The Pontifical and Royal

University of Santo Tomas

The Catholic University of the Philippines
COLLEGE OF NURSING

Nursing Pharmacology
Dosage and Solution Handout
​
Introduction:
Computing drug dosage is one of the most important skill that every nurse must develop
competence to ensure the safe and adequate delivery of medications to the patients. This handout will
provide a basic review of the different units of measurement. This will also assist the students to
develop the appropriate skill through this self-directed material and guide questions which can aid the
beginning nurses in doing computation exercises.

Measuring Systems

metric system: the most widely used system of measure, based on the decimal system, so all units in
the system are determined as multiples of ten
apothecary system: a very old system or measure that was specifically developed for use by
apothecaries or pharmacists; it uses the minim as the basic unit of liquid measure and the grain as the
basic unit of solid measure.
household system: measuring system found in recipe books
Avoirdupois system: older system used by pharmacists to compound medications

MEASURES TO REMEMBER BY HEART:

1 inch = 2.54 cm 1 kg = 2.2 lbs 1 g = 1,000 mg 1 mg = 1,000 mcg

1 grain = 60 mg 15-16 grain = 1 g 1 tsp = 5 ml 1 gtt = 4 mcgtts

Drop factor depends on the type of infusion set:

If macroset: 1 mL = 10 gtts/mL; 15 gtts/mL; 20 gtts/mL

If microset: 1 mL = 60 gtts/mL or it may be written as 60 mcgtts/mL
Microset or micro infusion set is usually used for pediatric patients and specific adult
patients who require a small, closely-regulated dose of IV solution as it delivers a small
quantity with each drop.

Volume Control Set

Infusion Pump
(Soluset as brand name) Infusion pumps may be capable of delivering fluids in
Administration of drug relies on gravity large or small amounts, and may be used to deliver
nutrients or medications – such as insulin or other
hormones, antibiotics, chemotherapy drugs, and pain
relievers.
An infusion pump draws fluid from a standard bag of intravenous fluid and controls the
rate of flow.
Syringe pumps contain a maximum volume of 50 ml, syringe pumps are used to
administer medications that have very small hourly volumes (for example, usually less than 5
ml/hr).

A number of commonly used infusion pumps are designed for specialized purposes. These
include:
• Enteral pump - A pump used to deliver liquid nutrients and medications to a patient’s
digestive tract.
▪ https://www.youtube.com/watch?v=v36FoLyiDpQ

• Patient-controlled analgesia (PCA) pump - A pump used to deliver pain medication,

which is equipped with a feature that allows patients to self-administer a controlled
amount of medication, as needed.
https://www.youtube.com/watch?v=aQHM5RwMUtc

• Insulin pump - A pump typically used to deliver insulin to patients with diabetes. Insulin
pumps are frequently used in the home.
https://www.youtube.com/watch?v=ZoH8U5HqyWE
Infusion pumps may be powered electrically or mechanically. Different pumps operate in
different ways. For example:
• In a syringe pump, fluid is held in the reservoir of a syringe, and a moveable piston
controls fluid delivery.

• In an elastomeric pump, fluid is held in a stretchable balloon reservoir, and pressure

from the elastic walls of the balloon drives fluid delivery.

• In a peristaltic pump, a set of rollers pinches down on a length of flexible tubing, pushing
fluid forward.
 • In a multi-channel pump, fluids can be delivered from multiple reservoirs at multiple
rates.

PARENTERAL DRUG ADMINISTRATION

IDEAL VOLUME TO BE ADMINISTERED:

Intradermal / Intracutaneous
➢ 0.01 to 0.1 ml

Intramuscular
➢ Ventrogluteal - 1 – 3 ml
➢ Dorsogluteal – 1-3 ml ; 5 ml for gammaglobulin
➢ Deltoid - 0.5 – 1 ml
➢ Vastus lateralis - < 0.5 in infants ( maximum of 1 ml )
1 ml pediatrics
1 – 1.5 ml adults ( maximum of 2 ml )
Subcutaneous
➢ 0.5 to 1.5 ml
** Z-Track Injection technique - done to prevent medication from leaking back into the SC
tissue. Particularly for medications that cause visible and permanent skin discoloration.
​ ​ ​Ex: iron dextran ( Imferon ) and hydroxyzine ( Vistazine )

Legend:
D – desired dose
S – stock or on hand dose
V – vehicle or drug form in which the drug comes ( tablet / capsule/ )
Q – quantity or amount of the solution
A – amount of drug calculated to be given to the client

Basic Formula
​ ​ ​D x V = amount to give
​ ​ ​S

​ ​ ​
ORAL DRUG ADMINISTRATION

a. Solid form
​ ​D x V =amount to be given ​
​ ​S

b. Liquid form
​ ​D X Q = amt. to be given
​ ​S

PARENTERAL DOSAGE

a. Powder form

b. Liquid form
​ ​ ​D X Q = amt. to be given
​ ​ ​S

Q will depend on the route and stock dose, the usual diluents are:
​If per IM dilute with 2-3mL
​If per IV stock < 500 mg dilute with 5mL
 ​If per Iv stock is >501 mg dilute with 10 mL
​
Note: refer to the drug insert for actual diluent
INTRAVENOUS FLUID COMPUTATION

a. gtts/min = total vol. of IVF x gtt. Factor (varies, but usually 15)
​ ​ duration in hours x 60mins.

b. mcgtt/min = total vol. of IVF x gtt. Factor(60)

​ ​ duration in hrs. x 60 mins.

c. cc/hr = total volume of IVF ​ ​OR ​ ​gtts./min X 60mins.

​ ​ duration in hours ​ ​ ​ ​ gtt.factor
​ ​ ​ ​
d. Duration in hours = total volume of IVF
​ ​ ​ ​ ​cc/hour

Note: In Cases of Incorporations:

• If the amount of drug to be incorporated is less than 100 mL it will not be included in
computing for the regulation if using a regular IV tubing set.
• However, if using an infusion pump, even if the amount of drug to be incorporated is less
than 100 mL it will be included in computing for the regulation.

TITRATION:
➢ All intensive care units use potent drugs that have a narrow therapeutic index. Titration is
done because the range between the dose in which the drug is effective and the dose in which
side effects offers is small.
o Ex: insulin, magnesium sulfate (anticonvulsants), sedatives, antidepressants &
anticoagulants
➢ The dose prescribed by physician either by flow rate (ml/hr or gtt/min) or
by dosage ( mg, mcg, units/kg/min or hour ).
➢ Because it is potent it needs to be titrated (adjusted by concentration and administration rate)
based on the client’s measurable reaction to the per minute dosage of medication.
➢ These medications are usually prescribed by a range of dosage with the lower level first set and
the infusion adjusted upward until the desired measurable response is obtained.
➢ Dosage are being titrated instead of abruptly stopping it.

IVF in gtts ​: ​amt. of drug to be ​:: ​X ​: ​amt. of drug to be

​ ​ incorporated in IVF in mg ​ ​ ​ to be delivered per minute
CONVERSION OF DRUG DOSAGE HAVING % AS STOCK DOSE

Ratio and Proportion * cc is the same as mL

% ​ ​: ​100cc ​ ​:: ​amt. of drugs in g ​: ​1

cc of H2O
​ ​ (constant) ​ ​ (x)

Written as: % = xg
100 mL 1 mL

th th
* % is a portion 100 Ex: 20% is 20 of 100 parts (20/100)

* 1 % means 1 gram dissolves in 100 mL of diluent

or a 1g of a drug in 100 mL of solution ( which is always constant)

* % are concentration of weight dissolved in a volume and is always expressed as

units of mass ( g, mg, mcg) per units of volume Example: g/mL, g/L, mg/mL

FORMULA:

1. Dosage calculation by Body Mass ( 1 kg = 2.2 lbs )

➢ it allows for the individualization of drug dose

Dose x wt in kg = dose / day

2. Dosage calculation by Body Surface Area ( BSA )

➢ this provides a good indication of the distribution, metabolism and excretion of medications.
➢ the most accurate way to calculate the drug dose for infants, children, older adults and clients
with antineoplastic agents whose body weight is low.

BSA – is determined by person’s height and weight intersecting the nomogram scale or computed
using the following formula:
 BSA = weight (lbs) x height (in)

3131
​BSA=

3. Pediatric Dosage using Adult Dosage

2
BSA in m x adult dose in mg = mg / dose
​ 1.73 m
2

4. Pediatric Dosage using Old Methods

​Clark’s Rule (infant & young children)

​ ​ ​Wt. in lbs. x Adult dose = mg / dose

​ ​ ​ 150

​Young’s Rule (2 years and older)

​ ​ ​___Age in year___ x Adult dose = mg / dose

​ ​ ​ Age in years + 12

​OR

​ ​ ​Age at next b-day x Adult dose Ex. 6 + 1 x Adult Dose

24 24

​Fried’s Rule (infants younger than 1 year)

​ ​ ​Age in months x Adult dose = mg / dose

​ ​ ​ 150
DRILL:

I. Oral Solid
1. Cloxacillin Na 0.5 g p.o. q6h. How many capsules will be administered per dose if the stock is
250 mg/cap?
2. Mefenamic acid 500 mg p.o. tid. How many tablets must be administered per dose if the stock is
250 mg/tab?
3. Codeine gr I p.o. STAT. How many tablets must be administered if the stock is 30 mg/tab?
4. Aspirin gr X q4h. How many tablets must be administered per dose if the stock is 300 mg
tablets?
5. Codeine 1/6 gr p.o. STAT. How many tablets must be prepared if the stock is 5mg/tab?

II. Oral Liquid

6. Chloramphenicol 125 mg p.o. qid. How many ml of the drug must be administered if the stock
is 250mg/5ml?
7. Phenytoin suspension 0.1 g p.o. tid. How many ml of the drug will be administered per dose if
the stock is 125 mg/5 ml?
8. Mycostatin 200,000 units q12h. How many ml should be administered if the stock is 500,000
units/5ml?
9. Paracetamol 1 tsp q4h prn for T>38.5 °C. How many mg of the drug is the client receiving per
dose if the stock is 125 mg/5 ml?

III. Parenteral Dosage

10. Gentamycin 50 mg IM q12h. How many ml of the drug must be administered if the stock is 80
mg/2ml?
11. Ceftazidime 250 mg IM q8h. How many ml of the drug will be administered if the stock is 1
g/vial
12. Amikacin 20 mg IM q12h. How many ml must be administered if the stock is 100 mg/ 2 ml?
13. Heparin 7,500 units SC od. How many ml should be administered if the stock is 5,000 units in
5cc vial?
14. Pen G 1,200,000 units IV q6h. How many ml of the drug should be administered if the stock is
1,000,000 units in a 10 ml vial?
15. Ampicillin 500 mg IV q6h. How many cc of the drug will be administered if the stock is 1 g/
vial?

IV. Dosage Calculation by Body Mass

16. Fluorouracil 12 mg/kg/day IV, not to exceed 800 mg/day. The adult weighs 132 lbs. How
many mg of the drug should the client receive per day?
17. Luminal 10 mg/kg IV. Client weighs 45 kg. How many ml should be administered if the stock
is 130 mg/ml?

18. diphenhydramine 50 mg qid. Weight = 15 lbs. Drug dosage = 20-40 mg/kg/day.

a) How many mL of the drug should be administered if the stock is 125 mg/5 ml?
b) Is the drug dosage within the recommended range?

19. Oxacillin 40 mg/kg/day in four divided dosage. Child weighs 33 lbs.

a) How many mg should the client receive per day?
b) How many ml of the drug should be administered per dose if the stock is 250 mg/5 ml?

V. Dosage Calculation by Body Surface Area

2 2
20. Mustargen 6 mg/m as a single IV dose. BSA = 1.5 m How many ml should be administered
per dose if the stock 10 mg/ ml?

2
21. Cyclophosphamide 100 mg/ m /day p.o. What is the dose per day if the client weighs 160 lbs
and is 5 ft and 10 in. tall?

2
22. Sulfisoxazole 2 g/ m / day in four divided doses. Child’s height is 50 in. and weighs 60 lbs.
a) What is the dose per day?
b) How many ml of the drug should be administered per dose if the stock is 500 mg/ 5 ml?

2
23. Methotrexate 50 mg/ m / weekly. Height = 54 Weight = 90 lbs.
2
Drug dosage: 25-75 mg/ m / weekly.
a) What is the weekly dose?
b) Is it within the recommended range?

VI. Pediatric Dosage by Adult Dosage

2
24. Ciprofloxacin BSA: 0.7 m Adult dose: 1000 mg/day in four divided doses.
a) How many mg should the child receive per day?
​b) How many ml should be administered per dose if the stock is 125 mg/ 5 ml?

25.Erythromycin 125 mg p.o. qid. Height = 42 in. Weight = 60 lbs.

Adult dosage : 1000 mg/ day.
​a) How many mg of the drug should the client receive everyday?
 ​b) Is the prescribed dose safe?

VII. Pediatric Dosage using Old Methods

26. The adult dose of sultamicillin is gr XX. What is the dose for a 4 yr old child?
27. What is the dose for a 5 month old infant prescribed with luminal Na the usual AD is 35mg
28. The usual adult dose of a given drug is 60 mg. What is the dose for a child weighing 50 lbs?
29. The average adult dose of a drug is 125 mg. Determine the dose for an 8 month old child.
30. The average adult dose of metronidazole is 250 mg. Determine the dose for a 6 year old and
who weighs 68 lbs.

VIII. Intravenous Fluid Regulation

31. Infuse D5NR 1 L for 8 hrs. What is the regulation in gtts/min.

32. How many hours will a 1 liter of D5 NM run if it will infuse at 25 gtts/min?

33. Infuse PLRS 1 L for 12 hrs. What is the regulation of the IVF in gtts/min?

34. Infuse D5NSS 1 L 40 gtts/min , with 1mL=20gtts as drop factor

​a. How many ml of the IVF is the client receiving per hour?
​b. If it is started at 8 am, at what time will it be consumed?
35. Incorporate 10 mEq KCl and 25 mEq NaCl to D5NR 1 L.
​a. How many ml of KCl will be incorporated if the stock is 40 mEq/20 ml?
​b. How many ml of NaCl will be incorporated if the stock is 50 mEq/20 ml?
​c. What is the regulation of the IVF if it is to run for 10 hours?

VIII. Titration , Ratio and Proportion

36. Incorporate 5 g of MgSO4 to D5W 500ml to infuse for 8 hours.

a. How many ml of MgSO4 will be incorporated if the stock is 25% in 10 ml ampule?

​b. What is the regulation of the IVF?

37. Administer 5 g of MgSO4 deep IM to be divided into 2 buttocks.

 How many ml of MgSO4 will be injected into each buttock if the stock is 50% in 10 ampule?

38. Administer 1 g of Xylocaine in 250 ml of D5W to deliver 2mg/min.

a. How many ml of Xylocaine will be incorporated in the IVF if the stock is 1% in 50ml vial?
​b. What is the regulation in mcgtts/min if it is to deliver 2mg/min?
39. Administer 2 g of Xylocaine in D5W 500 ml to deliver 2mg/min.

a. How many ml of Xylocaine will be incorporated if the stock is 2% in 50 ml vial?

​b. What is the flow rate in mcgtts/min?
40. Administer 1 g of Xylocaine in 250 cc of D5W to deliver 3 mg/min. Stock dose
is 2% in 50 ml vial.

a. How many ml of Xylocaine will be incorporated if the stock is 50 ml vial?

b. What is the regulation in mcgtts/min?

41. Start dopamine drip 400 mg in 250 mL D5W at 10 mL/hr initially with an increment or
decrement of 5 mL/hr (max. 45 mL / hr) to maintain BP > 90 / 60.

a. How many mg/min is the patient receiving initially?

b. At a maximum of 45 mL/hr regulation, how many mg will a patient receive in an hour?
c. How many mg/min is 5 mL/hr?
d. With an increment of 5 ml/hr, how many mg will a patient receive in 5 hours?

42. Prepare dopamine drip 800 mg in 500 mL D5W at 10 mcg/kg/min. Patient’s weight 55 kg.
​Stock dose reads: 40 mg/mL in a 5 mL vial

a. How many mL will the nurse aspirate?

b. How many vials will the nurse requisitioned in the pharmacy?
c. What syringe size the nurse would use in aspirating dopamine?
d. How many mcg/min will the patient receive?
e. What is the regulation of the infusion pump of the desired dose?

43. Prepare heparin drip 25,000 units in 250 mL D5W. Administer 30 units/kg as bolus dose and
increase by 2 units/kg/hr. Currently the patient is receiving 16 units/kg/hr.
Patient’s weight is 74 kg.
Stock dose: 5,000 units/mL in 5 mL vial and 10,000 units/mL in 5 mL vial.

a. How many units will the patient receive as bolus?

b. How many vials will the nurse requisition from the pharmacy, which stock dose would the
 nurse choose from?
c. Regulate the infusion pump with the current dose.
d. How many units per min is the patient receiving from the current dose?

44. The physician has ordered procainamide hydrochloride (Pronestyl) IV, titrated to control
dysrhythmia at a rate of 1,500 mcg per minute.
Stock dose vial contains 1,000 mg per 2 mL.
The physician orders 1,000 mg of Pronestyl to be added to 500 mL of D5W.
It is to be delivered via infusion pump and is set to deliver at 60 drops per mL or 60 mL/hr.

a. How many mL of Pronestyl should the nurse add to the 500 mL of D5W? ____ mL
b. How many mg of Pronestyl are present in 1 mL of the solution? ​ ____ mg/mL
c. Convert this value to mcg per mL ​ ​ ​ ​ ​ ​ ____
mcg/mL
d. How many mL per minute must infuse to deliver the prescribed amount
of the drug? ​ ​ ​ ​ ​ ​ ​ ​ ____mL/min
e. How many mL per hour should the infusion pump be set to deliver? ​ ____mL/hr

45. The physician has prescribed isoproterenol hydrochloride (Isuprel) 5 mcg per minute by IV
infusion. The physician ordered 2 mg of Isuprel be added to 500 mL of D5W.
Stock dose is 1 mg per 5 mL vial.
This is to be delivered via infusion pump and is set to deliver at 60 drops per mL or 60 mL/hr.

a. How many mL of Isuprel should the nurse add to the 500 mL of D5W? ____ mL
b. How many mg of Isuprel are present in 1 mL of the solution? ​ ​ ____
mg/mL
c. Convert this value to mcg per mL ​ ​ ​ ​ ​ ​ ____
mcg/mL
d. How many mL per minute must infuse to deliver the prescribed amount
of the drug? ​ ​ ​ ​ ​ ​ ​ ​ ____mL/min
e. How many mL per hour should the infusion pump be set to deliver? ​ ____mL/hr

46. The physician has ordered amiodarone hydrochloride (Cordarone IV) 900 mg to be added to
500 mL of D5W and run intravenously at a rate of 1 mg/min for 6 hours.
Stock dose is 3 mL vials of Cordarone IV which contains 50 mg per 1 mL.
This is to be delivered via infusion pump and is set to deliver at 60 drops per mL or 60 mL/hr.

a. How many mL of Cordarone IV should the nurse add to the 500 mL of D5W? ____ mL
b. How many mg of Cordarone IV are present in 1 mL of the solution? ​ ​____
 mg/mL
c. Convert this value to mcg per mL ​ ​ ​ ​ ​ ​ ____
mcg/mL
d. How many mL per minute must infuse to deliver the prescribed amount
of the drug? ​ ​ ​ ​ ​ ​ ​ ​ ____mL/min
e. How many mL per hour should the infusion pump be set to deliver? ​ ____mL/hr

47. The physician has ordered dobutamine hydrochloride (Dobutrex) 250 mg to be added to
500 mL of D5W and run intravenously at a rate of 5 mcg/kg/min for a patient weighing 65 kg.
Stock dose is 20 mL vials of Dobutrex IV which contains 250 mg.
This is to be delivered via infusion pump and is set to deliver at 60 drops per mL or 60 mL/hr.

a. How many mL of Dobutrex should the nurse add to the 500 mL of D5W? ____ mL
b. How many mg of Dobutrex are present in 1 mL of the solution? ​ ____
mg/mL
c. Convert this value to mcg per mL ​ ​ ​ ​ ​ ​ ____
mcg/mL
d. How many mL per minute must infuse to deliver the prescribed amount
of the drug? ​ ​ ​ ​ ​ ​ ​ ​ ____mL/min
e. How many mL per hour should the infusion pump be set to deliver? ​ ____mL/hr

49. The physician has ordered dopamine hydrochloride (Intropin) 200 mg to be added to
250 mL of D5W to run intravenously at a rate of 5 mcg/kg/min until the patient’s systolic BP is
greater than 110 mmHg. The patient’s weight 80 kg.
Stock dose is 20 mL vials of Dobutrex IV which contains 250 mg.
This is to be delivered via infusion pump and is set to deliver at 60 drops per mL or 60 mL/hr.

a. How many mL of Intropin should the nurse add to the 500 mL of D5W? ____ mL
b. How many mg of Intropin are present in 1 mL of the solution? ​ ____ mg/mL
c. Convert this value to mcg per mL ​ ​ ​ ​ ​ ​ ____
mcg/mL
 d. How many mL per minute must infuse to deliver the prescribed amount
of the drug? ​ ​ ​ ​ ​ ​ ​ ​ ____mL/min
e. How many mL per hour should the infusion pump be set to deliver? ​ ____mL/hr

References:
1. Karch, Amy M. “Focus on Nursing Pharmacology” 5th Edition 2009
th
2. Kee, Joyce L. and Hayes, Evelyn B. “Pharmacology: A Nursing Process Approach” 6 Edition 2008
th
3. Clayton & Stock “Basic Pharmacology for Nursing” 14 Edition 2007
th
4. Lilley, Harrington, Snyder “Pharmacology and the Nursing Process” 5 Edition, 2007

Prepared by:
Asst. Prof. Eleanore B. Lerma MAN, RN updated 2020 - 2021
UST College of Nursing – Center of Excellence in Nursing Education ​Page 1