Dosage Calculations

Chapter 5:
Prescriptions and
Dosage Calculations
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Responsible Parties
 The prescriber who orders the drug
 The pharmacist who dispenses the drug
 The nurse who administers the drug
Copyright © 2017 Wolters Kluwer • All Rights Reserved

PRESCRIPTION AND MEDICATION
ORDERS

PRESCRIPTION
• Prescription is a written order from
a licensed physician, dentist, and
veterinarian to a licensed pharmacist to
prepare and dispense speciﬁc
medication for a particular outpatient.

PARTS OF A
PRESCRIPTION
1. Patient Information
2. Date of prescribing
3. Superscription
4. Inscription
5. Subscription
6. Transcription
7. Prescriber information
8. Reﬁll information

Patient
Information
• Name
• Age
• Sex
• Weight and Height

Date of
Prescribing
• The date when the prescription was written by
the prescriber

Superscription
• It is represented by the symbol Rx which
means
• “you take” or
• “take though” or
• “recipe”

Inscription for Prepared
Drug
• Generic name of the drug
• Brand name of the drug
• Dosage form
• Potency/strength
• Quantity

AMALIA FUENTES, MD
INTERNAL MEDICINE – CARDIOLOGY
MAKATI MEDICAL CENTER ASIAN HOSPITAL & MEDICAL CENTER

10-‐12 TTH 1-‐3 MWF
Tel. 2314455 Tel . 445777
Pa3ent’s Name SUSAN ROCES

Age 55 Sex Female Date_April 5 2009_
Rx
Valsartan 160 mg tab #30
(Diovan)
Sig. ½ tablet aier dinner
A m a l i a Fuentes, MD
Lic. No. 55505
PTR No. 1583991
10

Inscription for Compounding
Drug
• Name of the ingredients

– Base
– Adjuvant
– Corrective
– Vehicle
• Quan3ty
11

Example of
Compounding Drug
Rx
Dextromethorphan 0.18
Guiafenesin syrup 1.2
Alcohol 2.1
Flavored syrup ad 60.0
M. Ft. Syr.
Sig. 5 mL t.i.d. for
cough
12

Subscription
• Direction to the pharmacist on how to prepare
the drug.
• Instruction usually make use of
Latin abbreviation
• Found only in compounding Rx
• e.g. M. i . sol.
• M. i . cap. Dtd #12
13

Transcription
• Direction to the patient on how, when, how much to
take, how long.
• Size of the dose
• Number of doses
• Number of days the drug must be taken
• Use of the drug (optional)
• Mode of administration
Sig. 1 tsp 3d for cough for 5 days
14

Size of the dose
• One cap
• One tablet
• One teaspoon or 5 mL
• One suppository
• One tablet dissolve in a glass of water
• One sachet
15

Number of doses
• Once a day or od
• Twice a day or bid
• Three 3mes a day or 3d
• Four 3mes a day or qid
• prn
16

Number of days the drug must
be taken
• For 1 day
• For 3 days
• For 5 days
• For 7 days
• For 30 days
• prn
17

Mode of Administration
• Take • Spray
• Instill • Place under the tongue
• Apply • Inject
• Insert – Intravenously
• Apply with rubbing – Intramuscularly
– Subcutaneous
• Dissolve in a glass of
– Intradermal
water
– Intraperitoneal
• Inhale

Prescriber information
• Name of the Prescriber
• Signature of the prescriber
• PTR number and date issued
• PRC license number and date issued
• S2 license number and date issued(for yellow
prescription)
19

Republic of the Philippines serial no. 1125
Doctor’s name Address
Opium license No.
Pa3ent’s name Date issued
Rx Address
Meperidine Hydrochloride ampoule # 10
(Demerol)
Signa: 1 ampoule IM prn .
Christopher de Leon,
MD PRC License No.
00452 PTR No. 21445
Dangerous Drug Prescrip3on or yellow prescrip3on

18
MEDICATION ORDERS
• MEDICATION ORDERS are orders for
medications by a licensed physician
intended for the use of a particular
inpatient in an institutional
setti ng .
21

INFORMATION IN THE MEDICATION ORDERS
1. Patient information(name and history no.)

2. Room number
3. Date and Time the order was written
4. Name of the drug, dosage form, potency, quantity and
route of administration
5. Prescriber’s signature
6. Directions for the pharmacist
7. Instruc7on for Administration, including quantity,
schedule and duration of use
8. Name or initials of person(s) who transcribed the order
(nurse or pharmacist)
22

Medical Center Hospital
Sampaloc , Manila
PATIENT MEDICATION
ORDERS
PATIENT NAME: DAVID GO

HISTORY NUMBER: 120579 ROOM NUMBER : 430
WEIGHT: 125 LB HEIGHT: 5”9” AGE: 62 y.o.
ATTENDING PHYSICIAN : DR. JAMES DINGLASAN
DATE TIME ORDERS

01/0106 1300 10,000 UNITS Heparin Sodium in 250 mL NS
Infuse IV over 4 hr. James Dinglasan, MD
Joan Cruz, RN 01/01/06
01/02/06 1400 Morphine sulfate 10 mg and atropine sulfate 0.4 mg
On call for surgery at 0800 on 01/03/06. give IM.
James Dinglasan, MD
Joan Cruz, RN 01/02/06
Inpatient Medication orders

23

Prescription and medication order
accuracy
• Each medication must be

– therapeutically appropriate to the patient
– prescribed at the correct dose
– dispensed in the correct strength and the dosage form
– correctly labeled with complete instructions for the
patient or caregiver
– for patient in the hospital, each medication must be
administered to the correct patient, at the correct time
and by the correct rate and route of administration
24

Dosing Considerations
 Packaging
 Sex
 Weight
 Age
 Physical Condition
 Other drugs that the patient is taking

Measuring Systems
 Metric System
 Apothecary System
 Household System
 Avoirdupois System

Metric System
 Solids: Gram (g)
o 1 milligram (mg) = 0.001 g
o 1 microgram (mcg) = 0.000001 g
o 1 kilogram (kg) = 1000 g
 Liquids: Liter (L)
o 1 milliliter (mL) = 0.001 L
o 1 mL = 1 cubic centimeter = 1 cc

Apothecary System
 Solids: Grain (gr)
o 60 gr = 1 dram (dr)
o 8 dr = 1 ounce (oz)
 Liquids: Minim (min)
o 60 minim = 1 fluid dram (f dr)
o 8 (f dr) = 1 fluid ounce (f oz)

Household System
 Solids: Pound (lb)

o 1 lb = 16 ounces (oz)
 Liquids: Pint (pt)
o 2 pt = 1 quart (qt)
o 4 qt = 1 gallon (gal)
o 16 oz = 1 pt = 2 cups (c)
o 32 tablespoons (tbsp) = 1 pt
o 3 teaspoons (tsp) = 1 tbsp
o 60 drops (gtt) = 1 tsp

Other Systems #1
 Avoirdupois System
o Older system
o Ounces and grains
 Other Systems
o Measures may reflect chemical activity or biological
equivalence
 Unit
 Milliequivalents
 International units

Other
Systems
#2

Prescription Abbreviations

Latin meaning
• p.o. – per os/per • t.i.d. – ter in die

orem • q.i.d. – quarter in die
• o.d. – oculus dexter /
• q.h.s. – quaque hora
once a day
somni
• o.s. – oculus sinister
• q.h. – quaque hora
• o.u. – oculus ulterque
• a.c. – ante cibum
• q.d. – quaque die
• p.c. – post cibum
• b.i.d. – bis in die

Other Abbreviations
• AAA – apply to affected area • DC, dc, d/c, disc. –
• a.c.h.s./ac&hs – ante cibum discontinue or discharge
et hora somni = before • dil. – dilute
meals and at bedtime • elix. – elixir
• a.l./a.s. – auris laeva/auris
• et – and
sinistra = left ear
• bucc. – bucca = inside cheek • gr. – granum = grain
• cap./caps. – casual – capsule • gtt(s)/gutt – gutta(e) =
drop(s)
• c̄ - cum = with
• IJ – injection = injection
• c.c. – cum cibo = cubic
• i – unus tabulleta = one tablet
centimeter = 1 mL
• DAW – dispense as written • ii – duo tabulleta = two tablets

Other Abbreviations part 2
• iii – tres tabulleta = three • NPO – nil per os / nothing per
tablets orem
• IO – intraosseous • p.c.h.s. /pc&hs – post cibum et
• IP – intraperitoneal hora somni = after meals and at
bedtime
• IT – intrathecal • p.r./PR – per rectum = rectally
• “IU” – international unit • pulv. – pulvis = poweder
• IV – intravenous • q1h/q1°- quaque hora
• IVP – intravenous push • SC/SQ – subcutaneous
• IVPB – intravenous piggy back • SL – sub lingua = sub
• mEq – milliequivalent lingual/under the tongue
• Neb/nebul – nebula = • Supp – suppositorium =
nebulizer/nebulize suppository

Other Abbreviations part 3
• Susp – suspension
• Syr – syrupus = syrup
• Tab – tabella = tablet
• Stat – statim = immediately
• tinct. – tincture = tincture
• top. – topical
• trit. – triturate = grind to a
powder

Question #1
Tell whether the following statement is true or false.
The avoirdupois system is a system of measurement that

uses ounces and grains.

Answer to Question #1
True
Rationale: The avoirdupois system is another older system

that was very popular when pharmacists routinely had to
compound medications on their own. This system uses
ounces and grains, but they measure differently than
those of the apothecary and household systems. The
avoirdupois system is seldom used by prescribers, but
may be used for bulk medications that come directly
from the manufacturer.

Calculating Dosage
 Oral Drugs
 Parenteral Drugs
 Intravenous Solutions

Ratio Proportion Conversion Between
Systems oral and parental

Example

Examples

Calculating IV Drip Rate

Differences Between Children and Adults
 Children absorb, distribute, metabolize, and excrete
drugs differently than adults
 Children’s organs are not as developed as an adult’s
organs

Pediatric Dosage Calculation
 Fried’s Rule
 Young’s Rule
 Clark’s Rule
 Surface Area Calculation- Most used

Fried’s Rule
This rule assumes that an adult dose would be appropriate

for a child who is 12.5 years (150 months) old

Young’s Rule

Clark’s Rule
Uses the child’s weight to calculate the appropriate dose
and assumes that the adult dose is based on a 150-lb
person

Surface Area Calculation #1
Determine the child’s surface area with the use of a

nomogram (the height and weight of the child are
taken into consideration in this chart)

Surface Area
Calculation #2

Question #2
What is the most accurate calculation for drug dosage in a

child?
A. Fried’s rule
B. Young’s rule
C. Clark’s rule
D. Surface area calculation

Answer to Question #2
D. Surface area calculation
Rationale: These rules are not usually used today. The

nomogram, which uses body surface area, is more
accurate for determining dosages

EXERCISES

ORAL SOLIDS
1. Cloxacillin Na 0.5g PO q6°. How many capsules will be

administered per dose if the stock is 250mg/cap?
2. Mefenamic Acid 500mg PO TID. How many Tablets must
be administered per dose if the stick is 250mg/tab?

ORAL LIQUIDS
1. Ampicillin 125mg PO QID. How many mL of drug must

be administered if the stick is 250mg/5mL?
2. Phenytoin suspension 0.5g PO TID. How many mL of the
drug will be administered if the stock is 125mg/mL?

PARENTHEREAL DOSAGE
1. Gentamycin 50mg IM q12h. How many mL of the drug

must be administered if the stock is 80mg/2mL?
2. Heparin 7,500 units SC OD. How many mL should be
administered if the stock is 5,000 units/mL in 5cc vial?

DOSAGE CALCULATIONS BY BODY MASS
1. Cefaclor 50mg QID. Weight = 15lbs. Drug Dosage= 20-

40mg/kg/day
1. How many cc of the drug should be administered if
the stock is 125mg/5mL?
2. Is the drug dosage within the recommended range?
2. Fluoroucil 12mg/kg/day IV, not to exceed 800mg/day. The adult
weighs 132 lbs. How many mg of the drug should the client
receive per day?

DRUG CALCULATIONS BY BODY SURFACE AREA
1. Mustargen 6mg/m2 as a single IV dose. BSA = 1.5 m2. How many
mL should be administered per dose if the stock is 10mg/mL?
2. Sulfisoxazole 2g/m2/day in four divided doses. Child’s height is 50
inches and weighs 60lbs
1. What is the dose/day?
2. How many mL of the drug should be administered per dose
if the stock is 500mg/5mL?

PEDIATRIC DOSAGE
1. Penicillin V BSA: 0.7 m2 Adult dose: 1000mg/day in four divided
doses
1. How many mg should the child receive per day?
2. How many mL of the drug should be administered per dose
if the stock is 125 mg/5mL?
2. The usual adult dose of a certain drug is 50mg. What is the dose
for an infant 15 months old?
3. The average adult dose of a drug is 125 mg. Determine the dose
for an 8 month old child?
4. The average adult dose of penicillin V is 250 mg. Determine the
dose for a 6 year old and who weighs 68 lbs.

IVF REGULATION
1. Infuse D5NR 1L for 8 hours. What is the regulation in gtts/min?
2. Infuse D5NSS 1L 40 gtts/min.
1. How many mL of the IVF is the client receiving per hour?
2. If it is started at 8 am, what time will it be consumed?
3. How many hours will a 1L of D5NM run if it will be infuse at 20
gtss/min?

PREPARING SOLUTIONS
1. Prepare 500 cc of a 5% Boric acid solution How many g of Boric
acid should be included in the solution?
2. A client is to have 25% of Ensure for NGT feeding. A 250 mL
Ensure is available. How many mL of the water is needed?

Dosage Calculations

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Chapter 5:

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

MAKATI MEDICAL CENTER ASIAN HOSPITAL & MEDICAL CENTER

Pa3ent’s Name SUSAN ROCES

Valsartan 160 mg tab #30

Sig. ½ tablet aier dinner

Copyright © 2017 Wolters Kluwer • All Rights Reserved

• Name of the ingredients

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Dangerous Drug Prescrip3on or yellow prescrip3on

Copyright © 2017 Wolters Kluwer • All Rights Reserved

1. Patient information(name and history no.)

Copyright © 2017 Wolters Kluwer • All Rights Reserved

PATIENT NAME: DAVID GO

DATE TIME ORDERS

Infuse IV over 4 hr. James Dinglasan, MD

Joan Cruz, RN 01/01/06

01/02/06 1400 Morphine sulfate 10 mg and atropine sulfate 0.4 mg

On call for surgery at 0800 on 01/03/06. give IM.

Joan Cruz, RN 01/02/06

Inpatient Medication orders

Copyright © 2017 Wolters Kluwer • All Rights Reserved

• Each medication must be

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

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 Solids: Pound (lb)

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• p.o. – per os/per • t.i.d. – ter in die

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Tell whether the following statement is true or false.

The avoirdupois system is a system of measurement that

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Rationale: The avoirdupois system is another older system

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Copyright © 2017 Wolters Kluwer • All Rights Reserved