Brush up on Your Drug Calculation Skills

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

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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.

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

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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 :: Means Extremes D Desired : X

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 : 1 XI. :: 100 0 : X

VIII. IX. X.

XIII.

XII. Fractional Equation

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

XIV.

H D = V X 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

XXII.

0.125 0.25 = 1 X XX. 0.125X = 0.25 0.25 X= 0.125 XXI. 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 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

4.

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: 1600 mcg/cc 400mg of Dopamine in 250 cc D5W = 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: IV set 15 gtts/ml 1. Order-1000 ml over 6 hrs 2. Order-500 ml over 4 hrs IV set 10 gtts/ml 3. Order-100 ml over 20 min. IV set 15 gtts/ml 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.

3.

4.

5.

6.

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? 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? 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? 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. 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

Reference:

Dosage Calculations Made Incredibly Easy! by Springhouse Corporation, 1998

Copyright 2002-2010, nursesaregreat.com ALL RIGHTS RESERVED

Common drop factors are: 10 drops/ml (blood set), 15 drops / ml (regular set), 60 drops / ml (microdrop). To measure the rate we must know: (a) the number of drops (b) time in minutes. The formula for working out flow rates is: volume (ml) X drop factor (drops/ml) ---------------------------------------------time (min) = drops / minute

Example: 1500 ml IV Saline is ordered over 12 hours. Using a drop factor of 15 drops / ml, how many drops per minute need to be delivered? 1500 (ml) X 15 (drops/ml) ---------------------------------------------12 x 60 (gives us total minutes)
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= 31 drops / minute

Nursing Made Incredibly Easy!:

March/April 2013 - Volume 11 - Issue 2 - p 12 doi: 10.1097/01.NME.0000426306.10980.65 Online exclusive

The nurse's quick guide to I.V. drug calculations

Wilson, Kelley Miller MSN, RN
Free Access

Article Outline

Author Information
Assistant Professor University of Maryland School of Nursing Baltimore, Md. The author has disclosed that she has no financial relationships related to this article. Nurses are often intimidated by the math that occurs in everyday practice. Patient safety depends on the practitioner's ability to calculate medications correctly and in a timely manner. This article will provide a simple and concise method for accurate computation using basic calculations (see Quick reference: Universal formulas).
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Doing the math

Even with the programmable I.V. pumps used in many clinical settings, it's advisable for the nurse to verify the correct dosage by calculation once during the shift; more often if a medication is being titrated or changed. Verification of correct dosages with another RN is also a widespread practice among many professionals and sometimes mandatory in institutions. Another resource that's present in many practice settings is the pharmacy. Pharmacists have an abundance of knowledge about medications, as well as an unparalleled proficiency with drug calculations; utilize their expertise if you're unsure of your computation. Knowing the therapeutic dosage for the desired effect is as important as knowing the correct calculations for the drug. For example, dopamine at doses of 3 to 5 mcg/kg/minute provides a

gentle dilatation of the renal arteries, increasing urine output with no effect on BP. At higher doses (up to 20 mcg/kg/minute), dopamine is used for BP support. Know the medication and what effect you're attempting to achieve, as well as the maximum recommended safe infusion dosage. Next time you have a patient on I.V. medication, try the following simple methods for calculating in a systematic way. Patient medication safety is a goal that all practitioners have in commonit starts with doing the math!
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Basic calculations
The universal formula is: Example:

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Administer heparin 5,000 units I.V. push. Available is heparin 10,000 units/mL. How many mL will you need to administer to achieve a 5,000 unit dose? Answer: X = 0.5 mL

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Calculations in mcg/minute
Follow these four steps to easily calculate your patient's accurate drug dosage. 1. Find out what's in your I.V. bottle (drug concentration or number of mL of fluid). 2. Determine in which units your drug is measured (units/hour, mg/hour, or mcg/kg/minute). 3. Know the patient's weight in kg if your calculation is weight based. 4. Use the universal formula below and then divide your final answer by the patient's weight in kg to arrive at mcg/kg/minute. Example:
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Figure. Quick refere...

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Dopamine is infusing. The bottle states dopamine 800 mg, and it's mixed in 500 mL of D 5W. The I.V. pump in your patient's room is set at 15 mL, and the patient weighs 60 kg (60,000 g). At how many mcg/kg/minute is the patient's dopamine infusing? Answer: X = 6.7 mcg/kg/minute

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Example:

Dobutamine 200 mg in 250 mL of D5W is ordered to run at 5 mcg/kg/minute. At how many mL/hour will you set the pump? Answer: X = 22.5 mL/hour

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Calculations in units/hour
To arrive at units/hour, the universal formula is: Example:

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Heparin 20,000 units in 500 mL D5W is ordered to run at 1,000 units/hour. How will the I.V. pump be set? Answer: X = 25 mL/hour

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Example: Heparin 20,000 units in 500 mL D5W is infusing at 20 mL/hour. At how many units/hour is the heparin infusing? Answer: X = 800 units/hour

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Precisely!
Patient safety depends on accurate I.V. drug dosing; precise calculations are essential to this process. Nurses shouldn't be apprehensive when I.V. drug dosages are presented in practice. Use the simple calculations conveyed in this article as a first step!