DRUG

ARITHMETICS
 LEARNING OBJECTIVES
 Describe four measuring systems
that can be used in drug therapy.
 Convert between different
measuring systems when given drug
orders and available forms of the
drugs.
NOTE:
 To determine the correct dose of a
particular drug for a patient, the
nurse must consider the patient’s
sex, weight, age, and physical
condition, as well as the other
drugs that the patient is taking.
MEASURING SYSTEMS
1.) Metric System- It is based on the
decimal system, so all units are
determined as multiples of 10.
 Uses the gram as the basic unit of
solid measure and the liter as the
basic unit of liquid measure.
2.) Apothecary System- Uses the

measure and the

 It uses Roman numerals placed after

the unit of measure to denote amount.
For example, 15 grains would be
written “gr xv.”
3.) Household System- found
in recipe books and uses the
teaspoon as the basic unit of
fluid measure and the
4.) Avoirdupois System- another
older system that was very popular
when pharmacists routinely had to
compound medications.
 It is seldom used by prescribers but
may be used for bulk medications
that come directly from the
manufacturer.
5.) Other System- Some drugs are
measured in “units”that reflect
chemical activity or biological
equivalence.
 A “unit” usually reflects the
biological activity of the drug in 1
mL of solution.
 The unit is unique for the drug it measures;
a unit of heparin is not comparable to a unit of
insulin.
 Milliequivalents (mEq) are used to measure
electrolytes (e.g., potassium, sodium, etc).
 The milliequivalent refers to the ionic
activity of the drug in question; the order is
usually written for a number of
milliequivalents instead of a volume of drug.
 International units are
sometimes used to

 These are also unique to each

drug and cannot be converted to
another measuring form.
CONVERSION
BETWEEN
SYSTEMS
EXAMPLE # 1
 Convert 6 fl oz (apothecary
system) to the metric system.
 Given:
1 fl oz = 30 mL
SOLUTION:

1 fl oz 6 fl oz
30 mL X
1 fl oz (X) 6 fl oz (30 mL)

1 fl oz X 180 fl oz (mL)
1 fl oz 1 fl oz
180 mL
EXAMPLE # 2
 Convert 32 gr (apothecary) to its
equivalent in the metric system,
expressing the answer in milligrams.
 Given:
1 gr = 60 mg
SOLUTION:

1 gr 32 gr
60 mg X
1gr (X) =60 mg (32 gr)
1 gr X = 1920 (mg) (gr)
1 gr 1 gr

x= 1920 mg
 DOSAGE
CALCULATIONS
 LEARNING OBJECTIVES
 Calculate the correct dose
of a drug when given
examples of drug orders
and available forms of the
drugs ordered.
ORAL DRUGS
 Frequently, tablets or capsules for oral
administration are not available in the
exact dose that has been ordered.
 The easiest way to determine dose is
to set up a ratio and proportion
equation.
GENERAL FORMULA:
Example # 1
 An order is written for 10 grains
of aspirin (gr x, aspirin). The
tablets that are available each
contain 5 grains. How many
tablets should the nurse give?
Solution:

X= 2 tablets
Example # 2
 An order is written for 0.05 g
Aldactone (spironolactone) to be
given orally (PO). The Aldactone is
available in 25-mg tablets. How
many tablets would you have to
give?
Solution:
1.) Convert gram to milligram

0.05 gram x 1000 mg

1 gram
= 50 mg
Solution:

50 (mg) (tab)
25 mg
= 2 tablets
A patient has a bottle of warfarin (Coumadin) 5
mg tablets at home. After his most recent
international normalized ratio (INR), the doctor
calls and tells him to take 7.5 mg/day. How many
tablets (scored) should the patient take?
7.5 mg/ 5mg* 1 tab= 1.5 tabs or 1 ½ tablets
The physician orders alprazolam (Xanax) 0.5 mg
PO. You have on hand Xanax 0.25 mg tablets.
How many tablet(s) will you give?
Desired: 0.5 mg
Stock: 0.25 mg
Quantity: 1 tab
X= 2 tabs
You need to administer 250 mg of erythromycin
(Erythrocin) PO. You have on hand 0.5 g tablets.
How many tablet(s) will you give?
Desired: 250 mg
Stock: 0.5 g= 500mg
Quantity: 1 tab
X= 0.5 or ½ tab
A patient with heart failure has a daily order for
digoxin (Lanoxin) 0.25 mg PO. Digoxin 0.125 mg
tablets are available. How many tablet(s)
should you give? 2 tabs
D- 0.25mg
S- 0.125 mg
Q- 1 tablet
X= 2 tabs
You have available lorazepam (Ativan) 0.5 mg
tablets, and you need to administer 1 mg PO.
How many tablet(s) will you administer?
D- 1 mg
S- 0.5 mg
Q- 1 tab
X= 2 tabs
Example # 3
 An order has been written for
250 mg of sulfisoxazole. The
bottle states that the solution
contains 125 mg/5 mL. How much
of the liquid should you give?
Solution:
The physician writes a “now” order
for codeine 45 mg IM for a patient
with a vertebral compression
fracture. You have on hand codeine
60 mg/2 mL. How many milliliters
should you give? 1.5 ml
D- 45 mg
S- 60 mg
You have an order to administer 40 mg of
methadone (Dolophine) SC for opioid
detoxification. You have on hand 30 mg/mL.
How much should you draw into the syringe?
1.3 ml
D-40 mg
S- 30 mg
Q- 1 ml
PARENTERAL DRUGS
 All drugs administered parenterally
must be administered in liquid form.
 The person administering the drug
needs to calculate the volume of the
liquid that must be given to administer
the prescribed dose.
Example # 1
 An order has been written for
75 mg of meperidine to be given
intramuscularly.
 The vial states that it contains
meperidine, 1.0 mL = 50.0 mg.
Solution:
The physician ordered paracetamol IV 150 mg to a patient with fever. The
order reads 150 mg IV every 4 hours prn to fever. The stock on hand includes
2ml of paracetamol at 150 mg in every 1 ml.

How many ml will we give to the patient? 1ml

D- 150mg 150 mg
S- 150 mg 300 mg
Q- 1ml 2ml
X= 1 ml 1 ml
How many dose are there in 1 ampule?2 doses
SITUATION: The physician ordered a macrolide antibiotic Gentamycin to a client
with PCAP. The order reads 160 mg IV every 8 hours. The stock on hand includes
four 2ml ampules of Gentamycin at 40 mg/ml.
How many ml should be given to the client per dose? 4ml
D=160 mg 160mg
s-= 80mg 40mg
Q= 2 ml 1ml
X= 4 ml 4ml
How many ampules shall be needed per dosage administration? 2ml
How many ml should be given to the client within 24 hours? 12ml
How many ampules shall be needed in 24 hours? 6 ampules
INTRAVENOUS SOLUTIONS
 Used to deliver a fluids, electrolytes, vitamins,
nutrients, or drugs directly into the
bloodstream.
 Microdrip delivery system delivers 60 drops
per milliliter.
 Macrodrip system delivers 15 drops per
mililiter and is used when a large volume must
be delivered quickly.
DRIP RATES
 It is when the infusion volume is
calculated into drops.
 General formula is:
Example # 1
 A patient is ordered to
receive 1000 mL of intravenous
fluids to run for 8 hours.
Calculate the drip rate.
Solution:
 DRIP RATES IN DROPS PER MINUTE
 There are two standard giving sets of drip rates.
 Macro drop factor = 15 drops per minute
(gtts/ min)
 Micro drop factor = 60 microdrops per
minute (ugtts/min)
 The formula in determining DR (drop
factor) in DPM: (flowrate)
Example # 2
 A patient is to receive 1 liter
of PNSS over the next 12 hours.
What is the rate of infusion in
drops per minute, if the drop
factor is 60 drops per milliliter.
METHOD 1: get the ml/hr then get the ml/min and then the DPM

ml/hr= volume in ml = 1000ml = 125 ml/hr

hours 8 hour
ml/min= ml/hr = 125 ml/hr= 2.08 ml/ min
60 mins 60 mins

FR or DPM= ml/min (DF)= 2.08 ml/min (15 gtts/ml) =31.25 or 31 gtts/min

31-32gtts/min
METHOD 2: get the ml/hr

ml/hr= vol in ml= 125ml/hr

6 hours

DPM= ml/hr (DF)= 125ml/hr (15gtts/ml) =31.25 0r 31 gtts/min

60 60
Solution:
HOOK PNSS 1 L to run at 8 hours the IV calibration set is 15 gtts/ ml.
How many drops per minutes will you infused? 31 gtts/min
1000ml/8 hours (15 gtts/ml/ 60 minutes/ hour)= 31.25 or 31 gtts/min
To hook 1 L of D5NM to an adult client to be infused in 6 hours.
How many gtts/min are you going to regulate the IVF? 41.6 or 42
gtts/min or 41-41 gtts/min

1000ml/ 6 hours (15gtts/ml/ 60 min/ hr)= 41-42 gtts/min

To hook ½ L of D5IMB to a pediatric client in 10 hours?
What is the flow rate? 50 ugtts/min
500ml/10 hours (60 ugtts/ml/ 60 mins/hr)=

Hook D5IMB 1.5 L to a pedia client to run at 24 hours. What will be

your regulation? 62.5 or 63 or 62-63ugtts/min

1500ml/ 24 hours (60 ugtts/ ml/ 60 mins)=

A patient is admitted in NICU. With a doctors order of IVF of D5IMB ½
to run at 12 hours.
What is your regulation? 41ugtts/min
500ml/12 hour ( 60 ugtts/ml/ 60 min/ hr)

A patient is admitted in Medical Ward with and order of PLRS 500 ml to

be infused in 6 hours? What is the flow rate? 20.8 or 21 gtts/min or 20-
21 gtts/min
500ml/ 6 hours (15 gtts/ml/ 60 mins/ hr)
The formula in determining the
number of hours to complete
before it runs out is:
Example # 3
 The volume of the fluid is
1000 ml and the IV pump is set
at 62 ml / hr. How long will it
take for the fluid to run?
Solution:
If an IVF solution is deliver in 180 ml each hour, how many hours are
required to administer 1.5 L? 8 hours

1500ml/ 180ml/hr= 8 hours

The solution delivers 250ml in 2 hours, how many hours will it takes to
administer 1L of PNSS? 8 hours

1000ml/ 125ml/ hr= 8 hours

The physician orders to hook D5IMB ½ L at 7pm to be infused at
50ml/hr. at what time the infusion be completed? 5am

500ml/ 50ml/ hr= 10 hours

• Duty is 2pm- 10 pm. During the endorsement at 2 pm you received
D5LRS 1 Liter at 500 ml level at 20 gtts/ min.
• What time you will change the IVF? 8:25 pm

T= volume in ml ( DF) = 500ml (15gtts/ml) = 375 mins/60 = 6. 25 or 6

hrs and 25 mins
flow Rate 20 gtts/min
At 2 pm you receive the IVF of the patient at IL running at 25 gtts/min
What time your IV will be consumed? 12 am
1000ml (15 gtts/ml) = 600 mins or 10 hours
25 gtts/min
VOLUME
V= flowrate(time in minute)
DF
The IVF is running at 20 gtts/min in 10 hours. How much will you
consume?

The is regulated at 80ugtts/min in 24 hours. How much will you

infused?
DR or drop factor: adult= 15gtts/ml
pedia= 60 ugtts/ml
What is the regulation? FLOW RATE= gtts/min or ugtts/min
What is the flow rate?

How long? DURATION= minutes or hours

what Time?
What is the duration?

How much? VOLUME= ml or L

How many ml? or L?
Insert PLRS 1L to run at 4 hours to an adult patient
What is the regulation?

How much will you consume in 2 hours?

• An adult patient is admitted to medical ward. The doctors orders IVF
of D5LRS to run at 8 hours at 30-31 gtts/mn. How much ml of IVF you
expect to receive by the patient?
 PEDIATRIC
CALCULATIONS
 LEARNING OBJECTIVES
 Discuss why children require
different dosages of drugs than
adults.
 Explain the calculations used to
determine a safe pediatric dose of
a drug.
PEDIATRIC CONSIDERATIONS
 An adult’s body handles drugs differently
and may respond to drugs differently than
a child.
A child’s body may handle a drug
differently in all areas of
pharmacokinetics—absorption,
distribution, metabolism, and excretion.
PEDIATRIC CONSIDERATIONS
 The responses of the child’s organs to
the effects of the drug may vary because
of the immaturity of the organs.
 Most of the time a child requires a
smaller dose of a drug to achieve the
comparable critical concentration as that
for an adult.
 FRIED'S RULE
 A calculation method that applies
to a child younger than 1 year of
age.
 The rule assumes that an adult
dose would be appropriate for a
child who is 12.5 years (150 months)
old.
FRIED'S RULE
PROBLEM # 1
 If an adult dose of a
particular medication is 50 mg,
what is the dosage of a 10
months old infant?
SOLUTION
PROBLEM # 2
 Calculate the dose for a 1
year old baby, where the adult
dose of the medicine is 400
mg.
SOLUTION
 YOUNG'S RULE
 A calculation method that applies
to children 1 to 12 years of age.
 The general formula is:
PROBLEM # 1
 If an adult dose of a
particular medication is 100
mg, what is the dose for a 10
year old child?
SOLUTION
PROBLEM # 2
 A 3-year-old child weighing 30
lb is to receive a therapeutic
dose of aspirin. The average
adult dose is 5 grams, and the
dose to be given is the unknown
.
SOLUTION
 CLARK'S RULE
 It uses the child’s weight in pounds to
calculate the dose and assumes that the
adult dose is based on a 150-lb person.
 The general formula is:
PROBLEM # 1
 A child weighs 40 lbs and is
5 years old. The adult dose is
250 mg. Calculate the
correct dose for the child?
SOLUTION
PROBLEM # 2
 A 2 years old child weighs
11.4 kg. The adult dose is
125 mg. Calculate the
correct dose for the child.
SOLUTION
1. The childs weight is 55 lbs. the average adult dose is 50 mg.
18.33mg
55lbs/150lbs (50mg)=
1. The patient is 24 months and the doctors order to give antibiotic
with an average adult dose of 500mg. 71.43 mg
2 years / 2years +12 (500mg)=

3. The childs 15 lbs and the AAD is 250 mg. 25 mg

15lbs/ 150lbs( 250 mg)=
BODY SURFACE AREA RULE
 The child’s surface area is determined with
the use of a nomogram.
 The height and weight of the child are
taken into consideration in this chart.
 The general formula is:
NOMOGRAM
 Draw a straight line
connecting the child’s
height to the child’s
weight.
 The BSA value, which is
calculated in square
meters, is found at the
point where the line
intersects the SA column.
PROBLEM # 1
SOLUTION
SOLUTION
PROBLEM # 2
SOLUTION
PROBLEM # 3
SOLUTION
SOLUTION
PROBLEM # 4
SOLUTION
SOLUTION
PROBLEM # 5
SOLUTION
SOLUTION
 MILLIGRAMS/ KILOGRAMS
OF BODY WEIGHT RULE
 This method of prescribing takes
into consideration the varying
weights of children and the need
for a higher dose of the drug
when the weight increases.
PROBLEM # 1
 If a child with postoperative
nausea is to be treated with
Vistaril (hydroxyzine), the
recommended dose is 1.1 mg/kg
by intramuscular injection.
SOLUTION
 If the child weighs 22 kg:
 If the child weighs 6 kg:
SUMMARY
 CALCULATING
THE SAFE DOSES
OF MEDICATIONS
Doctors orders Benadryl for a child that weighs 98
lbs. The safe dose for Benadryl is 5mg/kg/day.
What is the safe dose per day for this child.
The doctors order antibiotic to 28 lbs child. The safe dose for
antibiotic is 40mg/kg/day. What is the safe dose for the child?

Convert lbs-kg= 12.72kg

1. Multiply wt to safe dose= 509 mg/day

If the meds is given QID how many mg per dose will you give?
509.09 mg/day / 4 =127 mg/ dose
 Calculating the
Maximum Dosage
A child weighs 52 lbs. The child has a fever and the doctor
orders Tylenol. The safe dose range 10-15 mg/ kg q6 hrs.
What is the maximum safe dose for this child per dose?
What is the maximum safe dose for
this child per day?
 Calculating the
Minimum and the
Maximum Dose
The doctor orders 200 mg of Ibuprofen every 8
hrs. the child's weighs 49 lbs. the safe dosage
range for this medication is 5-10 mg /kg/dose.
What is the safe dosage for this particular child ?
Is this a safe dose for this child? How many mg
should be given in a day?
DO: 200mg/ 8 hours
Wt: 49 lbs
SDR: 5-10 mg/kg/dose
1. Convert the wt. lbs- kg =22.27 kg

2. Multiply wt. to SDR=111.35mg-222.7 mg/ kg/dose. Yes the dose is

safe
3. Multiply desired dose to number of times the medication should
be given= 200mg x 3= 600 mg/day
An antibiotic 100 mg every 6 hours is to be given to a child who weighs 55 lbs. the safe drug range is 12.5-
25mg/kg/day.

1. Is the prescribed dose safe? Yes. The dose is safe

Convert wt- 25kg
Multiply wt to sdr- 25kg( 12.5 )= 312.5 mg/day
25 kg (25)= 625 mg/day
100mg (4)= 400mg/day
1. What is the maximum mg to be given per day? 400mg/day
2. if the stock dose of the antibiotic is 62.5 mg/ 5 ml, how many ml should be given for each dose? 8ml
D: 100mg
S: 62.5 mg
Q: 5 ml
X= 8ml
D.O: Cefaclor 50 mg QID
Child’s wt: 15 lbs
Safe drug dose: 20- 40 mg/kg/day
Stock dose: Cefaclor 125 mg/ 5ml

Is the prescribed dose safe? Yes. It is safe

15lbs= 6.82 kg
6.82 kg ( 20)= 136.4 mg/ day
6.82 kg ( 40)= 272.8 mg/ day
50 mg (4)= 200mg/ day
How many ml should be given for each dose? 2 ml
D: 50 mg
S: 125 mg
Q: 5 ml
X= 2ml
D.O.
 The doctor orders Digoxin 0.92 mg daily for a child that
weighs 16 lbs. The safe dosage for this medication is 8-12
mcg/kg/day. Is this a safe dose order?
Conversion Guide

 1 Kilogram = 1000 grams

 1 Gram = 1000 milligrams = 15 grain
 60 mg = 1 grain
 1 Milligram = 1000 micrograms
 1 Microgram = 0.001 milligrams
 1 Milligrams = 0.001 grams
 1 Microgram = 10 -6 grams
 1 Nanogram = 10 -9 grams
 1 Grain = 65 milligrams
 60 Grain = 1 dram
 8 dram = 1 oz
 1 fluid dram = 60 minim
 1 cc = 15-16 min
 1 min = 0.06 cc
 8 fluid dram = 1 fluid oz
 2 fluid dram = 8 cc
 240 cc = 8 fluid oz
 30 cc = 1 fluid oz (f oz i) = 2 tbsp
 15-16 cc = 4 oz = 3 tsp = 1 tbsp
 1 Litre = 1000 cc
 1 OZ = 30 cc
 16 OZ = 480 cc = 1 Pint
 16 oz = 1 lb
 1 Pint = 480 cc
 1 Quart = 960 cc = 2 Pints
 1 Gallon = 3840 cc = 4 Quarts = 8 Pints
 2.2 lbs = 1 kg
 1 Teaspoonful = 5 cc = 60 gtts
 1 Tablespoonful = 15 cc
 1 Teacupful = 120 cc
 1 Wineglassful = 60 cc
 1 Tumblerful = 240 cc
1. You are caring for a patient at home who must take magnesium
hydroxide/aluminum hydroxide (Maalox) 30 mL PO. How will you instruct
the patient to measure the dose using ordinary household measuring
devices? Fill in the blanks. Record your answer to the nearest whole
number.

________tbsp

 One tablespoon is equal to 15 mL.

 Convert 30 mL to tablespoons by multiplying it by one tablespoon.
 Then, divide 30 by 15 mL to get the final answer of 2 tbsp.
Systems of Measurement

 There are three systems of measurement used in nursing: the metric

system, the apothecaries’ system, and household system.
 Metric System
 The most widely used international system of
measurement.
 The basic units of metric measures are the gram
(weight), meter (length or distance), and liter (volume).
 It is a decimal-based system that is logically organized into
units of 10. Basic units are multiplied or divided by 10 to
form secondary units.
 Apothecaries’ System
 The apothecaries’ system is one of the oldest systems of
measurement, older than the metric system and is
considered to be out of date.
 The basic units used in this system are the grain (gr) for
weight, minim for volume, ounce, and pound. All of which
are seldomly used in the clinical setting.
 Quantities in the apothecaries’ system are often expressed
by lowercase Roman numerals when the unit of measure is
abbreviated. And the unit of measure precedes the
quantity. Quantities less than 1 are expressed as fractions.
Examples: “gr ii”, “gr ¼ ”
 And yes, it can be confusing therefore use the metric
system instead to avoid medication errors.
 Household System
 Household system measures may be used when more
accurate systems of measure are not required.
 Included units are drops, teaspoons, tablespoons, cups,
pint, and glasses.
 Other Systems of Measurement
 Milliequivalent (mEq)
 The milliequivalent is an expression of the number
of grams of a medication contained in 1 milligram
of a solution.
  Examples: the measure of serum sodium,
serum potassium, and sodium bicarbonate is
given in milliequivalents.
 Unit (U)
Unit measures a medication in terms of its action,

not its physical weight.
 When documenting, do not write “U” for unit,
rather spell it as “unit” as it is often mistaken as
“0”.
 Examples: Insulin, penicillin, and heparin sodium
are measured in units.
Converting Units of Weight and Measure

 Converting values between metric system

 For drug dosages, the metric units used are the gram
(g), milligram (mg), and microgram (mcg). For volume
units milliliters (mL) and liters (L).
 It is simple to compute for equivalents using the metric
system. It can be done by dividing or multiplying; or by
moving the decimal point three places to the left or right.
 Do not use a “trailing zero” after the decimal point when
the dosage is expressed as a whole number. For example, if
the dosage is 2m mg, do not insert a decimal point or the
trailing zero as this could be mistaken for “20” if the
decimal point is not seen.
 On the other hand, do not leave a “naked” decimal point. If
a number begins with a decimal, it should be written with a
zero and a decimal point before it. For example, if the
dosage is 2/10 of a milligram, it should be written as 0.2
mg. It could be mistaken for 2 instead of 0.2.
 Converting Units Between Systems

 Household and metric measures are equivalent and not
equal measures.
 Conversions to equivalent measures between systems is
necessary when a medication prescription is written in one
system but the medication label is stated in another.
 Medications are not always prescribed and prepared in the
same system of measurement; therefore conversion of
units from one system to another is necessary.
 Common conversions in the healthcare setting include
pound to kilograms, milligrams to grains, minims to drops.
Methods for Drug Dosage Calculations

 Standard Method
 The commonly used formula for calculating drug dosages.
 Where in:
 D = Desired dose or dose ordered by the primary
care provider.
 H = dose on hand or dose on the label of bottle,
vial, ampule.
 V = vehicle or the form in which the drug comes
(i.e., tablet or liquid).

D/H*V= X
 Fluid Intake and Output Calculation
 Intake and output (I&O) measurement and recording is
usually done to monitor a client’s fluid and electrolyte
balance during a 24-hour period.
 Intake and output is done for patients with increased risk
for fluid and electrolyte imbalance (e.g., heart
failure, kidney failure).
 Unit used in measurement of I&O is milliliter (mL).
 Measuring fluid intake entails recording each item of fluid
consumed or administered, all of the following fluids are
recorded:
 Oral fluids (e.g., water, juice, milk, soup, water
taken with medication).
 Liquid foods at room temperature (e.g., ice cream,
gelatin, custard).
 Tube feedings including the water used for
flushes.
 Parenteral fluids
 Blood products
 IV medications
 Measurement of fluid output includes:
 Urinary output
 Vomitus
 Liquid feces
 Tube drainage
 Wound and fistula drainage
 Measurement of fluid input and output are totaled at the
end of the shift and documented in the patient’s chart.
 Determine if fluid intake and fluid output are proportional.
When there is a significant discrepancy between intake and
output, report to the primary care provider.