Drug Calculations
Conversion problems
9 oz = ________ mL
10 tsp = _______ mL
30 mg = _______ mcg
0.5 grams = ____ mcg
170 lbs = ______ kg
SOLUTIONS:
Drug order states: to give cimetidine 200 mg tablet. How many tablets
should you give per dose?
Drug order states: to give 50 mg of paracetamol P.O q4h for fever 38C and
above
Available is 25 mg/2 mL of paracetamol
(Q) How many tsp/dose should you give to your patient?
Drug order states to administer 0.5 mg digoxin (Lanoxin) P.O daily
Available: 100 mcg/tab digoxin (Lanoxin)
How many tablets should you administer per dose?
Drug order states to administer 1 mg IV epinephrine (Adrenaline) IV now.
Available: 0.4 mg/mL
How many mL should you administer to the patient?
SOLUTION:
Liquid or Syrup medications
Drug order states: amoxicillin (Amoxil) 100 mg. PO qid. How many
milliliters should you give to your patient per dose?
Different units
Order states to give digoxin (Lanoxin) 0.5 mg PO daily. How
many tablets should you give to the patient per dose?
Drug labels on vials and ampules provide the following
information:
(1) generic and brand name of the drug,
(2) drug dose in weight (milligrams, grams, milliequivalents)
and amount (milliliters),
(3) expiration date, and
(4) directions about administration.
Drug Order States to give meperidine (Demerol) 35 mg IM Stat.
How many milliliters should you give to the patient? What syringe
should you use?
Drug order states to give IM 1G nafcillin sodium q6h, ANST. How
many mL should you give per dose? What syringe should you
use?
Instructions states: dilute 6.6 mL of diluent, each vial contains 8
mL of solution.
Drug order states to give heparin
3,500 units SubQ now. How many
mL will you administer per dose?
What syringe are you going to use?
Available: heparin 10,000 units/mL
multiple-dose vial (10 mL)
The doctor orders an IV Heparin drip at 5 units/kg/hr and to administer a
bolus dose of 10 units/kg IV before initiation of the drip
Available: Heparin bag that reads 12,500 units/250mL.
The patient weighs 110 lbs
What rate (mL/hr) should you set the infusion pump?
Drug order states: give atropine sulfate 0.5 mg subQ. How many
mL should you give per dose?
What syringe should you use?
Drop factor – number of drops per milliliter
• Macrodrip set (10 to 20 gtt/mL) – infuse more than 100 mL/hr
• Microdrip (60 gtt/mL) – to infuse less than 100 mL/hr
KVO (Keep Vein Open) – reason???
Order states: Start 1 liter of D5 ½ NSS and
run for 24 hours
Available: macroset with 10 gtt/mL and a
microdrip set with 60 gtt/mL
a. Should a macrodrip or microdrip IV set be
used?
b. Calculate the IV flow rate in drops per
minute according to the IV set that was
selected
Order states: 4 L of IV solution to infuse over 32 hours
2 liter of D5W and 2 liters of D5 ½ NSS
a. One liter is equal to how many milliliters?
b. Each liter should infuse for how many hours?
c. The institution uses a set with a drop factor of 15 gtt/mL. How many
drops per minute should the patient receive?
Potassium Chloride and Vitamins
are frequently added to the IV
solution for continuous IV infusion
“Do not add the drug while the
infusion is running unless the bag is
rotated”
If drugs are injected into the IV bag
before use, the bag should be, the
bag should be refrigerated to
maintain drug potency
Drug order states: 1000 mL of 5% dextrose in water (D5W) with
potassium chloride (KCI) 20mEq in 12 hours.
Available: 1000 mL of D5 dextrose in water
Potassium Chloride 40 mEq/20 mL ampule.
IV set labeled 10 gtt/mL
(1) How many mL of KCI
should you incorporate?
(2) Calculate the flow rate
The doctor writes an order to infuse a solution: “Infuse 2L of D5 ½ NSS
Normal Saline with 50 mEq Potassium Chloride over 48 hours.
Available
The drip factor is 15 gtts/mL
(Q) Calculate the flow rate
Hourly rate? mL/hr
Doctors order is to infuse 2 L of ½ Normal saline over 48 hours
What is the hourly rate (mL/hr)?
Weight based calculations
The doctor writes an order to infuse 2 mcg/kg/min.
The patient weighs 130 lbs
Available: IV bag with 250 mg/250 mL
How many mL per hour will you administer
IV Infusion Time
IV Fluid: PNSS iL with a drip factor of 10
gtts/mL and a flow rate of 30 gtts/min.
1) How many hours will it take for the IV
fluid to be totally consumed?
2) What is the accurate time and date the
infusion will be consumed if you
started the IV at August 31 @ 8 am.
IV Infusion Time
IV Fluid: At the start of your rounds at 8 am August
31, you noticed that the IV of the patient is PLR iL
with only 400 mL remaining. The IV has a drip factor
of 60 gtts/mL and an IV flow rate of 80 gtt/min
1) How many hours will it take to consume the
remaining IVF?
2) What time do you think the whole IVF should be
consumed? (Accurate Time and Date)
The doctor writes an order to infuse 2L of Normal Saline at 150
mL/hr. You start the infusion at 0800.
At what time will the infusion be complete?
IV Piggyback
1) Calibrated cylinder with
tubing (Buretrol,
Volutrol, Solucet) –
holds 150 mL of solution
2) Secondary set – smaller
(50, 100, 250 mL)
IV Push
- Preferred route for patients with poor muscle mass or decreased
circulation for a drug that is poorly absorbed from the tissues.
- Rapid onset of action
- Calculation errors can have serious, fatal consequences
- The nurse must read drug information inserts
IV Push
Order: Lasix 40 mg, IV STAT
Available: Lasix 10 mg/mL. IV infusion not to exceed 40 mg/min
How many mL will you administer via IV Push
How many minutes should you administer the drug
• Set to deliver a prescribed rate of
IV solution, if the flow rate is
obstructed, an alarm sounds
• IV pumps deliver IV solution
against resistance
• Volumetric regulator – delivers
specific volume of fluid at a
specific rate (mL/hr)
• Nonvolumetric regulator –
designed to infuse at drops per
minute
• All IV infusions should be checked every half-hour or hour
• Kinked tubing
• Infiltration,
• “Free flow” rates”
Provide uniform serum concentration of drugs, thus avoiding drug peaks
and valleys
(1) Effective pain control without the patient feeling oversedated
(2) Considerable reduction in the amount of narcotic used
(3) Patient’s feelings of having greater control over their pain
Types of PCA
(1) At patient demand
(2) Continuously
(3) Continuously and supplemented by patient demand
Have naloxone (Narcan) easily accessible
• Inform the patient that pain should be tolerable, not necessarily absent
• Advise patient of the pump’s safety features, including the alarms
• Instruct the patient in the use of the control button (medication
administered when button is released)
• Instruct patient to report any side effects or adverse reactions to the
medications
Drug order states: ceftazidime (Fortaz) 1.5g mg IV q6h; 500 mL of D5W
Available: dilute Ceftazidime 2g vial with 9.5 mL Water for injection (to
make 10 mL solution).
Set and Cylinder: Dilute ceftazidime 1.5g in 100 mL of D5W and infuse
over 30 minutes.
(1) Calculate drug dosage according to drug label
(2) Calculate drops per minute for drug solution
(3) Calculate mL/hr using volumetric infusion pump
Drug order states: Ampicillin 300 mg IV q6h
Available: Add 9.5 mL of diluent = (2G = 10 mL)
Set and Solution: Cylinder set with a drop factor of 60 gtts/mL; 500 mL of D5W
Instruction: Dilute 300 mg ampicillin in 50 mL of D5W and infuse over 45
minutes
(1) How many mL should the patient receive per dose?
(2) How many gtt/min using the cylinder set?
(3) Determine the volumetric infusion rate (mL/hr)
Safe dosages/Drug Parameters
The order orders an IV drip that weighs 78 lbs.
The safe dosage range is 5-10 mcg/kg/min
What is the safe dosage range for this child?
Safe dosages/Drug Parameters
Drug order states: Gentamicin 100 mg IV q8h
Patient weighs 180 lbs
Drug parameters: 3 to 5 mg/kg/day in 3 divided doses
Available: gentamicin 80 mg/2 mL vial
Set and solution: Cylinder IV set with drop factor 60 gtt/mL: 250 mL of D5W
Instruction: Dilute gentamicin in 75 mL of D5W and infuse over 40 mins.
1) How many kg does the patient weigh?
2) Is the prescribed dose within safe drug parameters?
3) How many mL of gentamicin should the patient receive per dose?
4) What is the IV flow rate?
5) Determine the volumetric infusion rate
Order states : cefaclor 50 mg P.O q.i.d
Child weighs 20 lbs
Child’s drug dosage: 20 to 40 mg/kg/day in 3 divided doses
(1) Is the prescribed dose safe?
(2) How many mL will you give per dose?
Order states: nafcillin sodium 200 mg IM q6h
Child weighs 12 kg
Child’s drug dosage: 100 to 300 mg/kg/day in divided doses
Available: add 9.5 mL of diluent to make 10 mL (2g = 10 mL)
(1) How many milligrams will the child receive per day?
(2) Is the prescribed dose within safe drug parameters?
(3) How many milliliters should the child receive per dose?
A pediatric patient is ordered a medication dose of 10 mg/m2/day by
mouth for 7 days. The patient weighs 46 lbs and is 3 feet 9 inches
What is the daily dose of the medication, the patient will receive?
(mg/day)
A pediatric patient is 65 lbs and 4 feet 5 inches. The physician
orders an oral medication that has a normal adult dose of 250 mg.
How many milligrams should be administered?
A pediatric patient has a body surface area of 0.88 m2. The
physician orders an IV medication that has a normal adult dose of
125 mg.
Available: 30 mg/mL
How many mL will you administer
Order states: methotrexate (Mexate) 50 mg weekly
Child’s height is 60 inches and weight is 100 lb
Child’s drug dosage: 25 to 75 mg/m2/week
Is the prescribed dose safe?
