Drug calculations Drug calculations appear to be impossibly difficult, unless you break them down into small steps.

They are vitally important to get right, yet they are so easy to get wrong. This paper will now look at some commonly used drug calculations and the way that mistakes can happen. Type A calculations When the dose you want is not a whole ampoule. For example: - Prescription states 200mg (milligrams) - You have an ampoule of 500mg (milligrams) in 4ml (millilitres). What volume contains the dose you need? If you have an ampoule of 500mg in 4ml, and you need 200mg, it can appear to be a daunting calculation. The first step is to find out what volume contains 1mg (4/500) and then multiply it by how many mg you want (200). The easy way to remember this is the famous nursing equation: What you want, over what youve got, times what its in In this instance: 200mg x 4ml / 500mg = 1.6ml The common error here is to get it upside down, and divide what youve got by what you want. This fortuna tely gives you a stupid answer, which is obviously wrong, in this case 10ml. You already know that you need a fraction of an ampoule and not two and a bit ampoules, which highlights the error. To help make sure you get it the right way up, remember WIG: What you Want x what its In / What youve Got Converting units All weights, volumes and times in any equation must be in the same units. With weights the unit changes every thousand. For example, you need 1000 micrograms (mcg) to make 1 milligram (mg) and 1000 milligrams to make one gram (g) (Box 2). Type B calculations These are infusion rate calculations. For example: - Prescription states 30 mg/hour - You have a bag containing 250mg in 50ml Therefore, at what rate (ml/hr) do you set the pump? These are the same as type A calculations, only once you have worked out the volume that contains the amount of drug you need, you set the pump to give that amount per hour. In this instance, work out how many ml contain ONE mg of drug Using the WIG equation 30 x 50 / 250 = 6ml Therefore the calculation shows that, to give 30mg per hour, the infusion pump rate would need to be set at 6ml per hour. This calculation is straightforward when the rate you want (30mg/hour) and the amount of the drug in the bag (250mg) are both in the same units (mg). However, if the infusion required that 600 micrograms were to be infused each hour instead, this would first need to be converted into mg before the infusion rate was calculated, that is, 600 micrograms = 0.6mg. The equation for infusion rate calculation is dose stated in prescription (milligrams per hour) times volume in syringe (in millilitres) divided by the amount in the syringe (in milligrams) equals the infusion rate (millilitres per hour), or: Dose (mg/hr) x volume in syringe (ml) / Amount in syringe (mg) = Infusion rate Type C calculations Infusion rate is required, but dose is mg per kg. For example: - Prescription states 0.5mg/kg/hou - You have a bag of 250mg in 50m - Your patient weighs 70kg. At what rate (ml/hr) do you set the pump? To do this calculation you still use the WIG equation as above, but with one extra step to work out the what you want. First you need to convert the mg per kg into total mg by multiplying it by the patients weight. So for a person who weighs 70kg, 0.5mg per kg is the same as 35mg. Once you have calculated this, the infusion rate can be worked out as in the Type B calculations. In this instance: 0.5mg/kg/hr x 70kg x 50ml / 250mg = 7ml/hr

Type D calculations Infusion rate required, but dose is in mg/kg/min. For example: - Prescription states 0.5mg/kg/min - You have a syringe of 250mg in 50ml - Your patient weighs 70kg At what rate (ml/hr) do you set the pump? As before, you will need to calculate what you want by multiplying the amount per kg by the patients weight. In this case: 0.5mg x 70kg = 35mg This time, however, the prescription states the rate per minute. The pump demands that the rate be set in ml per hour, therefore the rate per minute will need to be converted before the equation can be completed, by multiplying 35 by 60; that is, 35mg/min (35 milligrams per minute) is converted to 2100mg/hr (2100 milligrams per hour). From here, once again we use the type B calculation to find the infusion rate, which as shown will be 420ml/hr. 2100 x 50 / 250mg = 420ml/hr Type E calculations Infusion rate is required, but the dose is in mcg/kg/min. For example: - Prescription states 3 micrograms (mcg)/kg/min - You have a syringe of 100mg in 50ml - Your patient weighs 70kg. At what rate do you set the pump (ml/hr)? As before, what you want is calculated by multiplying the amount per kg by the patients weight, that is: 3mcg/kg for a 70kg person is 210mcg. Next the prescription rate needs to be converted into rate per hour, that is, 210mcg/min = 12 600mcg/hr The prescription is in micrograms, but in your syringe you have milligrams. Both need to be in the same units, so you must convert one to the other, in this case mcg to mg. 12 600mcg/hr is the same as 12.6mg/hr. The calculation is then as follows: 12.6 x 50 / 100 = 6.3ml/hr

Mass/Time - IV mL Rate Questions Give an order in quantity of mass per time, determine the necessary IV flow rate in mL/hr based on the given mass per volume. These types of problems are often used in critical care nursing. Formula: Ordered Per Hour x Volume (mL) = Y (Flow Rate in mL/hr) Have

Example: Give patient 500 mg of dopamine in 250 mL of D5W to infuse at 20 mg/hr. Calculate the flow rate in mL/hr. Ordered Per Hour x Volume (mL) = Y (Flow Rate in mL/hr) Have 20 mg/hr x 250 mL = 10 mL/hr 500 mg Example: Aggrastat at 12.5 mg in 250 mL is prescribed to be infused at a rate of 6 mcg/kg/hr in a patient who weighs 100 kg. At what flow rate in mL/hr will you set the pump? Ordered Per Hour x Volume (mL) = Y (Flow Rate in mL/hr) Have The first step is to convert the order per time to the amount required for this particular patient. This is a Dosage By Weight Question. 100 kg is the weight in kg and 6 mcg/kg/hr is a dosage in terms of kg. Weight in Kg * Dosage Per Kg = Y (Required Dosage) 100 kg * 6 mcg/kg/hr = 600 mcg/hr Convert 600 mcg/hr to mg/hr. mcg mg g kg ( by 1,000 ) 600 1,000 = 0.6 mg/hr x = 12 250 mL/hr mL

0.6 mg/hr 12.5 mg

Dosage By Weight Questions

Given the weight of a patient and a dosage specified in terms of weight, calculate the necessary dosage. These problems are a type of pediatric dosage calculations. Formula: Weight in Kg * Dosage Per Kg = Y (Required Dosage) Example: A doctor orders 200 mg of Rocephin to be taken by a 15.4 lb infant every 8 hours. The medication label shows that 75-150 mg/kg per day is the appropriate

dosage range. Is this doctor's order within the desired range? Weight in Kg * Dosage Per Kg = Y (Required Dosage) Convert 15.4 lb to kg.

lb kg ( by 2.2 ) 15.4 lb 2.2 = 7 kg

7 kg * 75 mg/kg = 525 mg (Minimum Desired Dosage) 7 kg * 150 mg/kg = 1,050 mg (Maximum Desired Dosage) 24 hours in one day and the medication is ordered every 8 hours.

24 hrs / 8 hrs = 3 times per day doctor ordered medication 200 * 3 = 600 mg ordered per day 600 mg is within the desired range of 525-1,050 mg

Yes doctor has ordered a dosage within the desired range. Example: Solumedrol 1.5 mg/kg is ordered for a child weighing 74.8 lb. Solumedrol is available as 125 mg / 2mL. How many mL must the nurse administer? Weight in Kg * Dosage Per Kg = Y (Required Dosage) Convert 74.8 lb to kg.

lb kg ( by 2.2 ) 74.8 lb 2.2 = 34 kg

34 kg * 1.5 mg/kg = 51 mg

This is now an ordinary Mass/Liquid For Liquid Question. 51 mg is ordered and the medication is available as 125 mg / 2 mL. Ordered x Volume Per Have = Y (Liquid Required) Have 51 mg x 2 mL = 0.82 mL 125 mg

Volume/Time - IV Drop Rate Questions

Given a certain amount of liquid, a time period, and a drop factor (gtts/mL), what is the necessary IV flow rate in gtts/min? Measurement used when IV is regulated

manually. Because it is not possible to give a patient a fraction of a drop, it is typical to round answers for these problems up or down to the nearest whole number. Formula: Volume (mL) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Time (min) Example: Calculate the IV flow rate for 1200 mL of NS to be infused in 6 hours. The infusion set is calibrated for a drop factor of 15 gtts/mL. Volume (mL) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Time (min) Convert 6 hours to minutes.

min hr ( x by 60 ) 6 hr x 60 = 360 min

1200 mL x 15 gtts/mL = 50 gtts/min 360 min Example: Calculate the IV flow rate for 200 mL of 0.9% NaCl IV over 120 minutes. Infusion set has drop factor of 20 gtts/mL. Volume (mL) x Drop Factor (gtts/mL) = Y (Flow Rate in gtts/min) Time (min) 200 mL x 20 gtts/mL 120 min

Amount in IV Fluid Questions

Given a volume of IV fluid and a dosage expressed in percent, what is the mass of a particular dosage? Formula: Concentration % x Volume (mL) = Y (Dosage Amount in g) 100

Example: Calculate the amount of dextrose in 1000 mL D5W. Concentration % x Volume (mL) = Y (Dosage Amount in g) 100 5% x 1000 mL = 50 g 100

Example: Calculate the amount of sodium chloride in 2000 mL NS. Recall NS is 0.9% NaCl (sodium chloride) Concentration % x Volume (mL) = Y (Dosage Amount in g) 100 0.9% x 2000 mL = 18 g 100