Calculate with Confidence

5
th
edition
Gray Morris
Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Calculation of Oral Medications
Unit Four: Chapter 17
Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
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Calculation of Oral Medications:
Objectives
After reviewing this chapter, you should be able to:
1. Identify forms of oral medications
2. Identify terms on labels used in calculation
3. Calculate dosages for oral medications using
ratio and proportion, the formula method, and
dimensional analysis
4. Apply principles to obtain rational answers
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Background: Oral Medications
Most economical
Easiest to administer
Most common type of medication given
Available as solids and liquids
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Forms of Solid Medications
Tablets
Powdered medications molded in shapes
Caplets
Elongated tablets coated to ease swallowing
Scored tabletsuse pill cutter
Tablets with indented markings designed to cut
and deliver to what is in a whole tablet
Note: Breaking an unscored tablet is dangerous
and can result in an unintended dose
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Forms of Solid Medications
(contd)
Enteric-Coated Tablets
Special coating protects against gastric secretions
NEVER crush EC tabletsdefeats the purpose
Sublingual Tablets
Placed under tongue for direct absorption
NEVER swallow SL tabletsprevents desired
effect
Layered Tablets
Layers or cores of two meds with different
compatibilities or absorption components
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Forms of Solid Medications
(contd)
Time-Release and Extended-Release Tablets
Labeled SA, LA, XL, SR, or ER
Released over a period of time
NEVER crush, chew, or break
Capsules
Contains powder, liquid, or oil with hard/soft
gelatin coating
NEVER crush, chew, or break without consulting a
pharmacist
Others: Troches, Lozenges, Pulvules
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Figure 17-1 A, Various shapes of tablets. B, Tablets scored in halves and fourths. (From Kee
JL, Marshall SM: Clinical calculations: with applications to general and specialty areas, ed. 6, St. Louis, 2009, Saunders.)
Figure 17-3 Pill/tablet cutter. (From Kee JL, Marshall SM: Clinical calculations: with applications to
general and specialty areas, ed. 6, St. Louis, 2009, Saunders.)
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Figure 17-4 Layered tablet. (From Clayton BD,
Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14, St.
Louis, 2007, Mosby.)
Figure 17-5 Timed-release capsule. (From Clayton BD, Stock YN,
Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007,
Mosby.)
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Figure 17-6 Various types of capsules. A, Lanoxicap. B, Different types of
capsules. (A from Mosbys drug consult 2003, St. Louis, 2003, Mosby. B courtesy
Amanda Politte, St. Louis.)
Figure 17-7 Forms of solid oral medications. Top row, Uniquely shaped
tablet, capsule, scored tablet; bottom row, gelatin-coated liquid capsule,
extended-release capsule, enteric-coated tablet. (From Potter PA, Perry
AG: Fundamentals of nursing, ed. 7, St. Louis, 2009, Mosby.)
Figure 17-8 Various sizes of gelatin capsules. (Courtesy
Oscar H Allison. From Clayton BD, Stock YN, Harroun RD:
Basic pharmacology for nurses, ed. 14, St. Louis, 2007,
Mosby.)
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Points to Remember
Converting dosages from apothecary to
metric can result in discrepancies
ASA (CF: gr i = 60 to 65 mg)
10% ruleno more than 10% variance
should exist between dose ordered and dose
administered
Capsules are administered whole
Tablets are available in different strengths
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Points to Remember (contd)
It is safer to give whole tablets equal to the
dose than to cut tablets
Maximum number of tablets or capsules used
to deliver a dose is usually three (3)
Exceptions exist, such as some HIV meds
always double-check dosage
Some measures and units such as mEq do
not convert between metric and apothecary
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Examples
The following three examples are based on
this order:

Give: Digoxin 0.375 mg p.o. daily
Available: Digoxin in scored tablets of 0.25 mg
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0.25 mg : 1 tab = 0.375 mg : tab

(known) (unknown)
(available) (ordered)
0.25 mg 0.375 mg
1 tab tab
0.25 = 0.375 (1)
0.25 0.375
0.25 0.25
1
1.5 tabs = 1 tabs
2
x
x
x
x
x
Ratio and Proportion Method
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Formula Method

(D) 0.375 mg
(Q) 1 tab = x tab
(H) 0.25 mg
0.375
=
0.25
1
1 tabs
2
x
x
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1 tab 0.375 mg
tab =
0.25 mg 1
0.375
tab =
0.25
1
= 1 tabs
2
x
x
x
Dimensional Analysis Method
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Additional Example
The following example is a dimensional
analysis item that incorporates a conversion
and is based on this order:

Give: Nitroglycerin gr 1/150 sublingual p.r.n.
chest pain
Available: Sublingual nitroglycerin tabs labeled
0.4 mg
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Dimensional Analysis
with Conversion

1
gr
1 tab 60 mg
150
tab =
0.4 mg gr i 1
1
60
150
tab =
0.4
60
150
=
0.4
0.4
0.4
1 tab
x
x
x
x
x
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Variations of Tablet/Capsule
Problems
To determine the number of tablets needed
over a period of days, multiply doses per
day by the number of days
Example: Valium 10 mg p.o. q.i.d for 7 days. Tablets
available are 5 mg tablets.
1. Multiply 5 mg 2 for each dose = 2 tablets per
dose
2. Multiply 2 tablets 4 for 4 doses/day = 8
tablets/day
3. Multiply 8 tablets per day 7 to find number
needed for 7 days = 56 tablets
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Variations of Tablet/Capsule
Problems (contd)
Determining dosage to be given each time
Example: A client is to receive 1 g of a drug daily in
four divided doses
Total daily allowance
Dosage to be delivered
Number of doses per day
1 g or (1,000 mg)
= 250 mg each time the medication is given
4

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Calculating Oral Liquids
For clients with dysphagia (difficulty swallowing)
or a nasogastric, jejunostomy, or gastrostomy
tube
For infants and young children
Typesmay contain multiple meds
Elixirmeds dissolved in alcohol and water
aromatic
Suspensionmeds dissolved in water
Syrupone or more meds dissolved in sugar and
water
Note: NEVER give oral liquids by IVFATAL!
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Measuring Oral Liquids
1. Standard calibrated measuring cup
Metric, apothecary, or household measure
Place on flat surface and view at eye level
Pour with label facing you so it can be read
2. Calibrated droppers
Use only dropper supplied with medication
3. Calibrated oral syringes (tsp/mL marks)
Used for accuracy of liquid doses (e.g., 6.4 mL)
Pour medication in cup and draw up into syringe
NEVER use oral syringes for parenteral meds
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Figure 17-9 Reading meniscus. The meniscus is caused by
the surface tension of the solution against the walls of the container.
The surface tension causes the formation of a concave or
hollowed curvature on the surface of the solution. Read the level
at the lowest point of the concave curve. (From Clayton BD,
Stock YN, Harroun RD: Basic pharmacology for nurses, ed. 14,
St. Louis, 2007, Mosby.)
Figure 17-11 Oral syringes. (Courtesy Chuck Dresner. From Clayton BD, Stock YN,
Harroun RD: Basic pharmacology for nurses, ed. 14, St. Louis, 2007, Mosby.)
Figure 17-10 Medicine dropper. (Modified from
Clayton BN, Stock YN, Harroun RD: Basic
pharmacology for nurses, ed. 14,
St. Louis, 2007 Mosby.)
Figure 17-12 Filling a syringe directly from medicine
cup. (Modified from Clayton BD, Stock YN, Harroun RD:
Basic pharmacology for nurses, ed. 14, St. Louis, 2007,
Mosby.)
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Measuring Oral Liquids (contd)
Do NOT confuse dosage strength with total
volume in container
Example: May contain 100 mL in bottle, but strength
will be something like 125 mg in 5 mL
Calculations are performed in the same
manner as for solid forms of medicines
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Order: Dilantin 200 mg p.o. t.i.d.
Available: Dilantin suspension 125 mg in 5 mL

125 mg : 5 mL = 200 mg : mL
(known) (unknown)
125 = 200 5
125 1,000
125 125
1,000
125
8 mL
x
x
x
x
x