Pharmaceutical and

Clinical Calculation in
Hospital Pharmacy Settings

Asst. Prof. Jay P. Jazul, RPh, MSc.

in partnership with
 Hospital Settings
• Pharmaceutical dosages are calculated to
give the maximum blood and tissues
concentration of a medication without
causing overdosage or adverse effects.
• Dosage is the amount of a drug or
medicine prescribed by a licensed
physician for a given patient or condition.
• A patient’s dose is the measured portion of
the drug to be taken at one time.
 Factors:
• Age- children & elderly persons require less
than a normal usual adult dose.
• Sex- women require smaller doses than the
male because they are more susceptible to
the action of certain drugs and are smaller in
built.
• Weight-for a person who is lighter in weight,
accumulation of the tissues is greater,
therefore, the effect of the drug is more
potent.
• Condition of the patient- smaller doses is
indicated for patients with lowered resistance
 Factors:
• Method of administration- for drugs
administered orally & rectally, larger doses are
required; for parenteral administration, smaller
doses are administered
• Absorption and Excretion - drugs that are
rapidly absorbed and excreted are given at more
frequent intervals. However, if the drug is rapidly
absorbed but excretion is slow, they are given at
less intervals to prevent accumulation of drug
which results to untoward reactions or effects.
• Race- drug dosage may also depend on the race
of the patient as they differ in built & lifestyle.
 Remember:
• When the drug is supplied in solid form,
simply calculate the number of tablet or
capsules that contains the prescribed
dosage. The label indicates the dosage
preparation per tablet or capsule.
Example: Diazepam 5mg tablet
 Remember:
• The given amount of the drug is always per
tablet, as in 5mg per tablet.
• When the drug is supplied in
liquid/suspension form, calculate the volume
that contains the prescribed dosage. The label
indicates the dosage preparation of drug per
mL of the solution/suspension.
Example: Co-amoxiclav 312.5mg/5mL
 To compute for the dosage:
Step 1 CONVERT Ensure that all measurements are the same
unit of measurement.
Step 2 THINK Estimate first what is the reasonable amount of
drug to be administered/dispensed as you may
not need to do a long computation.
Step 3 COMPUTE Apply the formula
 DOSE

• Number of Doses = Total Quantity

Size of Dose

In using the equation, the total quantity and the size of

dose must be in the same unit of measure.
Interpreting Labels
Commonly used abbreviations
English and Roman Numerals
Systems of Measurement and
Conversion
Metric Basic Equivalents
Apothecary Method
Basic Equivalences
Sample Computation
Calculation for Oral Dosages
Dosage Calculation
Example
Example
Example
Example
Example
Calculating Dosages for Oral Liquids
Example
 PEDIATRIC DOSE
• Infants and children require smaller quantities of
drugs than adults. Certain drugs cannot be
prescribed for neonates and infants because their
livers and kidneys are not fully developed. Since
very small dosages are prescribed for infants and
children, all calculations must be precise for the
patient’s safety.
• The method most frequently used to calculate a
prescribed dosage form is based upon the child’s
body weight of body surface area. It is also
considered the most accurate method of
calculation. There are two methods for calculating
drug dosages using BSA (body surface area).
 Method 1:
Pediatric dose = body surface area in m2 x dose in m2

Method 2:

where: 1.73 is the ave. BSA of adult in m2

 If Nomogram is not available:
• Dose for child = BSA for child_____ x adult dose
1.73 m2 (average adult BSA)

• Dose for adult = BSA of adult (m2)_____ x usual adult dose

1.73 m2 (average adult BSA)
 Sample Problem
• If the adult dose of a drug is 75 mg, what
would be the dose of a child weighing 40 lbs
and measuring 32 inches in height?
 Sample Problem
• If the usual adult dose of a drug is 120 mg,
what would be the dose based on BSA for a
person measuring 6 ft tall and weighing 200?
Another BSA Equation
BSA Formulas
Example
Example
Based on Age:
Based on Age:
Based on Weight:
 Sample Problems
• Order is Gentamicin 50mg IVPB q8 for a child
weighing 40 lbs. The recommended dosage for
a child is 6 to 7.5 mg/kg/day divided q8. Is the
dosage ordered safe?
 Sample Problems
• A 4 year old patient weighs 17 Kg. She has been prescribed a drug
that is available as a 0.5 % solution and prepackaged with an oral
dosing spoon embossed with a milliliter scale. The normal adult
dosage for this medication is 100 mg. What dosage should the
child receive if Clark’s rule is used to calculate it?
 Sample Problems
• An infant, 15 months old and needs Streptomycin sulfate
which is usually administered to adults as 1 gram, as daily
IM injection. What is the appropriate dosage for the
infant? What is the dosage if using the Young’s rule?
 Sample Problems
• How many milligrams of Zofran will a 10-year old child
receive if the adult dose is 4 mg?

• If the medication is available in 4 mg/5 mL, how many mL

will the child receive per dose?
 Geriatric Doses
• Geriatric patients are not necessarily divided
into a specific age group because of the wide
variety in the aging process. A person who is
60 years old may or may not possess all the
contributory factors affecting mental and
physical state of the individual in order to
determine the appropriate dosage regimen.
 Factors:
• Decrease gastrointestinal function that may cause poor
absorption. Geriatric patients often suffer from
constipation.
• Impaired or reduced metabolism.
• Changes in body composition, limitations, deformities.
• Alterations in circulation, liver, and kidney function.
• Changes in body functioning, systems, eye, ears, and
speech.
• Sensitivity to drugs.
 Factors:
• Number of medications the patient is taking, and drug
interactions.
• Psychosocial changes like: alertness, forgetfulness,
confusion, misunderstanding, attitude, and memory
loss.
• Disease process: multiple conditions
• Self medication: over the counter drugs
• Cost
• Living conditions: alone the with mate, nursing home
or others
• Poor water intake
Geriatric Dose
 Cockcroft Gault Equation

Normal Creatinine Clearance Normal Serum Creatinine

Women: 88 – 128 mL/min Women: 0.7 to 1.3 mg/dL
Men: 97 – 137 mL/min Men: 0.6 to 1.1 mg/dL
 Sample Problem
• JS is a 65 year old who presents with a bad case of cellulitis after
a recent golf tournament. The physician decides to use
vancomycin for empiric gram (+) coverage and requests that
pharmacy doses it. The patient is 5’7 and weighs 154 lbs, and his
serum creatinine is 0.9 mg/dL. All other laboratories are within
the normal limits. How would you dose the vancomycin given
the following chart and dosing of 15 to 20 mg/Kg?
Gentamicin

Source: Global RPh

 Should find Drug Information or
Reference from Reputable Source
Parenteral Medication
Parenteral Medication
Calculation of Parenteral Dosage
Drug Strengths and Stated
Concentrations
Advanced Dosage Calculations
Reconstitution of Powder Drugs
Example
Powders for Suspension/Reconstitution
• Some drugs, mostly antibiotics, which are
unstable for prolonged periods of time in solution
are manufactured in powder form and packaged
in single dose, multiple dose or in bottles for
suspension.
• Prior to use, the powder which is to be
reconstituted or suspended with a solvent,
should be shaken to loosen the powder.
• Solvent to be used for reconstitution are Purified
Water or Distilled Water (for oral suspensions);
Sterile Water for Injection, Bacteriostatic Water
for Injection, 0.9% NaCl or other special solvents
for parenteral use which are sometimes indicated
in the label.
 Powders for Suspension/Reconstitution
• In preparing the drug for parenteral use, the volume
of solvent to be used will prepare the prescribed
dosage in:

1. A concentration which will cause minimal

irritation; and
2. A volume which can be correctly measured and
safely administered by the intramuscular, intravenous
& subcutaneous route.
 Sample Problems
(Reconstitution)
• If the volume of 250 mg of ceftriaxone
sodium is 0.1 mL, how much diluent
should be added to 500 mg of ceftriaxone
sodium powder to make a suspension
having a concentration of 250 mg per mL?

• What is the volume of dry powder

Cefonicid, if 2.5 mL of diluent is added to 1
gram of powder to make a solution having
a concentration of 325 mg/mL?
 Mixing and Labeling
• Accurately measure the amount of solvent to be
added, slowly add to the powder and shake
intermittently.
• Avoid rotating with your palms as some drugs
display reaction to body temperature.
• Wait until the solution is free from bubbles to
ensure accuracy.
• The bottle/vial usually has a line drawn under the
neck. This indicates that the final amount of the
suspended drug should reach the line.
• If the solution does not reach the line, fill it up
with the solvent. Do not exceed beyond the line.
Reconstituted preparation should bear
the following:
• Patient’s name, room & bed number
• Date & time of reconstitution
• Solvent added & the amount
• Final dosage preparation of the reconstituted
preparation
• Total volume of the preparation
• Directions for administration & storage
• Date of effectivity & expiration
• Name of pharmacist
 Sample Problems
• Two measures are used to determine the amount
of medication that is to be administered: these
are by weight and by volume. Medications
prepared for geriatric patient for administration is
dispensed in unit dose or multiple dose form
(liquid or solid)
• Two of the most useful methods when calculating
the dosage to be administered are the Ratio &
Proportion method and the Formula method.
 Drugs Expressed in Units
• The potency of some drugs is expressed in terms
of units (µ). Examples are serum, vaccines, and
animals from animal sources. these units are
referred to as USP units of activity which are
equivalent to the corresponding international
units and to the units of activity established by
the FDA in the case of biological products. The
units of activity are determined by comparison
against a suitable working a standard, officially a
USP Reference Standard. Reference standards are
authentic specimen used as comparison
standards in tests and assays.
 Drugs Expressed in Units
• Packaging of these drugs may vary from a few
to millions of units per mL depending on the
source, condition and manner in which they
are obtained. Since many of the drugs
dispensed in units are extremely potent,
dosages are often administered in very little
quantity, which requires use of special
syringes.
 Insulin
• These preparations are divided into three
categories based on promptness, duration and
intensity of action following subcutaneous
injection.
• Commercial insulin is available in 40, 100 & 500
units per mL of the preparation.
• A calibrated insulin syringe is designed to be used
for this dosage preparation wherein the
pharmacist simply draws up the prescribed dose.
Another syringe that can be used for this is the
tuberculin syringe.
 Insulin
• Some patients need a mixture of insulin
preparations, a long acting or immediate
acting and a short acting insulin. Although
there are preparations of Mixed Insulin, it is
important that the pharmacist know how to
prepare from different preparations.
Type of Insulin Dosage Form
Insulin Administration
 Important Points
The following are the important points in mixing the
2 different preparations:
• If not specified in the doctor’s order, use insulin
of the same concentration.
• Use either an insulin or a tuberculin syringe.
• Do not contaminate the contents of one vial with
the contents of the other vial.
• Always draw the short acting (Regular) insulin
first, followed by the long-acting or immediate
acting ( Modified) insulin.
 Parenterals and IV Fluids
• Parenterals are dosage forms which are
absorbed directly into the bloodstream for
immediate action of the drug. Injectables are
available in both powders & liquid form.
Powders are reconstituted until completely
dissolved.
 Parenterals and IV fluids
• Ampules- made entirely of glass intended for single use
only.
• Vials- glass or plastic containers closed with a rubber
stopper & sealed with an aluminum crimp. And can be
designed for multiple doses.
• Prefilled syringes- contains drugs intended for immediate
injection in emergency cases.
• Prefilled cartridges- ready to use parenteral packages that
offer improved sterility & accuracy. They consist of a plastic
cartridge holder and a prefilled medication cartridge with a
needle attached.The medication is premixed &
premeasured. Narcotics are commonly available in prefilled
cartridges.
• Infusion solutions- small volume (less than 100 mL) & large
volume ( more than 100 mL) parenterals.
 Parenterals and IV fluids
• There are various types of syringe available,
most of which are single-use disposable units
with attached needled, the syringe may be
made of plastic or glass (not common) and are
pre-packaged in sterile packets.
 Syringes Available:
• Hypodermic syringe-used for subcutaneous (SC) and intramuscular
(IM) injections, calibrated in tenths of a cubic centimetre (cm²) and
in minims; usual size is 2 to 5.3 mL.
• Tuberculin syringe- a double-scale 1 mL syringe used for intradermal
injections and for administering less than 1 mL of the drug,
calibrated in tenths & hundredths of a cm² and in minims.
• Insulin syringe- calibrated in units & used only in administering
insulin, available in 2 sizes: a 1 cc which measures up to 100 units
and 0.5 mL which measures up to 50 units. These are commonly
referred to as U-100 syringes.
• Cartridge Injection- a metal or plastic holder and plunger used with
glass cartridges containing a premeasured medication and a needle
that is permanently attached to the cartridge, usually calibrated in
tenths of a cubic centimetre.
Hypodermic Syringe
Tuberculin Syringe
Insulin Syringe
Cartridge Syringe
Guides for Selecting Needle and Syringe
Calculating Drip Rates
Example
Example
Calculating Infusion Rates for
Infusion Devices
Examples
Examples
 Dextrose
Dextrose (D-glucose) solutions are most frequently
used glucose solutions in parenteral preparations.

Uses: D5 Water (dextrose 5% solution in water)- used as

a vehicle in IV admixtures; serves as a hydrating solution.
In higher concentrations, dextrose provides source a of
carbohydrates in parenteral nutritions solutions.
Example: D10 Water (dextrose 10% solution in water).
This should be used cautiously in patients with diabetes
mellitus.
 NSS
Sodium chloride- is usually given as a 0.9%
solution. It is called normal saline solution
(NSS) because it is isotonic with blood.
• Uses: NaCl for injection (a solution of 0.9%
NaCl)- used as vehicle in IV admixture
andfo r fluid and electrolyte replacement.
In smaller concentrations, it is suitable for
the reconstitution of various medications.
 NSS
• Bacteriostatic NaCl for injection (also a 0.9%
solution)- intended solely for multiple
reconstitutions.
 Water
• used for reconstitution and for dilution of such
IV solutions as dextrose and sodium chloride.
Waters suitable for parenteral preparations
include sterile water for injection and
bacteriostatic water for injection.
 Ringer’s Solution
Used for post surgical procedure

• Lactated Ringer’s Solution:

contains sodium lactate, NaCl, KCl, CaCl.
Frequently it is combined with dextrose.
Example: D5LR- dextrose 5% in Lactated Ringer’s
solution
• Ringer’s Injection – differs from lactated
ringer’s in that it does not contain sodium
lactate and has slightly different concentration
of NaCl and CaCl2
 IV Sets
used to administer intravenous solutions as
primary set-up for continuous infusion and as
secondary set-up for intermittent infusion. An IV
set consists of the following parts:
• IV tubing
• Drip chamber
• Regulator clamp
• Protective caps (to maintain sterility)
 IV Sets
The size of the opening into the chamber
determines the size of drop delivered by the IV
set. There are 2 types of IV set:
• Macrodrip or Macroset- delivers 10, 15 or 20
drops per mL; usually used for adults
• Microdrip or Microset- delivers 60 drops per
mL; designed to administer small & very
precise amount of fluid; usually used for
children.
 IV fluid
Controlling the infusion rate of the IV fluid is a
simple yet important calculation. We calculate
the drip rate to maintain a closer watch of the
fluid volumes so as not to overload the patient
with the IV fluid. Calculating the drip rate
depends on the type of the tubing that is used.