CALCULATIONS

Definition of terms
Dosage – the measured quantity of a medicine
Equation – a statement of equivalence in mathematical expressions
Equivalent – the same in number, value or meaning
Intravenous Injection – a means of administering medicine or feeding a patient through injection
Substernal – situated below or behind the sternum or breastbone

Vial – a small, closable vessel for fluids

Suppository – small piece medicine designed to melt within a body opening other than the mouth,
especially the rectum or vagina.
CALCULATIONS THAT COUNT

A glance at numerical relationships

Ratios, fractions, and proportions describe relationships between numbers.
Ratio is a quick way to compare numbers. It uses a colon between the numbers in relationship.
Ex.: 3:5 8:12 4:7
Fraction, as we all know, is a part of a whole or a portion of a certain number. It uses a slash between
numbers in the relationship.
Ex.: 2/3 4/5 6/8
A proportion is an equation written in the form stating that two ratios are equivalent.
For instance, to show that 3:6 is equal to 9:18, we would write:
3:6::9:18 or 3/6 = 9/18
2:3::4:6 or 2/3 = 4/6
5:8::10:16 or 5/8 = 10/16
 Major problem solvers
For dosages computation, we use ratios, fractions, and proportions most of the time. We will be using them in
calculating I.V. infusion rates, administering medication, converting weights between systems of measurement, and
in performing many other related tasks.
RATIOS AND FRACTIONS

Ratios and fractions are numerical ways to compare anything. We can’t simply ignore them. We use them every
day, whether we realize it or not.

Bring it on! Do the comparison!

If 1 pad has 20 tablets, then the number of pads compared to the number of tablets is 1 to 20.
In ratio, it is written as: 1:20
In fraction, it is written as: 1/20

Want more? Just go on!

If there are 5 nurses for every 35 patients in a hospital, what would be the ratio? What would be the fraction?
In fraction, it is written as; 5/35 or 1/7. In ration, it is written as; 5:35 or 1:7.
PROPORTIONS
A proportion is an equation of two ratios which can also be expressed as two fractions.

Using ratios in proportions

When using ratios in a proportion, a double colon serves as a separator. Double colon shows equality between
the two ratios.

In the example previously given, the ratio of pads with the tablets is 1:20, then 2 pads have 40 tablets. In
proportion, it is written as:
1 pad : 20 tablets :: 2 pads : 40 tablets or 1:20 :: 2:40

Go marathon using ratios in proportions!

On the second example, there are 5 nurses for every 35 patients and the ratio is 5:35. We can therefore say that
there are 10 nurses for 70 patients. In a proportion, we can express the comparison as:

5 nurses : 35 patients :: 10 nurses :: 70 patients or 5:35 :: 10:70

Using fractions in proportions

A proportion that can be expressed using ratios can also be expressed using fractions. Let’s refer to the
examples given before.

1 pad has 20 tablets which means that 2 pads have 40 tablets. Using fractions, we can write the proportion
as: or

Enjoy using fractions in proportions

There are 5 nurses for every 35 patients which equals to 10 nurses for 70 patients. We can express this in
fraction as:
WHAT IS AN “X”?

Finding the value of X is very important in dosage calculations. X is the unknown amount or quantity we are going to
compute so we can identify what is being asked for in an equation.

Steps in Solving the Value of X Using Ratios in Proportion

1. Prepare the equation.

2. Start with the solution by doing a multiplication.
Note: The product of the means is equivalent to the product of the extremes. Means are the middle quantities while the
extremes are the external quantities 3. Solve for the value of X.
4. Double check your work by completing the equation.

Example 1:

How many nurses will take charge of 15 patients if 6 nurses handle 30 patients?

Step 1. Prepare the equation.

X : 15 patients :: 6 nurses : 30 patients

Step 2. Start with the solution by doing a multiplication. Multiply the means (middle) using the left side and multiply
the extremes (external items) using the right side. Put an equal sign between both sides.

15 patients x 6 nurses = X x 30 patients

Step 2.
Start with the solution by doing a multiplication. Multiply the means (middle) using the left side and multiply the
extremes (external items) using the right side. Put an equal sign between both sides.

15 patients x 6 nurses = X x 30 patients

Step 3: Solve for the value of X. In the given problem, the value of X refers to

15 patients x 6 nurses = X x 30 patients

90 = 30 X

90 / 30 = X

or

X = 3 nurses

Therefore, 3 nurses will take charge of 15 patients while 6 nurses handle 30 patients.

Step 4:
Double check your work by completing the equation.

3 nurses : 15 patients :: 6 nurses : 30 patients

Example 2:

Find the value of X using the equation given below:

2500 mg : 10 tablets :: X : 3 tablets

To compute,
10 tablets x X = 2500 mg x 3 tablets
10 X = 7500 mg
X = 7500 / 10
X = 750 mg
Check and complete the equation
2500 mg : 10 tablets :: 750 mg : 3 tablets
Steps in Solving the Value of X Using Fractions in Proportion

1. Prepare the equation.

2. Start with the solution by doing cross multiplication.
3. Solve for the value of X.
4. Double check your work by completing the equation.

Example 1:

How many nurses will take charge of 15 patients if 6 nurses handle 30 patients?

Step 1. Prepare the equation

Step 2. Start with the solution by doing a cross multiplication .

15 patients x 6 nurses = X x 30 patients

Step 3: Solve for the value of X. In the given problem, the value of X refers to

15 patients x 6 nurses = X x 30 patients

90 = 30 X

90 / 30 = X or X = 3 nurses

Therefore, 3 nurses will take charge of 15 patients while 6 nurses handle 30 patients.

Step 4: Double check your work by completing the equation.

 We use a colon ( : ) or a double colon ( :: ) in ratios  The external items in a proportion are called ―extremes‖
 We use a forward slash ( / ) or a horizontal bar ( -------- ) in  X in an equation which stands for the missing or unknown
fractions value
 Proportion is an equation showing 2 sets of equal ratios

 The middle items in a proportion is called ―means‖

 A GLANCE AT MEASUREMENTS ANDCONVERSIONS

Dosage calculations involve measurements and conversions of the formulation, ingredients, and components of drugs.
Measurements and conversions must be calculated accurately to ensure that we will be able to give the correct dosage to our
patients.

Below is a table of most commonly used measurements with its corresponding conversions.
 
DOSAGE CALCULATION CONVERSIONS

1 liter (L)   1000 milliliters (ml)

1 ounce (oz)   30 milliliters (ml)

1 ounce (oz)   2 tablespoons (tbsp)

1 milliliter (ml)   1 cubic centimeter (cc)

1 gram (g)   1000 milligrams (mg)

1 pint   500 milligrams (mg)

1 milligram (mg)   1000 micrograms (mcg)

1 kilogram (kg)   1000 grams (g)

1 kilogram (kg)   2.2 pounds (lb)

1 inch (in) (")   2.5 centimeters (cm)

 DRUG DOSE CALCULATION USING MEASUREMENTS / CONVERSIONS

Formula:

Example 1.
Doctor orders 5 mg of morphine to be administered intravenously to a patient with substernal chest pain. You have 1 ml vial
that contains 10mg of morphine (10 mg/ml). How many milliliters are you going to have to draw up into a syringe and push IV
into your patient’s IV line port?

What are given?

Desired Dose – 5 mg of morphine IV

Concentration – 10 mg
Volume on Hand – 1 ml

What is asked? Dosage to be given to the patient, in ml

Formula:
METRIC CONVERSIONS

There are instances when we need to convert a unit of measurement to another when calculating for drug dosages.

The metric system of measurements is based on a number of basic measures or units. Take a quick look at the table below .

QUANTITY UNIT SYMBOL

length metre m

mass gram g

volume litre l

time second s
 Large and small amounts of these units often have a prefix. Also, some common units of measurement are
prefix symbol multiplication factor.
For conversion of one metric unit to another will require us to
move the decimal place to the left or to the right.

To know how many decimal places to move, follow these

steps:

1. Write the metric scale.

2. Find out what the two units in the problem are.
3. Count the number of units from the given one to the
desired one.
Example 1. Example 2.

Convert .1 decigrams to micrograms Convert 250 millilitres to litres

The decimal place is moved 3 places to the right using The decimal place is moved 3 places to the left

mg -- kg -- hg -- dag -- g -- dg -- cg -- mg -- mcg ml -- kl -- hl -- dal -- l -- dl -- cl -- ml -- mcl

Therefore, 0.1 dg = 1000 mg
Therefore, 250 ml = 0.250 l
CALCULATING ORAL DRUG DOSAGES

A Glance at Oral Drugs

These substances which are administered orally can be in the form of tablet, capsule, or liquid. Oral drugs are mostly
available in a limited number of strengths or concentrations. It is, therefore, very important that you have the skill to calculate
prescribed dosages for different drug forms.

Interpreting Oral Drug Labels

For you to administer an oral drug safely, you must make sure that it is the correct drug with the right dosage. Therefore, it is
very vital that you would be able to read and interpret oral drug labels.

1. Identify the Drug Name

Know the difference between the brand name and generic name. Verify the generic name first. If the drug has two names, the
generic name usually appears in lowercase print and sometimes in parentheses.

The generic names are the active ingredients in the medicine. Whether the brand name of generic name is used, be very
careful when reading the label to avoid errors.

Important:
Pay attention to the active, or generic name, since too much of an active ingredient can be harmful if you take more than one
product with the same active ingredient without knowing it.
2. See the Dosage Strength

After identifying the drug name, look for the dose strength on the label.

Important:
Pay close attention to the labels of two same drugs which may look exactly alike aside from that of the dose strength. One of
them might indicate 125mg and the other one is 250mg. Be keen in checking the dose strength because it forms part of the
dosage calculation
3. Check the Expiration Date

You also have to check the expiry date. It is a vital information which is sometimes overlooked.

Tip:
For best shelf life, store all medications in a cool, dry place.

Calculating Drug Dosages

Most of the time, you will use ratios in proportion to compute for drug dosages. At this point in time, you should already be
familiar in dealing with the equation using ratios in proportions.

Rules in Calculating Drug Dosages

Remember the rules to accurately calculate drug dosages and eliminate errors as well.

1. Use the correct units of measure to avoid errors in calculating doses.

2. Be careful in placing decimal and zero.
3. Double-check strange answers.
Steps in Calculating Drug Dosages Using Ratios in Proportion

1. Prepare the equation by using ratios in proportion.

2. Start with the solution by considering that the product of the means is equivalent to the product of the extremes.
Means being the middle items and extremes being the external items.
3. Solve for the value of X.
4. Double check your work by completing the equation using ratios in proportion.

Example 1:

How many ml of a medicine are in two bottles if one bottle has 60 ml?

Step 1. Prepare the equation by using ratios in proportion.

1 bottle : 60 ml :: 2 bottles : X

Step 2: Start with the solution by considering that the product of the means is equivalent to the product of the extremes.
Means being the inner items and extremes being the external items.

60 ml x 2 bottles = 1 bottle x X
Step 3: Solve for the value of X. In the given problem, the value of X
refers to
Example 2:
60 ml x 2 bottles = 1 bottle x X
How many mg of a drug are in 4 capsules if 3 capsules contain
120 ml = 1 X 1500 mg?

or Equation:
3 capsules : 1500 mg :: 4 capsules : X
X = 120 ml
Solution:
Therefore, the 2 bottles contain 20ml of medicine. 1500 mg x 4 capsules = 3 capsules x X

Step 4: Double check your work by completing the equation using 6000 mg = 3 X
ratios in proportion.
X = 6000 mg / 3
1 bottle : 60 ml :: 2 bottles : 120 ml
X = 2000 mg

Complete Equation:
3 capsules : 1500 mg :: 4 capsules : 2000 mg
A GLANCE AT RECTAL DRUGS

Rectal drugs are medications prepared specifically for insertion into the rectum. They could be in the form of cream, lotion, or
ointment. Administering the drugs rectally is best for patients who cannot take drugs orally. Rectal drugs include enemas and
suppositories.

Interpret Rectal Drug Labels

As we administer medicines to our patients, it is vital to read drug labels at all times. Paying close attention to the drug labels
helps us calculate the dosage we will give to our patients.

- identify the drug name / generic name

- check for the dose strength
- expiration date

Types of Rectal Drugs

1. Enema - the injection of liquid into the rectum through the anus for cleansing, for stimulating evacuation of the bowels, or
for other therapeutic or diagnostic purposes

2. Suppository - a small piece of medicated substance, usually conical, ovoid, or cylindrical, introduced into a body
passage, as the rectum or vagina, where body heat causes it to melt
Dosage Calculation for Rectal Drugs

Suppository is considered to be the most used form of rectal medicine. By calculating the number of suppositories we give to
the patient, we will use the ratios in proportion method.

Example 1:

Calculate for a suppository dosage supposing a patient needs 250 mg of a suppository and the package label says 125 mg.

Using ratios in proportion, we will find the value of X (number of suppository needed) and our equation will be written as follows:

1 suppository : 125 mg :: X ( # of suppository needed) : 250 mg

Let us compute:
125 mg x X ( # of suppository needed ) = 1 suppository x 250 mg

125 mg ( X ) = 1 x 250 mg

125 mg ( X ) = 250 mg

X = 250 mg / 125 mg

X = 2 suppositories
To sum it up, we will have to give 2 suppositories to the patient since 2 suppositories equal 250 mg.
Example 2:

A doctor asked the nurse to give the patient 20 mg of suppository. The suppositories on the shelf show 10 mg each.
How many pieces of suppository should you give to the patient?

This is how to solve it using ratios in proportion method. Let our equation be read as:

1 suppository : 10 mg :: X ( # of suppository needed ) : 20 mg

Let us compute for X which is the number of suppository needed

10 mg x X = 1 suppository x 20 mg

10 mg ( X ) = 1 x 20 mg

X = 20 mg / 10 mg

X = 2 suppositories

Since the patient needs 20 mg of suppository, we will give him / her 2 suppositories with 10 mg each. To check, 2
suppositories multiplied to 10 mg will give us 20 mg of suppository.
A GLANCE AT CALCULATING PEDIATRIC DOSAGES FOR ORAL DRUGS

In calculating drug dosages for pediatric patients, we have to bear in mind that children are completely different from adults.
An inaccurate dosage is more likely to harm a child than that of an adult.

Administering Pediatric Oral Drugs

Infants and young children who can hardly take tablets or capsules are given oral drugs in the form of liquid. In some cases
wherein liquid medicines are not available, you may crush a tablet and mix it with a little amount of liquid. If the medication
is mixed in a large amount of liquid (full bottle), the child will not get the entire dose if he is unable to finish the liquid.

Important:
Do not mix crushed tablet with breast milk and infant formula because it may lead to feeding refusal in the future.

Devices Used in Giving Out Pediatric Oral Drugs

• cup - can be used by bigger children

• dropper - usually used for infants

• syringe - usually used for infants

• hollow-handle spoon - usually used for toddlers

Tips in Calculating Safe Pediatric Drug Dosages

• Use a calculator in solving equations.

• Ask advice from a formulary or consult a drug handbook to verify a drug dose. If still in doubt, call a pharmacist.
• Keep a record of your patient's weight in kilograms so you do not have to estimate it or weigh him all the time.

Methods Used in Calculating Pediatric Doses

1. Body Surface Area (BSA) Method - also called the dosage-per-kilogram-of-body-weight method; considered to be the
most accurate and safest method in calculating pediatric doses

2. Clark's Rule - uses child's weight to calculate approximate dosage

3. Young's Rule - normally used for children who are two years of age or more

4. Fried's Rule - normally used for children who are two years of age or less
Body Surface Area (BSA) Method
We will have to use the nomogram to determine a child's BSA then setup an equation using the formula.
Here is the formula: Clark’s Rule

Average adult dose ( child's BSA in m² ÷ average Clark's Rule uses Weight in lbs., NEVER in kg.
adult BSA ) = Child's dose in mg
Here is the formula:
Note: Average adult BSA = 1.73 m²
Adult dose (child's weight ÷ 150) = Approximate child's
Sample: dose
We have to compute for a child's dose who weighs 40
lbs. and 36" tall. What is the safe drug dose if the Simple Sample:
average adult dose is 500mg. Using the nomogram, We have to compute for a 2-year old child's dose who weighs
the child's BSA is 0.72 m². 28 lbs. wherein the adult dose is 500mg.

Computation Based on BSA Method

500mg ( 0.72 m² ÷ 1.73 m² ) = child's dose in mg Computation Based on Clark's Rule

500mg ( .42 ) = child's dose 500mg ( 28 ÷ 150 ) = approximate child's dose

500mg ( .42 ) = 210mg 500mg ( .19 ) = approximate child's dose

child's dose = 210mg 500mg ( .19 ) = 95mg

approximate child's dose = 95mg

Young’s Rule for Children from 1 to 12 years old

Young’s Rule uses age in years.

(which makes it easier to remember, the word young refers to age)

Here is the formula:

Adult dose [ child's age in year ÷ ( child's age in year +12 ) ] = Approximate child's dose

Same Simple Sample:

We have to compute for a 2-year old child's dose who weighs 28 lbs. Wherein the adult dose is 500mg. Note that the
weight has no bearing using Young's Rule.

Computation Based on Young's Rule

500mg [ 2 ÷ ( 2 + 12 ) ] = approximate child's dose

500mg ( 2 ÷ 14 ) = approximate child's dose

500mg ( .14 ) = approximate child's dose

500mg ( .14 ) = 70 mg

Approximate child's dose = 70 mg

Fried’s Rule for Infants and Children up to 2 years

Fried's Rule uses age in months.

Here is the formula:

Adult dose ( child's age in months ÷ 150 ) = Approximate child's dose

Still the Same Simple Sample:

We have to compute for a 2-year old child's dose who weighs 28 lbs. wherein the adult dose is 500mg. Note that the weight
has no bearing using Fried's Rule.

Computation Based on Fried's Rule

500mg [ ( 2 x 12 months ) ÷ 150 ] = approximate child's dose

500mg ( 24 ÷ 150 ) = approximate child's dose

500mg ( .16 ) = approximate child's dose

500mg ( .16 ) = 80 mg

Approximate child's dose = 80 mg

 Prepared by:
May Isabel M. Reyes
Jessa Fae Mendez
Gemma Rose Ramos

BTVTED-II