Brush up on Your Drug Calculation Skills  

  Means    
Many nurses are weak with drug calculations of all sorts. This article will help to review
Extremes
the major concepts related to drug calculations, help walk you through a few exercises, and
provide a few exercises you can perform on your own to check your skills. There are many III. Left side are known quantities
reference books available to review basic math skills, if you find that you have difficulty IV. Right side is desired dose and amount to give
with even the basic conversion exercises. V. Multiply the means and the extremes
HX = DV
DV
X=
Common Conversions: H
Example: Order-Keflex 1 gm p.o. BID
1 Liter = 1000 Milliliters Drug available-Keflex 250 mg per capsule
1 Gram = 1000 Milligrams VIII. D=1 gm (note: need to convert to milligrams)
1 Milligram = 1000 Micrograms 1 gm = 1000 mg
1 Kilogram = 2.2 pounds IX. H=250 mg
X. V=1 capsule
25
: 1 :: 1000 : X
Methods of Calculation 0

Any of the following three methods can be used to perform drug calculations. Please
review all three methods and select the one that works for you. It is important to practice XI. 250X = 1000
the method that you prefer to become proficient in calculating drug dosages.
1000
X=
Remember: Before doing the calculation, convert units of measurement to one system. 250

I. Basic Formula: Frequently used to calculate drug dosages. XII. X = 4 capsules

XIII. Fractional Equation
D (Desired dose)
H (Dose on hand) H D
=
V (Vehicle-tablet or liquid) V X
D
x V = Amount to Give
H XIV. Cross multiply and solve for X.
D = dose ordered or desired dose
H = dose on container label or dose on hand
H D
V = form and amount in which drug comes (tablet, capsule, liquid) =
V X
Example: Order-Dilantin 50 mg p.o. TID
Drug available-Dilantin 125 mg/5ml HX = DV
DV
X=
D=50 mg H=125 mg V=5 ml H
Example: Order - Digoxin 0.25 mg p.o. QD
50 250 Drug Available - 0.125 mg per tablet
x5= = 2 ml
125 125
D=0.25 mg H=0.125 mg V=1 tablet
II. Ratio & Proportion: Oldest method used in calculating dosage.
0.125 0.25
=
1 X
Known   Desired
XX. 0.125X = 0.25
H : V :: D : X
0.25
X=
0.125
 XXI. X = 2 tablets Drug mcg
XXII. Intravenous Flow Rate Calculation (two methods)     Drug mcg x cc/hr    
= mcg/hr
Solution cc x 60 min/hr
Two Step
Rule of Thumb
Step 1 - Amount of fluid divided by hours to administer = ml/hr
ml/hr x gtts/ml(IV set) NTG 100 mg/250 cc
Step 2 - = gtts/min
60 min
1 cc/hr = 6.6 mcg/min
One Step
NTG 50 mg/250 cc
amount of fluid x drops/milliliter (IV set)
hours to administer x minutes/hour (60) 1 cc/hr = 3.3 mcg/min
Example: 1000 ml over 8 hrs
IV set = 15 gtts/ml
G. mcg/kg/min (For example - Dopamine, Dobutamine, Nipride, etc.)
Two Step
1. To calculate cc/hr (gtts/min)
1000
Step 1 - = 125
8 Solution cc
x 60 min/hr x kg x mcg/kg/min = cc/hr
125 x 15 Drug mcg
Step 2 - = 31.25 (31 gtts/min)
60 Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min.
One Step Patient’s weight is 190 lbs.
1000 x 15 15,000     250 cc    
= = 31.25 (31gtts/min) x 60 min x 86.4 x 5 mcg/kg/min = 16.2 cc/hr
8 hrs x 60 480 400,000 mcg

XXIII. How to Calculate Continuous Infusions 4. To calculate mcg/kg/min

A. mg/min (For example - Lidocaine, Pronestyl)       Drug mcg/ x cc/hr      

= mcg/kg/min
Solution cc x 60 min/hr x kg
Solution cc x 60 min/hr x mg/min Example: Nipride 100 mg/250 cc D5W was ordered to decrease your patient’s
= cc/hr blood pressure.
Drug mg
    Drug mg x cc/hr     The patient’s weight is 143 lbs, and the IV pump is set at 25 cc/hr.
= mg/hr How many mcg/kg/min of Nipride is the patient receiving?
Solution cc x 60 min/hr
100,000 mcg x 25 cc/hr 2,500,000
= = 2.5 mcg/kg/min
Rule of Thumb 250 cc x 60 min x 65 kg 975,000

Lidocaine, Pronestyl A. How to calculate mcg/kg/min if you know the rate of the infusion
2 gms/250 cc D5W
Dosage (in mcg/cc/min) x rate on pump
= mcg/kg/min
1 mg = 7 cc/hr Patient’s weight in kg
2 mg = 15 cc/hr
3 mg = 22 cc/hr B. For example:
4 mg = 30 cc/hr

1600 mcg/cc
400mg of Dopamine in 250 cc D5W =
D. mcg/min (For example - Nitroglycerin) 60 min/hr
   
Solution cc x 60 min/hr x mcg/min = cc/hr = 26.6 mcg/cc/min
 C. 26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 1. 2.5 liters to milliliters
400 mg in 250 cc of IV fluid. You need this to calculate this dosage 2. 7.5 grams to milligrams
concentration first for all drug calculations. Once you do this step, you can do 3. 10 milligrams to micrograms
anything! 4. 500 milligrams to grams
D. NOW DO THE REST! 5. 7500 micrograms to milligrams
E. If you have a 75 kg patient for example... 6. 2800 milliliters to liters
7. 165 pounds to kilograms
26.6 mcg/cc/min x 10 cc on pump 8. 80 kilograms to pounds
= 3.54 mcg/kg/min B. Practice Problems: Use the method you have chosen to calculate the amount to
Patients’s weight in kg (75 kg)
give.
  = 3.5 mcg/kg/min (rounded down) 1. Order-Dexamethasone 1 mg
Drug available-Dexamethasone 0.5 mg per tablet
F. How to calculate drips in cc per hour when you know the mcg/kg/min that is 2. Order-Tagamet 0.6 gm
ordered or desired Drug available-Tagamet 300 mg per tablet
3. Order-Phenobarbital 60 mg
mcg/kg/min x patient’s weight in kg Drug available-Phenobarbital 15 mg per tablet
= rate on pump 4. Order-Ampicillin 0.5 gm
dosage concentration in mcg/cc/min
Drug available-Ampicillin 250 mg per 5 ml
5. Order-Dicloxacillin 125 mg
G. For example: Drug Available-Dicloxacillin 62.5 mg per 5 ml
H. 400 mg Dopamine in 250 cc D5W = 26.6 mcg/cc/min 6. Order-Medrol 75 mg IM
Drug Available-Medrol 125 mg per 2 ml
3.5 mcg/kg/min x 75 kg 7. Order-Lidocaine 1 mg per kg
= 9.86 cc Patient’s weight is 152 pounds
26.6 mcg/cc/min
= 10 cc rounded up 8. Order- 520 mg of a medication in a 24 hour period. The drug is ordered
every 6 hours.
How many milligrams will be given for each dose?
I. ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE C. Practice Problems:
CHECK YOUR MATH! 1. Order-1000 ml over 6
J. For example: hrs IV set 15 gtts/ml
2. Order-500 ml over 4
10 cc x 26.6 mcg/cc/min hrs      IV set 10 gtts/ml
= 3.5 mcg/kg/min 3. Order-100 ml over 20
75 Kg
Dosage (in mcg/cc/min) x rate on pump min.
= mcg/kg/min IV set 15 gtts/ml
Patient’s weight in kg

L. For example: D. Practice Problems:

M. 400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min 1. Dopamine 400 mg in 250 cc D5W to infuse at 5 mcg/kg/min. The
N. 26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having patient’s weight is 200 pounds. How many cc/hour would this be on an
400 mg in 250 cc of IV fluid. You need this to calculate this dosage infusion pump?
concentration first for all drug calculations. Once you do this step, you can do 2. A Dopamine drip (400mg in 250 cc of IV fluid) is infusing on your 80
anything! kg patient at 20 cc/hour. How many mcg/kg/min are infusing for this
O. NOW DO THE REST!! patient?
P. If you have a 75 kg patient for example 3. A Nitroglycerin drip is ordered for your patient to control his chest
pain. The concentration is 100 mg in 250 cc D5W. The order is to begin
26.6 mcg/cc/min x 10 cc on pump the infusion at 20 mcg/min. What is the rate you would begin the
= 3.54 mcg/kg/min infusion on the infusion pump?
Patients’s weight in kg (75 kg)
4. A Nitroglycerin drip (100mg in 250 cc D5W) is infusing on your
patient at 28 cc/hour on the infusion pump. How many mcg/min is your
patient receiving?
Now do some practice exercises to check what you learned 5. A procainamide drip is ordered (2gms in 250 cc D5W) to infuse at 4
mg/min. The patient weighs 165 pounds. Calculate the drip rate in
A. Practice Problems: cc/hour for which the infusion pump will be set at.
 6. A Lidocaine drip is infusion on your 90 kg patient at 22 cc/hour. The 4. 10 mL
Lidocaine concentration is 2 grams in 250 cc of D5W. How many 5. 10 mL
mg/min is your patient receiving? 6. 1.2 mL
7. 69 kg = 69 mg
8. 130 mg for 4 doses
Summary C. Practice Problems
1. 41.6 (42)
2. 20.8 (21)
Many nurses have difficulty with drug calculations. Mostly because they don’t enjoy or 3. 75
understand math. Practicing drug calculations will help nurses develop stronger and more D. Practice Problems
confident math skills. Many drugs require some type of calculation prior to administration. 1. 17 cc/hr
The drug calculations range in complexity from requiring a simple conversion calculation 2. 6.65 mcg/kg/min
to a more complex calculation for drugs administered by mcg/kg/min. Regardless of the 3. 3 cc
drug to be administered, careful and accurate calculations are important to help prevent 4. 186.5 mcg/min
medication errors. Many nurses become overwhelmed when performing the drug 5. 30 cc/hr
calculations, when they require multiple steps or involve life-threatening drugs. The main 6. 3 mg/min
principle is to remain focused on what you are doing and try to not let outside distractions
cause you to make a error in calculations. It is always a good idea to have another nurse
double check your calculations. Sometimes nurses have difficulty calculating dosages on
drugs that are potentially life threatening. This is often because they become focused on the
actual drug and the possible consequences of an error in calculation. The best way to
prevent this is to remember that the drug calculations are performed the same way
regardless of what the drug is. For example, whether the infusion is a big bag of vitamins or
a life threatening vasoactive cardiac drug, the calculation is done exactly the same way.

Many facilities use monitors to calculate the infusion rates, by plugging the numbers in the
computer or monitor with a keypad and getting the exact infusion titration chart specifically
for that patient. If you use this method for beginning your infusions and titrating the
infusion rates, be very careful that you have entered the correct data to obtain the chart.
Many errors take place because erroneous data is first entered and not identified. The
nurses then titrate the drugs or administer the drugs based on an incorrect chart. A method
to help prevent errors with this type of system is to have another nurse double check the
data and the chart, or to do a hand calculation for comparison. The use of computers for
drug calculations also causes nurses to get “rusty” in their abilities to perform drug
calculations. It is suggested that the nurse perform the hand calculations from time to time,
to maintain her/his math skills.

Answers to Practice Problems

A. Practice Problems
1. 2500 mL
2. 7500 mg
3. 10,000 mcg
4. 0.5 gm
5. 7.5 mg
6. 2.8 L
7. 75 kg
8. 176 lbs
B. Practice Problems
1. 2 tablets
2. 2 tablets
3. 4 tablets