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Chapter 4

Conversions and Calculations


Used by Pharmacy
Technicians

Copyright © 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1
Introduction

 The ability to manipulate conversions is a


required competency of pharmacy
technicians
 It is a foundation for filling orders and

calculating dosages in the pharmacy


 All transcribing calculations need to be

checked by a pharmacist

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Introduction (Continued)
 Pharmacy measurements come from
different regions of the world
 The four most common types of
calculation systems are:
 Metric system
 Household measurements
 Apothecary system
 Avoirdupois system

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Introduction (Continued)

 A good way to become familiar with


common pharmacy measurements is
to start with what you know and then
slowly build on that knowledge
 The pharmacy technician must translate
the doctor’s orders into lay terms
 You must make the instructions easy
enough for a child to understand

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Objectives

 Describe the differences among the


following measurement systems:
 Apothecary system
 Avoirdupois system
 Metric system
 Common household measurements

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Objectives (Continued)

 Convert Arabic numbers into Roman


numerals.
 Demonstrate the ability to convert among

the following measurement systems


commonly used on prescriptions:
 Metric system
 Apothecary system
 Household system

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Objectives (Continued)

 Use mathematical calculations to


determine dosage:
 Ratios/proportions
 Fractions
 Percentages

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Objectives (Continued)

 Demonstrate the ability to set up


equations and solve problems for the
following:
 Determining day’s supply
 Pediatric dosages
 Drip rates
 Alligation
 Percent dosages

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Metric System

 Used throughout pharmacy because of its


accuracy
 Metric units include:

 Milliliters, cubic centimeters, and liters for


volume
 Kilograms, grams, milligrams, and
micrograms for weight
 Millimeters and meters for distance

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Metric System (Continued)

 There is a 1000-unit difference between


each measurement

Most Common Metric Measurements


kg______g________mg________mcg
1000x 1000x 1000x

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Metric System (Continued)

 The use of millimeters is reserved for drug


calculations based on body surface areas
 Knowing the basics for volume and weight

conversions is adequate

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Household Measurements

 The most common measurement system still


used in the United States is the household
system
 Measurements come in a variety of units
 Volume refers to liquids
 Weight refers to dry ingredients
 Length refers to distance
 Most common measurement is the teaspoon

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Common Household Measurements
Household
Measurements Metric
(Volume) (Volume) Household
1 teaspoon 5 ml or cc* 1 teaspoon
1 tablespoon 15 ml or cc 3 teaspoons
1 cup 240 ml or cc 8 ounces
1 pint 480 ml or cc 2 cups
1 quart 960 ml or cc 4 cups
1 gallon 3840 ml or cc 16 cups
or 3.84 L
*Remember that 1 ml and 1 cc contain the same amount of liquid.

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Apothecary System

 Originated in Europe
 Units used in this system are grains and

scruples for dry weight


 Drams and minims for liquids

 More common measurements include

ounces and pounds

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Apothecary Weights
Dry Weight Fluid Weight
1 grain = 60 mg 1 dram = 60

15 grains = 1 gram 8 drams = 480


20 grains = Э1 3 scruples* =1
1 dram = Э3
1 ounce = 8 or
= Э 24
= gr 480
= 31.1 grams
1 pound = 16 ounces
= 96
= Э 288
= gr 5760
= 454 grams

*Scruples and minims are not commonly used units

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Conversion Table:
Apothecary/Metric/Household

Apothecary Apothecary Metric Metric Common Volume


Weight Volume Weight Household
1 1 30 ml 30 g 2 tbsp
4 4 15 ml 15 g 1 tbsp
2 2 7.5 ml 7.5 g ½ tbsp
1 gr 60 4 ml 4g 1 tsp
½ gr 30 2 ml 2g ½ tsp

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Avoirdupois System

 Originated in England
 Similar to the apothecary system because

it also uses grains, ounces, and pounds


for weight
 For avoirdupois and metric equivalents,

refer to Table 4-3

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Important Differences Among Systems

 The metric system is used for compounding


drugs
 There are differences among manufacturer’s
products and their weights
 Conversions with these variances are
approximate
 A pint can be 473 ml, 480 ml, or 500 ml
 1 pound = 454 g in metric, but only 373 g in the
apothecary system

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Writing Units Using Each System

 All four systems will be used in writing


prescriptions, but pharmacies primarily
use the metric system
 Regardless of what system is used in a

prescription, it must be converted to the


household system

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Writing Units Using Each System (Continued)

 Metric measurements
 cc and ml can be used interchangeably
 Dry weights use mcg, mg, g, and kg
 Liquid volumes use ml and L

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Writing Units Using Each System (Continued)

 Apothecary measurements
 Dry weights use pounds, ounces, drams,
scruples, and grains
 Liquid volume weights use gallons, pints,
fluid ounces, fluid drams, and minims

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Writing Units Using Each System (Continued)

 Avoirdupois measurements
 Dry weights using pounds, ounces, and
grains

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Conversions

 Metric system slide


 When converting metric measurements
from one unit to another you need to move
the decimal either to the right or to the left
 All changes of the metric system involve
either dividing or multiplying by tens
 Each unit is a multiple of 1000

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Conversions (Continued)

 By moving the decimal three spaces (to


the right or left), you can change between
these units
 Remember the difference between 1 kg, 1

g, 1 mg, and 1 mcg is 1000

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Conversions (Continued)

 Method A for determining metric


conversions
Left Right
Largest Smallest
1________1_______1_________1_______
1000 kg 1000 g 1000 mg mcg
1 kg 1000 g 1,000,000 mg 1,000,000,000
mcg

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Conversions (Continued)

 Decimals are not placed at the end of a


number unless there is a fraction, such as
1.1 kg
 Decimals and periods have been the main

source of mistakes in pharmacies

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Conversions (Continued)

 Method B: Large number to small number


 Don’t divide—multiply
 When converting from large to small, you
multiply
 When converting from small to large, you
divide

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Conversions (Continued)

 Fractions
 There is a two-step process for converting
fractions into percentages
 Percentage is always a portion of 100
 To convert a decimal into a percentage
you simply multiply by 100

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Conversions (Continued)

 Percentages
 Represent a portion of a whole (100)
 Used in compounding
 Used to calculate markup on prices,
payment discounts, net profits, gross
profits

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Conversions (Continued)

 Ratio/proportion or formula method


 Ratios can be considered as parts or
fractions
 A concentration of 1:1000 means there is
1 part to 1000 parts or 1 g of drug in 1000
ml of solution

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Conversions (Continued)

 90% of the orders you will encounter in the


pharmacy will be ratio/proportion equations
 This is three-step process:
 Filter out the unnecessary information

 Find what strength you have in stock and what


strength you need
 Set up an equation and double-check the
calculations

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Conversions (Continued)
 Two methods:
 Method A:
(have = need or ratio/proportion)
 Method B:
D / H x Q = Medication to give
D = desired dose
H = have in stock
Q = quantity needed
 See Examples 4-2 to 4-6

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Pediatric Dosing

 When the strength of the medication


needed cannot be measured with a
teaspoon or is an odd amount, droppers
must be used
 The pharmacist, not the technician,

should show the parent of the patient how


to measure the correct amount

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Common Liquid Measuring Devices

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Determining Weight
Because all manufacturers provide proper
dosing regimens based on kilograms, it is
necessary to convert pounds into kilograms
There are 2.2 pounds per kilogram

16 ounces = 1 lb 2.2 pounds = 1 kg


To determine how many kg in 1 lb, divide

To determine how many lbs in 1 kg, multiply

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Drip Rates

 Hospital pharmacy technicians deliver


a 24-hour supply of IV solutions to
nursing units daily
 Most IV piggybacks are smaller IV
solutions that are given over
30 to 60 minutes
 Large volume medications need to be

given at a slow rate because the veins


can only handle a small volume

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Drip Rates (Continued)

 For large volume drips, pharmacy


technicians must be able to calculate
the volume needed to last over a certain
amount of time, or they might need to
calculate how much longer a currently
hanging IV solution will last

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Intravenous
(IV) Drip
System
Slide
clamp

100 ml

Volume-
control
chamber
Microdrip
chamber
Roller
clamp

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Drip Rates (Continued)

 Calculations involve the following:


 The right amount of drug that is to be
given over time
 The amount of time left until an IV runs out
 The amount of drug needed to last a
certain amount of time

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Drip Rates (Continued)

 Basic conversions are as follows:


 Time: 1 hour = 60 minutes,
24 hours = 1 day
 Volume: 5 mL = 60 gtt

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Drip Rates (Continued)
 Steps involved in determining drops per
minute:
 What is the drop factor?
 What will be the milliliters per hour?
 What will be the milliliters per minute?
 What will be the drops per minute?
 See Examples 4-12 to 4-14

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Alligation

 Alligation is used when you need to


prepare (compound) percent strength that
you do not have in stock

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Roman Numerals

 The number system commonly used in the


United States is the Arabic system,
consisting of numbers 1, 2, 3, and so forth
 Many physicians use Roman numerals to

indicate the quantity of tablets or capsules


to be filled or to order the strength of
medication

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Roman Numerals (Continued)

 When working with Roman numerals,


remember that if a larger number is placed
in front of a smaller one, you must add
both to determine the value
 However, if a smaller number is placed

before a larger number, then you must


subtract

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International Time

 In hospital settings, international time,


also known as military time, is used
exclusively
 Orders are written 24 hours a day and all

medical-related caretakers must


understand exactly when the order was
written and when the medication or
treatment is to take place

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International Time (Continued)

 The system is based on 100


 Starting with the first hour of the day, the

clock begins at 0100 (1 AM) through 2400


or 12 midnight
 By using this system there is never any

question as to when an order was written


or which order supersedes another

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Military Time Clock

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