by Louise Diehl, RN, MSN, ND, CCRN, ACNS-BC, NP-C Nurse Practitioner - Owner Doctor of Naturopathy Lehigh Valley

Wellness Center

Many nurses are weak with drug calculations of all sorts. This article will help to review 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 reference books available to review basic math skills, if you find that you have difficulty with even the basic conversion exercises.

Common Conversions:
1 Liter = 1000 Milliliters 1 Gram = 1000 Milligrams 1 Milligram = 1000 Micrograms 1 Kilogram = 2.2 pounds

Methods of Calculation
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 the method that you prefer to become proficient in calculating drug dosages. Remember: Before doing the calculation, convert units of measurement to one system. I. Basic Formula: Frequently used to calculate drug dosages. D (Desired dose) H (Dose on hand) V (Vehicle-tablet or liquid) D x V = Amount to Give H D = dose ordered or desired dose H = dose on container label or dose on hand V = form and amount in which drug comes (tablet, capsule, liquid) Example: Order-Dilantin 50 mg p.o. TID Drug available-Dilantin 125 mg/5ml

D=50 mg

H=125 mg

V=5 ml

II.

50 250 x5= = 2 ml 125 125 Ratio & Proportion: Oldest method used in calculating dosage. Known H : V : : Desired D : X

Means Extremes III. IV. V. Left side are known quantities Right side is desired dose and amount to give Multiply the means and the extremes HX = DV DV X= H Example: Order-Keflex 1 gm p.o. BID Drug available-Keflex 250 mg per capsule D=1 gm (note: need to convert to milligrams) 1 gm = 1000 mg H=250 mg V=1 capsule 25 0 : XI. 1 : : 100 0 : X

VIII. IX. X.

250X = 1000 X= 1000 250 X = 4 capsules

XII. XIII. Fractional Equation

H D = V X XIV. Cross multiply and solve for X. H D = V X HX = DV DV X= H

Example: Order - Digoxin 0.25 mg p.o. QD Drug Available - 0.125 mg per tablet D=0.25 mg H=0.125 mg V=1 tablet

0.125 0.25 = 1 X XX. 0.125X = 0.25 X= XXI. XXII. 0.25 0.125 X = 2 tablets

Intravenous Flow Rate Calculation (two methods) Two Step Step 1 - Amount of fluid divided by hours to administer = ml/hr ml/hr x gtts/ml(IV set) Step 2 = gtts/min 60 min One Step amount of fluid x drops/milliliter (IV set) hours to administer x minutes/hour (60) Example: 1000 ml over 8 hrs IV set = 15 gtts/ml Two Step 1000 = 125 8 125 x 15 Step 2 = 31.25 (31 gtts/min) 60 One Step 1000 x 15 15,000 = = 31.25 (31gtts/min) 8 hrs x 60 480 How to Calculate Continuous Infusions Step 1 A. mg/min (For example - Lidocaine, Pronestyl) Solution cc x 60 min/hr x mg/min = cc/hr Drug mg Drug mg x cc/hr = mg/hr Solution cc x 60 min/hr

XXIII.

Rule of Thumb

Lidocaine, Pronestyl 2 gms/250 cc D5W 1 mg = 7 cc/hr 2 mg = 15 cc/hr 3 mg = 22 cc/hr 4 mg = 30 cc/hr D. mcg/min (For example - Nitroglycerin) Solution cc x 60 min/hr x mcg/min = cc/hr Drug mcg Drug mcg x cc/hr = mcg/hr Solution cc x 60 min/hr

Rule of Thumb
NTG 100 mg/250 cc 1 cc/hr = 6.6 mcg/min NTG 50 mg/250 cc 1 cc/hr = 3.3 mcg/min G. mcg/kg/min (For example - Dopamine, Dobutamine, Nipride, etc.) 1. To calculate cc/hr (gtts/min) Solution cc x 60 min/hr x kg x mcg/kg/min = cc/hr Drug mcg Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min. Patients weight is 190 lbs. 250 cc x 60 min x 86.4 x 5 mcg/kg/min = 16.2 cc/hr 400,000 mcg 4. To calculate mcg/kg/min Drug mcg/ x cc/hr = mcg/kg/min Solution cc x 60 min/hr x kg Example: Nipride 100 mg/250 cc D5W was ordered to decrease your patients blood pressure. The patients weight is 143 lbs, and the IV pump is set at 25 cc/hr. How many mcg/kg/min of Nipride is the patient receiving? 100,000 mcg x 25 cc/hr 2,500,000 = = 2.5 mcg/kg/min 250 cc x 60 min x 65 kg 975,000

A. How to calculate mcg/kg/min if you know the rate of the infusion Dosage (in mcg/cc/min) x rate on pump = mcg/kg/min Patients weight in kg B. For example: 400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr

= 26.6 mcg/cc/min C. 26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid. You need this to calculate this dosage concentration first for all drug calculations. Once you do this step, you can do anything! D. NOW DO THE REST! E. If you have a 75 kg patient for example... 26.6 mcg/cc/min x 10 cc on pump = 3.54 mcg/kg/min Patientss weight in kg (75 kg) = 3.5 mcg/kg/min (rounded down) F. How to calculate drips in cc per hour when you know the mcg/kg/min that is ordered or desired mcg/kg/min x patients weight in kg = rate on pump dosage concentration in mcg/cc/min G. For example: H. 400 mg Dopamine in 250 cc D5W = 26.6 mcg/cc/min 3.5 mcg/kg/min x 75 kg = 9.86 cc 26.6 mcg/cc/min = 10 cc rounded up I. ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE CHECK YOUR MATH! J. For example: 10 cc x 26.6 mcg/cc/min = 3.5 mcg/kg/min 75 Kg Dosage (in mcg/cc/min) x rate on pump = mcg/kg/min Patients weight in kg L. For example: M. 400mg of Dopamine in 250 cc D5W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min N. 26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400 mg in 250 cc of IV fluid. You need this to calculate this dosage concentration first for all drug calculations. Once you do this step, you can do anything!

O. NOW DO THE REST!! P. If you have a 75 kg patient for example 26.6 mcg/cc/min x 10 cc on pump = 3.54 mcg/kg/min Patientss weight in kg (75 kg) Now do some practice exercises to check what you learned A. Practice Problems: 1. 2.5 liters to milliliters 2. 7.5 grams to milligrams 3. 10 milligrams to micrograms 4. 500 milligrams to grams 5. 7500 micrograms to milligrams 6. 2800 milliliters to liters 7. 165 pounds to kilograms 8. 80 kilograms to pounds B. Practice Problems: Use the method you have chosen to calculate the amount to give. 1. Order-Dexamethasone 1 mg Drug available-Dexamethasone 0.5 mg per tablet 2. Order-Tagamet 0.6 gm Drug available-Tagamet 300 mg per tablet 3. Order-Phenobarbital 60 mg Drug available-Phenobarbital 15 mg per tablet 4. Order-Ampicillin 0.5 gm Drug available-Ampicillin 250 mg per 5 ml 5. Order-Dicloxacillin 125 mg Drug Available-Dicloxacillin 62.5 mg per 5 ml 6. Order-Medrol 75 mg IM Drug Available-Medrol 125 mg per 2 ml 7. Order-Lidocaine 1 mg per kg Patients weight is 152 pounds 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? C. Practice Problems: 1. hrs 2. hrs 3. Order-100 ml over 20 Order-500 ml over 4 Order-1000 ml over 6 IV set 15 gtts/ml IV set 10 gtts/ml IV set 15 gtts/ml

min. D. Practice Problems: 1. Dopamine 400 mg in 250 cc D5W to infuse at 5 mcg/kg/min. The patients weight is 200 pounds. How many cc/hour would this be on an infusion pump? 2. A Dopamine drip (400mg in 250 cc of IV fluid) is infusing on your 80 kg patient at 20 cc/hour. How many mcg/kg/min are infusing for this patient? 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 the infusion at 20 mcg/min. What is the rate you would begin the infusion on the infusion pump? 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? 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 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 Lidocaine concentration is 2 grams in 250 cc of D5W. How many mg/min is your patient receiving?

Summary
Many nurses have difficulty with drug calculations. Mostly because they dont enjoy or understand math. Practicing drug calculations will help nurses develop stronger and more confident math skills. Many drugs require some type of calculation prior to administration. The drug calculations range in complexity from requiring a simple conversion calculation to a more complex calculation for drugs administered by mcg/kg/min. Regardless of the drug to be administered, careful and accurate calculations are important to help prevent medication errors. Many nurses become overwhelmed when performing the drug calculations, when they require multiple steps or involve life-threatening drugs. The main 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

4. 10 mL 5. 10 mL 6. 1.2 mL 7. 69 kg = 69 mg 8. 130 mg for 4 doses C. Practice Problems 1. 41.6 (42) 2. 20.8 (21) 3. 75 D. Practice Problems 1. 17 cc/hr 2. 6.65 mcg/kg/min 3. 3 cc 4. 186.5 mcg/min 5. 30 cc/hr 6. 3 mg/min