/cc/min) x rate on pump = mcg/kg/min Patient¶s weight in kg L.6 mcg/cc/min Now do some practice exercises to check what you learned A.520 mg of a medication in a 24 hour period.

or to do a hand calculation for comparison. 0. 7. by plugging the numbers in the computer or monitor with a keypad and getting the exact infusion titration chart specifically for that patient. The use of computers for drug calculations also causes nurses to get ³rusty´ in their abilities to perform drug calculations. 75 kg 8. How many mg/min is your patient receiving? Answers to Practice Problems A.1. This is often because they become focused on the actual drug and the possible consequences of an error in calculation. 6. 10 mL 6. The drug calculations range in complexity from requiring a simple conversion calculation to a more complex calculation for drugs administered by mcg/kg/min. Practice Problems 1.8 (21) 3. 2 tablets 2. The order is to begin the infusion at 20 mcg/min. Many drugs require some type of calculation prior to administration. 6. 10 mL 5. 17 cc/hr 2. 69 kg = 69 mg 8. 75 Practice Problems 1. The patient weighs 165 pounds. 2. A method to help prevent errors with this type of system is to have another nurse double check the data and the chart. C. careful and accurate calculations are important to help prevent medication errors.2 mL 7. 30 cc/hr 6. How many mcg/min is your patient receiving? A procainamide drip is ordered (2gms in 250 cc D5W) to infuse at 4 mg/min. The concentration is 100 mg in 250 cc D5W. Summary Many nurses have difficulty with drug calculations.8 L 7. 3.65 mcg/kg/min 3. How many cc/hour would this be on an infusion pump? A Dopamine drip (400mg in 250 cc of IV fluid) is infusing on your 80 kg patient at 20 cc/hour. the calculation is done exactly the same way. The patient¶s weight is 200 pounds. 20. How many mcg/kg/min are infusing for this patient? A Nitroglycerin drip is ordered for your patient to control his chest pain. The nurses then titrate the drugs or administer the drugs based on an incorrect chart. 4 tablets 4. Regardless of the drug to be administered. D. Many facilities use monitors to calculate the infusion rates. 130 mg for 4 doses Practice Problems 1.5 gm 5. to maintain her/his math skills. 186. Mostly because they don¶t enjoy or understand math. 2 tablets 3. Many nurses become overwhelmed when performing the drug calculations. Many errors take place because erroneous data is first entered and not identified. 1. If you use this method for beginning your infusions and titrating the infusion rates. The Lidocaine concentration is 2 grams in 250 cc of D5W. 2500 mL 2. Dopamine 400 mg in 250 cc D5W to infuse at 5 mcg/kg/min. 5. The best way to prevent this is to remember that the drug calculations are performed the same way regardless of what the drug is.000 mcg 4.5 mg 6. It is suggested that the nurse perform the hand calculations from time to time.5 mcg/min 5. whether the infusion is a big bag of vitamins or a life threatening vasoactive cardiac drug. Practicing drug calculations will help nurses develop stronger and more confident math skills. 7500 mg 3. . 3 cc 4. For example. 4. 2. Sometimes nurses have difficulty calculating dosages on drugs that are potentially life threatening. Calculate the drip rate in cc/hour for which the infusion pump will be set at. when they require multiple steps or involve life-threatening drugs. 3 mg/min B. A Lidocaine drip is infusion on your 90 kg patient at 22 cc/hour. 176 lbs Practice Problems 1. What is the rate you would begin the infusion on the infusion pump? A Nitroglycerin drip (100mg in 250 cc D5W) is infusing on your patient at 28 cc/hour on the infusion pump. be very careful that you have entered the correct data to obtain the chart. It is always a good idea to have another nurse double check your calculations. The main principle is to remain focused on what you are doing and try to not let outside distractions cause you to make a error in calculations.6 (42) 2. 41. 10.

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