DOSAGE CALCULATIONS

DOSE DETERMINATION FACTORS:

 Sex  Physical Condition
 Weight  Other Active Drugs
 Age

NOTE: Frequently, the dose that is 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.

Mathematical Calculations Responsibility (Legally and Professionally) of:

 Prescriber - orders
 Pharmacist – dispenses
 Nurse - administers

MEASURING CALCULATIONS:
4 Different Systems:
1. Metric System – (most common and widely used even in the hospital! worldwide; medium of sharing
easier) based on the decimal system, so all units are determined as multiples of 10.
a. Gram (g) / Liter (L)

2. Apothecary System – (very old system) specifically developed for use by apothecaries or pharmacists.
much harder to use; rarely seen in most clinical settings.
a. Uses Roman numerals placed after the unit of measure to denote amount (15 grains = gr xv)
b. Grain (gr) / Minim (min)

ORDER: Give Phenobarbital (kind of barbiturates that is a medicine given for seizures! Available for
grain V / X ) gr X (10 grain) PO (per orem / orally) T/D (8-1-6 / 9-1-5)

CONVERT INTO MILIGRAM! (since its on tablet form + oral route)

REFERENCE IF SOLID FORM: gr I = 60 mg / IF LIQUID FORM: 1 minim = 60 mL
gr 10 x 60 = 600 mg

If available drug is by 300 mg per tablet. How many would you give? ANSWER: 2 TABLETS

3. Household System – (found in recipe books) Patients need to be advised that flatware teaspoons and
drinking cups vary tremendously in the volume that they contain.
a. A flatware teaspoon could hold up to two measuring teaspoons of quantity.
NOTE: Important to clarify to the patients that the measures indicated in the instructions refer to
a standardized measuring device.
b. Pound (lb) / tablespoons (tbsp)

ORDER: Give Salbutamol + Guaifenesin 30mL PO T/D

CONVERT INTO TSP:

REFENCE: 1 TSP = 5 mL / 3 TSP = 1 TBSP
1 TSP = 5 ML X 3 = 15mL x 2 TSP = 30 mL = ANSWER GIVE 2 TBSP
4. Avoirdupois System – (older system that was very popular when pharmacists routinely had to
compound medications) seldom used by prescribers but may be used for bulk medications that come
directly from the manufacturer
5. OTHER SYSTEMS – mEq reflects the biological activity of the drug in 1mL of solution especially for
electrolytes; IU are uniquely used for vitamins and enzymes
Ex: KCL (Potassium Chloride) = 2 mEq/mL (plastic vial)
NaCl (Sodium Chloride)

ORDER: IVF of 500 cc PNSS (Plain Normal Saline Solution) + 25 units Humulin N (example of
insulin; interacting insulin) + 10 mEq KCL x (to run) 10 mgHs/m (microdrop per minute)
**insulin syringe per calibration is 1 ml
HOW MANY KCL is needed to mix on IV fluid? ANSWER IS 5 mL
 KCL Stock is 2 mEq/mL = d over s x q
D – desired dose = 10 mEq
S – stock dose = 2 mEq/mL
Q – quantity = 1 mL

(Get PNSS 500 mL + 25 units Humulin N + 5mL KCL and then regulate it to 10 mgHS/m)
** 2mEq/mL usual preparation in hospital!

ORDER: VIT A 200,000 IU (international units; looks like a tear drop with color red caplet | for kids
(blue) – 100,000 IU)
**1 caplet of 200,000 IU = normally 4 drops (but give only 2 then discard for kids / if for adult
using blue caplet= give 2 caplet)

NOTE: important to be able to perform conversions—finding the equivalent values between two types of
measure (each and between systems of measure)

HISTORY CHECK!
1995 - U.S. Pharmacopeia Convention
 established standards requiring that all prescriptions include the metric measure for the quantity and strength of drug.
 established that drugs may be dispensed only in the metric form.

Other Systems:
 Unit - usually reflects the biological activity of the drug in 1 mL of solution. (unique for the drug it
measures)
o Example: a unit of heparin is not comparable to a unit of insulin.
 Milliequivalents (mEq) - measure electrolytes (e.g., potassium, sodium, calcium, fluoride)
o refers to the ionic activity of the drug in question
o order is usually written for a number of milliequivalents instead of a volume of drug.
 International units (IU) - sometimes used to measure certain vitamins or enzymes.
o These are also unique to each drug and cannot be converted to another measuring form.

MEASURING CALCULATIONS:
Simplest Way: Ratio and Proportion Equation
The ratio containing two known equivalent amounts is placed on one side of an equation, and the ratio
containing the amount you wish to convert and its unknown equivalent is placed on
the other side.
NOTE: Necessary to first check a table of conversions to determine the equivalent measure in the two systems
you are using

Example:

Calculating dose:
1. ORAL DRUGS - Frequently, tablets or capsules are not available in the exact dose that has been
ordered.
 Known Equivalent - amount of drug available in one tablet or capsule
 Unknown Equivalent - number of tablets or capsules that are needed for the prescribed dose
Example:

ORDER TABLET: Cefuroxime 1000 mg PO BID (2x a day / 8-6 / 9-5 or after meal)
D – desired dose = 1000 mg
S – stock dose = cefu 500 mg / tab
HOW MANY TABLETS TO BE GIVEN?
ANSWER: 2 TABS

ORDER TABLET: Cefuroxime 750 mg IV q bar every 8 hrs after - ANST (after negative skin test)
**normally since thru IV, must be diluted to sterile water, cefuroxime is hurtful thru IV – you can
dilute for 5 cc of sterile water to dilute and lessen the pain
D – desired dose = 750 mg
S – stock dose = cefu 750 mg / vial
Q – quantity = 5 cc
ANSWER: 5 cc

**PATIENT HAS A STABBED WOUND (need an emergency exploratory laparotomy)

ORDER TABLET: Cefazolin (antibacterial under cephalosporin) 1g IV LD (loading dose) then 500
mg IV q bar every 12 hrs ANST
**Cefazolin is also painful so you can dilute it on 10 cc of sterile water
D – desired dose = 1000 mg
S – stock dose = cefazolin 1000 mg / vial
Q – quantity = ?? not give but you can put10 cc value of the sterile water for d i l u t i o n
HOW MANY mL of the meds you will give to the patient? ANSWER: 10 cc

NOTES:
 Merrem can be diluted on 50 cc sterile water
incorporated in soluset (has IV chamber and
calibration which is normally 100 cc)
 Penicillin G 1 million unit / vial is also painful but
practice in OM, it is diluted on 1 cc only but you can dilute it to 5 cc / 10 cc too = to
lessen pain
 Metoclopramide (for emetic patients / nagsusuka, an anti emetic drug) 25 mg / 2ml
ampule
o Can be used for hyper emesis gravidarum
 Give metoclopramide 25 mg TID
 D – desired dose = 25 mg
 S – stock dose = 25 mg
 Q – quantity = 2 mL
 HOW MANY given through IV? ANSWER: 2 mL

NOTE:
 Sometimes the desired dose will be a fraction of a tablet or capsule (1/2 or 1/4)
 Some tablets come with scored markings that allow them to be cut using Pill cutters
 Many tablets come in a matrix system that allows for slow and steady release of the
active drug (cannot be cut, crushed, or chewed)
o Any tablet that is designated as having delayed or sustained release may very well
be one that cannot be cut.
o Capsules can be very difficult to divide precisely, and some of them also come
with warnings
 Always consult a drug reference before cutting
 BEFORE CUTTING - different formulation of the drug, a different drug, or a different
approach to treating the patient should be tried.
  Liquid Preparations (pediatrics and for adults who might have difficulty swallowing) The ratio
on the left of the equation shows the known equivalents, and the ratio on the right side contains
the unknown. The phrase “amount of drug” must appear in the numerator of both ratios, and the
volume to administer is the unknown (X).
Example:

2. PARENTERAL DRUGS - 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:

3. INTRAVENOUS SOLUTION - used to deliver a prescribed amount of fluid, electrolytes, vitamins,

nutrients, or drugs directly into the bloodstream.
Standard Control:
 Microdrip - each milliliter delivered contains 60 drops.
 Macrodrip - deliver 15 drops/mL; usually used when a large volume must be delivered quickly.
NOTE: Always check the packaging of the IV tubing to see how many drops/mL are delivered by that
particular device if you have any doubts or are unfamiliar with the system.
Example:

Drop Rate / gHs / min: volume to be infused in mL over how

long will you infused (hrs multiply by drop factor (depends on the
manufacturer: macro set (adult) vs micro set (pediatric / adults in
terms of side drip / piggy back))
**Drop Factor Macro Set = 15 / 20
**Drop Factor Micro Set = 60 constant

ORDER: IVF OF D5LR (IVF type used for patients undergoing

surgery / OBY Patient) x 8 hrs
**( 1000 ml divided by 8 ) multiplied by (15 divided by 60 ) = 31 . 25 / 31 – 32 drops / min
** 0 – 17 years old = considered as pediatrics = micro set
** 18 and above years old = macro set

ORDER: IVF OF PNSS 1L x (to run) 24 hrs

**( 1000 ml divided by 24 ) multiplied by (15 divided by 60 ) = 10 . 41 / 10-11 drops / min or KVO
(keep vein open) – needed when patient does not really IVF but needs an IV line for his / her
antibiotic
** 0 – 17 years old = considered as pediatrics = micro set
** 18 and above years old = macro set

PEDIATRIC CONSIDERATIONS
 The “standard” drug dose that is listed on package inserts and in many
references refers to the dose that has been found to be most effective in the
adult male.
 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.
FACTORS: Child’s Age & Weight or Body Surface.

BODY SURFACE AREA: use of a nomogram (height and weight)

If such a nomogram is not available, however, it is good to know that other methods
can be used.
Regardless of the calculation method used for children, even a tiny dose error can be critical. When working in
pediatrics, one needs to be familiar with at least one of these
methods of determining the drug dose.

Formulas for Calculating Pediatric Doses

1. Fried’s Rule – 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.

2. Young’s Rule - children 1 to 12 years of age.

3. 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.

**PRE CLINICAL TRIAL – PHASE 1 TO PHASE 4: Normally Subjects are adult male (150 pounds)

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.
Example:
If a child with postoperative nausea is to be treated with Vistaril (hydroxyzine) the recommended dose is 1.1
mg/kg by intramuscular injection.
 If the child weighs 22 kg, the dose for this child would be 1.1 mg/kg times 22 kg, or 24.2 mg, rounded
down to 24 mg.
 If a child weighed only 6 kg, the recommended dose would be 1.1 mg/kg times 6 kg, or 6.6 mg.
The established guidelines allow the drug to be used safely within a large range of children. Some adult doses
will also be written in this way.
Usually found in drugs with a small margin of safety / high potential for toxic effects, such as antineoplastic
drugs.

Normal Body Surface Area: 1.73 – normal adult male