NCM 212 - PHARMACOLOGY
Dosage Calculations 🧑‍⚕️ DESIATA, LYRIZZA
Dosage Calculations
PROPER PREPARATION AND MEDICATION ADMINISTRATION
One of the first general principles in medication
administration that a nurse must adhere to is to personally
prepare any medications properly ordered for a patient and to
personally administer those medications.
Review your prior knowledge about Basic mathematics and
simple abbreviation and the use of single Roman numbers.
It is important to determine the correct dose of a particular
drug for a patient, one should take into consideration the
patient's sex, weight, age and physical condition, as well as the
other drugs that the patient is taking.
It is necessary for practicing nurses to know how to convert
drug orders into available forms of a drug to ensure that the right
patient is getting the right dose of a drug.
Before we will start with Dosage Calculations, let us watch
this short video which shows the 10 Rights in Giving Medications.
This is the integration of what you learned from your Nursing
Process. It is important for us to be reminded of our Nursing
Responsibilities in giving drugs to prevent Medication Error to
happen that may cause the lives of our patient.
MEDICATION ADMINISTRATION THE 10 RIGHTS
The process of medication administration is an
extremely important part of nursing education. Unfortunately
errors do occur during medication administration.
“Nurses who administer medications are responsible for their own
actions”
Before administering medications the nurse must assess
the patient’s:
● Blood Pressure and Pulse Rate.
● Are they nauseated?
● Do they have a fever?
● Are they having difficulty swallowing foods or liquids?
● Are they in any pain?
THE TEN (10) RIGHTS IN GIVING MEDICATIONS
1. The Right Medication
2. The Right Dose
3. The Right Time
4. The Right Route
5. The Right Patient
6. The Right Patient Education
7. The Right Documentation
8. The Right to Refuse
9. The Right Assessment
10. The Right Evaluation
1. The Right Medication
● It is important to check your medication with your MAR
(Medical Administration Record) to make sure it’s the right
medication and remember to always check the expiration
date.
2. The Right Dose
● It is always important to make sure this medication is the
right dose for your patient. Take the time to look at any
medications you’re not sure of.
3.. The Right Time
● Medications are considered on time 30 minutes before or
after the ordered time.
4. The Right Route
● Always check to see how your medication is to be
administered. Is it to be given orally or in the IV or by
injection?
5. The Right Patient
● Identifying your patient is vital to safe medication
administration.
6. The Right Patient Education
● Patients need to know what their medications are and what
effect they can expect after taking these medications.
7. The Right Documentation
● You should write your initials in your MAR (Medical
Administration Record) only after you have given the
patient their medication. If a medication is being held, you
must document why the medication is being held and notify
the physician if necessary.
8. The Right to Refuse
● Patients have a right to refuse but the nurse needs to
explain the problems the patient might encounter by not
taking the medication. If the patient still does not want to
take the medication, then proper documentation and
physician notification is necessary.
9. The Right Assessment
● It is important to always check pulse rates, blood pressures,
and review administration parameters prior to giving the
patient his/her medications.
10.The Right Evaluation
● After giving medications, you should always evaluate your
patient to see if the medication has been effective.
DOSAGE CALCULATIONS 3 SYSTEMS OF MEASUREMENT
Flow of Discussion Three (3) systems of measurement are used during the
a. Measurement Conversion calculation, preparation, and administration of medicines.
b. Methods of Calculation 1. METRIC SYSTEM OR SI
c. Calculation of Oral Dosages ● It was invented in France in the late 18th century.
d. Calculation of Injectable Dosages ● Most widely used system of measure.
e. Pediatric Dosage ● Based on the decimal system, all units are determined as
I. Clark’s Rule multiples of 10.
II. Body Surface Area (BSA) ○ Gram as basic unit of solid (weight)
III. Dosage based on weight ○ Liter as basic unit of liquid volume; and
f. Intravenous Fluids Calculation ○ Meter as basic unit of length
● Metric unit most frequently used
PREVENTION OF MEDICATION ERRORS ○ 1g = 1000mg
Medication errors fall into several categories, such as ○ 1kg = 1000g
omitting the dose, administering the wrong dose, administering ○ 1L = 1000mL
an extra dose, administering an unprescribed drug, ○ 1mg = 1000mcg
administering by the wrong route, and administering at the 2. HOUSEHOLD SYSTEM
wrong time. ● Measuring system that is found in recipe books
The errors that occur when the drug prescription is ● Primarily used by patients who take medication at home,
misinterpreted. Often, the way the amounts are expressed in the however they are at least accurate
original prescription for weights, volumes, and units can cause ○ Teaspoon as basic unit of fluid measure;
interpretational errors ○ Pound as basic unit of solid measure;
● Common Household Equivalents
❖ In General, the following rules should be followed in ○ 1 quart = 4 cups
transcribing prescriptions: ○ 1 pint = 2 cups
1. Never leave a decimal point naked. Always place a zero ○ 1 med size glass = 8 ounces
before a decimal expression less than one. ○ 1 teacup = 6 ounces
a. Example: 0.2, 0.5 ○ 1 tablespoon = 3 teaspoons
2. Never place a decimal point and zero after a whole ○ 1 teaspoon = approximately 5ml
number, because the decimal may not be seen and result 3. APOTHECARY SYSTEM
in a 10-fold overdose ● Originated in Greece, but eventually it made its’ way to
a. Example: 0.2mg read as 20mg by mistake. The correct England where it was used during the late 1600s
way is to write 2mg ● It is an ancient system, means “pharmacist” or druggist
3. Avoid using decimals whenever whole numbers can be ● Very old system of measure
used as alternatives. ● Uses Roman numerals to denote amount, ex: 15 grains
a. Example: 0.5g should be expressed as 500mg, and written as “gr xv”
0.4mg should be expressed as 400mcg ○ Minim as basic unit of liquid volume;
4. Whenever possible, use the metric system rather than grains ○ Grain as basic unit of solid measure;
5. Consult the facility procedure manual for abbreviations ○ Eg: grains — 1 / 150
banned in that facility
6. Always spell out the word units. The abbreviation “U” for unit
can be mistaken for a zero
a. Example: 10 U interpreted as 100 units. The better way is
to write out 10 units.
7. Avoid drug-drug interactions by assessing client’s current
medication prescriptions and medication, OTC, and herbal
history.
 CALCULATING MEDICATION DOSAGE VALUES OF SINGLE ROMAN NUMBERS

INTERPRETING DRUG PRESCRIPTIONS

ROMAN NUMERALS VALUE
❖ EXAMPLE 1:
Caps. Diphenhydramine (Benadryl) 25mg q4h po I or i 1
INTERPRETATION:
“Give the client one 25mg capsule by mouth every 4 hours.” V or v 5

❖ EXAMPLE 2: X or x 10

Elixir acetaminophen (Elixir Tylenol) 80 mg tid pc and at

L or l 50
bedtime po.
INTERPRETATION: C or c 100
“Give 80mg of elixir acetaminophen by mouth three times a day
after meals and at bedtime.” D or d 500

M or m 1, 000
AMOUNT/DOSAGE

ABBREVIATION LATIN DERIVATION ENGLISH

GENERAL METHODS FOR DRUG CALCULATION
G Gramma Gram 1. Ratio & Proportion
2. Fractional Equation
Gr Granum Grain 3. Basic Formula
4. Body Weight (used for pedia patient)
Gtt Gutta Drop
5. Body Surface Area (used for pedia patient)

Lb Libra Pound
TERMS
mL Milliliter ● Route
○ how the medication is entering the body.
No Numerus Number ■ PO?
■ IV?
Qs Quantum Sufficient
■ Topical?
● Medications
TIMING OF ADMINISTRATION ○ The actual compound that is completing the desired
effect
ABBREVIATION LATIN DERIVATION ENGLISH
● Dose
a Ante Before ○ How much of this medication is being administered?
● Vehicle
ac Ante cibum Before meals ○ The way/size the medication is available

am Ante meridian Before noon

bid Bis in die Twice a Day

h Hora Hour

p Post After

pc Post cibum After meals

pm Post meridian After noon

Prn Pro re nata Whenever

necessary

q Quaque Every

qid Quarter in die 4 Times a Day

tid Ter in die 3 times a day

RATIO AND PROPORTION FRACTION
● Ration ● Sometimes, the desired dose will be a fraction of a tablet or
○ The relationship of two quantities capsule, like ½ or ¼
○ It may be expressed in the form “1:10” or “1:2, 500” ● Some tablets come with score markings that allow them to
○ It may be expressed as a fraction “1/10” or be cut
“1/ 2,500” ● Pill cutters are readily available in most pharmacies to help
● Proportion patients cut tablets appropriately
○ Formed by using two ratios that are equal
EXAMPLE 1
An order is written for 10 grains of aspirin (gr x,
CALCULATING MEDICATION DOSAGE: BASIC FORMULA
aspirin). The tablets that are available each contain 5 CALCULATING DOSAGE: BASIC FORMULA
grains. How many tablets should be given? What will be ORAL DRUGS
your answer? ○ Frequently, tablets or capsules
First, set up the equation: ○ For solid and liquid preparation
5 𝑔𝑟 10 𝑔𝑟 FORMULA:
1 𝑡𝑎𝑏𝑙𝑒𝑡
= 𝑥 𝐷(𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒)
Cross multiply the ratio: 𝐻 (𝑎𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑑𝑟𝑢𝑔 𝑜𝑛 ℎ𝑎𝑛𝑑)
× 𝑉𝑒ℎ𝑖𝑐𝑙𝑒 = 𝐴𝑚𝑜𝑢𝑛𝑡 𝑡𝑜 𝑔𝑖𝑣𝑒
or
5(𝑔𝑟)𝑥 = 10(𝑔𝑟)(𝑡𝑎𝑏𝑙𝑒𝑡)
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑒
Rearrange and cancel the units and numbers: 𝑠𝑡𝑜𝑐𝑘 𝑜𝑛 ℎ𝑎𝑛𝑑
× 𝑉𝑒ℎ𝑖𝑐𝑙𝑒 = 𝐴𝑚𝑜𝑢𝑛𝑡 𝑡𝑜 𝑔𝑖𝑣𝑒
10 (𝑔𝑟)(𝑡𝑎𝑏𝑙𝑒𝑡)
𝑥 = For solid:
5(𝑔𝑟)
➔ A health care provider orders that a patient receive 1g of
𝑥 = 2 𝑡𝑎𝑏𝑙𝑒𝑡𝑠 ampicillin. The ampicillin bottle states that each tablet in
the bottle contains 0.5g. Solution
EXAMPLE 2 𝐷 1.0𝑔
𝑆
= 0.5𝑔
= 2 𝑡𝑎𝑏𝑙𝑒𝑡𝑠
An order is written for 0.05g Aldactone to be
given orally (PO). The Aldactone is available in 25mg If the dosage on hand and dosage ordered are both in
tablets. How many tablets would you have to give? the same system of measurement, but they are not in
First, you will need to convert the grams to milligrams: the same unit of weight within the system, the units of
1𝑔 0.05𝑔 weight must first be converted.
1000𝑚𝑔
= 𝑥 ➔ The health care provider orders 1000 milligrams (metric) of
Cross multiply the ratio: ampicillin. On hand is 0.25g (metric) per tablet
𝐷𝑜𝑠𝑒 𝑑𝑒𝑠𝑖𝑟𝑒𝑑 1000𝑚𝑔
1(𝑔)𝑥 = (0. 05 × 1000(𝑔)(𝑚𝑔) 𝐷𝑜𝑠𝑒 𝑜𝑛 ℎ𝑎𝑛𝑑
= 250𝑚𝑔
= 4 𝑡𝑎𝑏𝑙𝑒𝑡𝑠
Simplify:
For liquid:
50 (𝑔)(𝑚𝑔)
𝑥 = ➔ The order is for Potassium Chloride (KCI)20
1(𝑔)
mEq[milliequivalent]. The bottle is labeled KCI elixir 10
𝑥 = 50 𝑚𝑔 mEq/mL. How many mL will be given?
The order has been converted to the same
= 2 mL
𝐷𝑜𝑠𝑒 𝑑𝑒𝑠𝑖𝑟𝑒𝑑 20𝑚𝐸𝑞
𝐷𝑜𝑠𝑒 𝑜𝑛 ℎ𝑎𝑛𝑑
= 10 𝑚𝐸𝑞/𝑚𝐿
measurement as the available tablets. Now, solve for
the number of tablets that you will need, letting X be For capsule:
the desired dose. ➔ The order reads: Phenytoin sodium capsules (Dilantin) gr. v
25 (𝑚𝑔) 50 (𝑚𝑔) orally. Available is a bottle labeled Dilantin 100 mg per
1(𝑡𝑎𝑏𝑙𝑒𝑡)
= 𝑥 capsule. How many capsules will be given? 1 gr. = 60mg

= 3 caps
𝐷𝑜𝑠𝑒 𝑑𝑒𝑠𝑖𝑟𝑒𝑑 300𝑚𝑔
25 (𝑚𝑔) 𝑥 = (50 × 1)(𝑚𝑔)(𝑡𝑎𝑏𝑙𝑒𝑡) 𝐷𝑜𝑠𝑒 𝑜𝑛 ℎ𝑎𝑛𝑑
= 100𝑚𝑔
50 (𝑚𝑔)(𝑡𝑎𝑏𝑙𝑒𝑡)
𝑥 = For parenteral:
25(𝑚𝑔)
➔ The order reads: Furosemide (Lasix) 35mg IV. The vial is
𝑥 = 2 𝑡𝑎𝑏𝑙𝑒𝑡𝑠 labeled 40mg = 4mL. How many mL should be given?
40 𝑚𝑔 35 (𝑚𝑔)
4𝑚𝐿
= 𝑥

40 (𝑚𝑔) 𝑥 = (35𝑚𝑔)( 4𝑚𝑙)

(35𝑚𝑔)(4𝑚𝐿)
𝑥 = 40(𝑚𝑔)

𝑥 = 3.5mL
PROBLEM:
An order has been written for 75mg meperidine to be
PEDIATRIC DOSAGE CALCULATIONS
given intramuscularly (IM). The vial states that it contains PEDIATRIC CONSIDERATIONS
meperidine, 1.0mL = 50.0mg. How much should the nurse ● A child’s body may handle a drug differently in all
administer? areas of pharmacokinetics - absorption, distribution,
50.0 𝑚𝑔 75 (𝑚𝑔) metabolism and excretion.
=
1.0𝑚𝐿 𝑥 ● The responses of the child’s organs to the effects of the

50. 0 (𝑚𝑔) 𝑥 = (75𝑚𝑔)(1. 0𝑚𝑙) drug also may vary because of the immaturity of the
organs.
(75𝑚𝑔)(1.0𝑚𝐿)
𝑥 = 050.0(𝑚𝑔) METHODS OF PEDIATRIC DOS
a. Clark’s rule
𝑥 = 1.5mL
b. Body Surface Area (BSA)
c. Dosage based on weight
For parenteral:
(Some medications such as heparin and penicillin are ordered in
CLARK’S RULE
units)
● Uses the child’s weight to calculate the appropriate
➔ An order has been written for penicillin 750,000 units. The vial
dose and assumes that the adult dose is based on a
reads 300,000 units/2mL. How many mL will be given?
150lb person.
● Uses weight in Lbs (pounds), NEVER in Kg (kilograms)
300,000 𝑢𝑛𝑖𝑡𝑠 750,000 𝑢𝑛𝑖𝑡𝑠
= FORMULA:
2𝑚𝐿 𝑥
𝐶ℎ𝑖𝑙𝑑'𝑠 𝑊𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝐿𝑏𝑠) × 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 =
(300, 000 𝑢𝑛𝑖𝑡𝑠) (𝑥) = (750, 000 𝑢𝑛𝑖𝑡𝑠)(2𝑚𝐿) 150 𝐿𝑏𝑠

(750,000𝑢𝑛𝑖𝑡𝑠)(2𝑚𝐿) Problem:
𝑥 = (300,000 𝑢𝑛𝑖𝑡𝑠) The usual adult dose of Benadryl is 50mg. What would
be the safe dose for a child weighing 27lbs.
𝑥 = 5mL 27𝐿𝑏𝑠 × 50𝑚𝑔
➔ The order is penicillin 50,000 units. The vial reads penicillin
𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 150 𝐿𝑏𝑠
500,000 units. Add 4.3mL to yield 5mL. 1, 350 𝑚𝑔
𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 150 𝐿𝑏𝑠
500,000 𝑢𝑛𝑖𝑡𝑠 50,000 𝑢𝑛𝑖𝑡𝑠
5𝑚𝐿
= 𝑥 𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 9𝑚𝑔
(500, 000 𝑢𝑛𝑖𝑡𝑠) (𝑥) = (50, 000 𝑢𝑛𝑖𝑡𝑠)(5𝑚𝐿)
(50,000𝑚𝑔)(5𝑚𝐿)
𝑥 = (500,000 𝑢𝑛𝑖𝑡𝑠) BODY SURFACE AREA (BSA)
The most accurate method for calculating pediatric
𝑥 = 0.5mL ●
dosages.
FORMULA:
𝐵𝑆𝐴 (𝑚2) × 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 1.73 𝑚2
Problem:
The adult dose is 100mg/mL. Demerol. The child weighs
20kg and is 40 inches tall. BSA is 0.77m2.
0.77𝑚2 × 100 𝑚𝑔/𝑚𝐿
𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 1.73 𝑚2
77 𝑚𝑔/𝑚𝐿
𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 1.73

𝐶ℎ𝑖𝑙𝑑'𝑠 𝐷𝑜𝑠𝑒 = 44. 5 𝑚𝑔/𝑚𝐿

DOSAGE BASED ON WEIGHT The manufacturer of the macrodrip administration set has
● Most medications for pediatric clients are done by standardized the drops per milliliter called the drop factor (DF)
child’s weight in order to more accurately dose for a specific brand of administration set as follows:
Problem: A specific brand of administration set as follows:
A 1.5 year old child is prescribed an amoxicillin
COMPANY NAME DROP FACTOR (gtt/mL)
suspension. The dose prescribed is 40mg/kg/day divide into
equal BID doses. The suspension is available in a 400mg/5ml Abbott 15
suspension. What is the dose in mL? The child weighs 22 pounds
4 STEPS TO FOLLOW Baxter International 10
1. Convert pounds (lbs) to kilograms (kg).
22𝐿𝑏𝑠 B. Braun 15
2.2 𝐿𝑏𝑠
= 10𝑘𝑔
2. Calculate the dose in mg (milligrams). IVAC 20
10𝑘𝑔 × 40𝑚𝑔/𝑘𝑔/𝑑𝑎𝑦 = 400 𝑚𝑔/𝑑𝑎𝑦 CALCULATION OF FLOW RATES
3. Divide the overall dose by the frequency (BID, TID, etc.) a. Milliliters per Hour (mL/hr)
400 𝑚𝑔/𝑑𝑎𝑦
2 (𝑏𝑖𝑑)
= 200𝑚𝑔/𝑑𝑜𝑠𝑒
4. Calculate the dose in ml (milliliters) or tablets (follow the
same formula with adults) b. Milliliters per Min (mL/min)
𝐷 200𝑚𝑔
𝑆
× 𝑉 − 400𝑚𝑔
× 5𝑚𝐿
= 0. 5 × 5 𝑚𝐿 = 2. 5𝑚𝐿
Problem
➔ Infuse 1000mL Lactated Ringer’s (LR) solution over 10
hours

INTRAVENOUS FLUIDS CALCULATIONS CALCULATE THE FOLLOWING PROBLEMS

Intravenous (IV) solutions (fluids) consist of a liquid
HEALTHCARE PROVIDERS DURATION
(solvent) containing one or more dissolved substances (solutes).
ORDER OF
(Rate (mL/hr) INFUSION
ADMINISTRATION SET
● It is used to deliver a specified volume of solution that is 1000 mL 5% dextrose in water
= 83mL/hr
1000 𝑚𝐿
different, depending on the company manufacturing 12 hrs 12 ℎ𝑟𝑠

the set.
1000 mL Lactated Ringer’s
= 166.6 mL/hr
1000 𝑚𝐿
MICRODROP
6 hrs 6 ℎ𝑟𝑠
● A chamber that delivers large drops
● Adult giving sets and drip chambers are calibrated 500 mL 0.9 sodium chloride
= 125 mL/hr
500 𝑚𝐿
such that 20 drops of fluid = 1mL. 4 hrs 4 ℎ𝑟𝑠
DOSAGE CALCULATION FOR IV MEDS
1. Macrodrop
CALCULATING RATES OF INFUSION FOR OTHER THAN 1 HOUR
● More commonly used in adult IVF.
● In order to calculate the flow rate, need to
know the drop factor: 10, 15, or 20 gtt/mL.
Compute:
2. Microdrop
1. 50mL 0.9 NaCl with ampicillin 1g for 20 mins
● More commonly used for children, elderly or
50 𝑚𝐿 × 60 𝑚𝑖𝑛/ℎ𝑟
critically ill where exact control is required 𝑚𝐿/ℎ𝑟 = 20 𝑚𝑖𝑛𝑠
● Drop factor is always 60 gtt/mL.
𝑚𝐿/ℎ𝑟 = 150
2. 150mL D5W with gentamicin 80mg to run for 30 mins
150 𝑚𝐿 × 60 𝑚𝑖𝑛/ℎ𝑟
𝑚𝐿/ℎ𝑟 = 30 𝑚𝑖𝑛𝑠

𝑚𝐿/ℎ𝑟 = 300
DROPS PER MINUTE (gtt/min) PROBLEM
Doctor’s order: Infuse 1200mL of 0.45% Normal Saline at
125mL/hr to run 8 hours. Drop factor: 12 gtts/mL. How many
gtts/mL will you regulate the IV?
Directions:
Formula
- Use a drop factor of 15 gtt/mL for volumes of 100mL or
gtt/min = ml/hr * gtt/ml / 60 min.
more per hour
Here:
- Use a microdrip (60gtt/mL) for volumes below 100/hr
ml/hr = 125 ml.
CALCULATE THE FOLLOWING PROBLEMS
Drop factor = 12 gtt/ml.
HEALTHCARE DURATION As per above formula
PROVIDERS OF gtt/min gtt/min = 125 * 12 / 60
ORDER INFUSION
= 1500 / 60
(Rate (mL/hr)
= 25 gtt/ml.
125 mL D5S 125𝑚𝐿 × 15𝑔𝑡𝑡/𝑚𝐿
= 31gtt/min
60 min 60𝑚𝑖𝑛

100 mL LR 100𝑚𝐿 × 15𝑔𝑡𝑡/𝑚𝐿

= 25 gtt/min
60 min 60 𝑚𝑖𝑛

50 mL 0.9 NaCl 50 𝑚𝐿 × 60𝑔𝑡𝑡/𝑚𝐿

= 150 gtt/min
20 min 20 𝑚𝑖𝑛

Example
The order is for 1000 mL NS over 8 hours; drop factor is
10 gtt/mL
1000 × 10𝑔𝑡𝑡/𝑚𝐿
480 𝑚𝑖𝑛
20.8 OR 21gtt/min

The same formula can be used for IV’s requiring microdrip

rates or the following formula can be used:
● mL / hr = microdrops / min
● Microdrop – 60 micro gtts/ml
● Hour is 60 mins
Example:
Order is for 1000 mL D5NS over 24 hours. Drop factor is 60
gtt/ml.

1000𝑚𝑙 × 60𝑔𝑡𝑡/𝑚𝐿
1440 𝑚𝑖𝑛
41.66 OR 42gtts/min