DOSAGE CALCULATIONS 4.

Avoirdupois System
FACTORS TO DETERMINE THE CORRECT DOSE OF A
PARTICULARY DRUG FOR A PATIENT
1. Sex
2. Weight
3. Age
4. Physical condition
5. Other drugs that the patient is taking
Dose
- frequently, the one needed for a patient is not the
dose that is available, and it is necessary to convert
the dose form available into the prescribed dose
PEOPLE RESPONSIBLE FOR DOING THE NECESSARY
MATHEMATICAL CALCULATIONS
1. Prescriber
- who orders the drug
2. Pharmacist
- who dispenses the drug
3. Nurse
- who administers the drug
Prescriber, Pharmacist and Nurse
- allows the necessary checks on the dose being given
before the patient actually receives the drug
MEASURING SYSTEMS CURRENTLY USED IN DRUG
PREPARATION AND DELIVERY
1. Metric System
- most widely used system of measure
- based on the decimal system, so all units are
determined as multiples of 10
- uses the:
• Gram as the basic unit of solid measure
• Liter as the basic unit of liquid measure
2. Apothecary System
- very old system of measurement that was
specifically developed for use by apothecaries or
pharmacists
- uses the:
• Minim as the basic unit of liquid measure
• Grain as the basic unit of solid measure
- much harder to use and is rarely seen in most
clinical settings
- interesting feature of this system is that it uses
Roman numerals placed after the unit of
measure to denote amount
3. Household System
- found in recipe books
- uses the:
• Teaspoon as the basic unit of fluid measure
• Pound as the basic unit of solid measure
- another older system that was very popular
when pharmacists routinely had to compound
medications
- uses ounces and grains, but they measure
differently than those of the apothecary and
household systems
- seldom used by prescribers but may be used for
bulk medications that come directly from the
manufacturer
5. Other Systems
- some drugs are measured in units
- these measures may reflect chemical activity or
biological equivalence
Unit
- reflects the biological activity of the drug in 1 mL
of solution
Milliequivalents (mEq)
- refers to the ionic activity
- used to measure electrolytes (e.g., potassium,
sodium, calcium, fluoride)
International Units
- sometimes used to measure certain vitamins or
enzymes
Ratio and Proportion Equation
- simplest way to convert measurements from one
system to another
Table of Conversions
- necessary to determine the equivalent measure in
the two systems you are using
Conversion Guide
- good idea to post this in the medication room or on
the medication cart for easy access
Ex.

Systems of Measurement
- several are available that might be used when a drug
is ordered
Drugs
- some are available only in certain forms or doses, it
may be necessary to calculate what the patient
should be receiving
1. Oral Drugs
- frequently, tablets or capsules for oral
administration are not available in the exact
dose that has been ordered
- nurse who is administering the drug must
calculate the number of tablets or capsules to
give for the ordered dose
2. Parenteral Drugs
- all drugs administered parenterally must be
administered in liquid form
- person administering the drug needs to calculate
the volume of the liquid that must be given to
administer the prescribed dose
3. Intravenous Solutions
- used to deliver a prescribed amount of fluid,
electrolytes, vitamins, nutrients, or drugs
directly into the bloodstream
IV Delivery Systems
- most come with a standard control called a
microdrip
Microdrip
- each milliliter = 60 drops
Macrodrip Systems
- 15 drops/mL
- available and used when a large volume must be
delivered quickly
IV Tubing
- always check its packaging to see how many
drops/mL are delivered
Pediatric Considerations
- children require doses different from those given to
adults
- most of the time a child requires a smaller dose of a
drug to achieve the comparable critical
concentration as that for an adult
- on rare occasions, a child may require a higher dose
of a drug
- formulas can be used to estimate the appropriate
dose
“Standard” Drug Dose
- listed on package inserts and in many references
refers to the dose that has been found to be most
effective in the adult male
Adult’s Body
- handles drugs differently and may respond to drugs
differently than a child’s
Child’s Organs
- its responses to the effects of the drug also may vary
because of the immaturity of the organs
THINGS TO CONSIDER IN DETERMINNG A PEDIATRIC
DOSE
1. Age
2. Weight
3. Body surface
METHODS FOR PEDIATRIC DOSE
1. Fried’s Rule
- method of determining a pediatric drug dose for
a child younger than 1 year of age, based on the
child’s age and the usual adult dose
- assumes that an adult dose would be
appropriate for a 12.5-year-old child
2. Young’s Rule
- method for determining pediatric drug dose
based on the child’s age and the usual adult dose
3. Clark’s Rule
- method of determining the correct drug dose for
a child based on the known adult dose
- assumes that the adult dose is based on a 150-lb
person

Fried’s, Young’s and Clark’s Rule

- not usually used today
Nomogram
- uses body surface area is more accurate for
determining doses
- height and weight of the child are taken into
consideration in this chart
Pediatrics
- when working here, one needs to be familiar with at
least one of these methods of determining the drug
dose
Two Nurses
- many institutions need this to check for critical
pediatric doses
Surface Area of a Child’s Body
- used to determine the approximate dose that should
be used
- to do this, the child’s surface area is determined with
the use of a nomogram
- more precise than the formula methods

Milligrams/Kilograms of Body Weight

- when a safe and effective pediatric dose has been
established, the orders for the drug dose are often
written in milligrams/kilograms
- takes into consideration the varying weights of
children and the need for a higher dose of the drug
when the weight increases