Drug Calculations

A Guide for Medical Students

Joanne Carling
Senior Clinical Lecturer
Undergraduate Department
Learning, Research & Innovation Institute (LRI)
James Cook University Hospital

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Contents

1) Introduction

2) Commonly used abbreviations

3) Hints & tips

4) Numeracy skills

5) Converting units of weight & volume

6) Drug calculations

7) References

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Introduction

Calculating the right dose or rate of a medicine is potentially complex and it is

easy to make mistakes when working in busy clinical settings.

The wrong dose, strength or frequency of medicine account for a third of

National Reporting and Learning System between January 2005 and June
2006. (NPSA 2007, Safety in Doses)

It is therefore essential that medical students develop their drug calculation

skills in addition to their safe prescribing.

Drug calculation are also assessed as part of the National Prescribing Safety
Assessment (PSA) that all final year students have to complete.

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

 Commonly Used Abbreviations

kilogram kg
gram g
milligram mg
microgram Must be written in full as microgram
nanogram Must be written in full as nanogram
litre L
millilitre ml or mL
units or international units Must be written in full as units or international units
millimoles Mmol or mMol

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Hints & Tips

1) Before doing a calculation, a golden rule is to estimate the dose you

are likely to require so you know whether your final calculation seems
reasonable i.e. roughly what you expected.

2) Drugs are formulated into medicines in such a way that most adult
doses are easily calculated and predictable i.e. 1 or 2 tablets, 1 or 2
capsules etc.

3) Dose volumes or oral liquid medicines are typically 5-20ml for adults
and 5ml or less for children (Baxter, 2014).

4) Avoid crushing tablets wherever possible. Refer to the BNF

(preparations) to check if required medicine is available in oral solution
or suspension. Check with pharmacist if necessary.

5) If you feel that something is wrong or are in doubt about a calculation,

stop and seek help by contacting the ward pharmacist, prescriber or
ask a colleague to check it with you.

6) When double-checking a calculation, perform the calculation

independently and then compare answer with your colleagues answer.
If there is still a discrepancy, repeat the check independently again. If
the calculation is still different, contact a more senior colleague or
pharmacist.

7) When double checking a calculation

8) Always check
weighed in kg and recorded as kg.

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Numeracy Skills

Weights
When administering drugs the amounts given to patients are relatively small.
Doses are often measured in grams, milligrams and sometimes nanograms.

It is important to know their relative values:

1 Kilogram = 1000 grams
1 gram = 1000 milligrams
1 milligram = 1000 micrograms
1 microgram = 1000 nanograms

To convert between the different units, you need to know:

To change:

From To Do This
Kilograms grams Multiply by1000
Grams milligrams
Milligrams micrograms
Micrograms nanograms

Nanograms micrograms Divide by 1000

Micrograms milligrams
Milligrams grams
Grams kilograms

These calculations demonstrate this:

500 milligrams = 500/1000 = 0.5 grams

1250 micrograms = 1250/1000 = 1.25 milligrams

0.25 grams = 0.25 x 1000 = 250 milligrams

0.05 milligrams = 0.05 x 1000 = 50 microgram

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Drug Calculations Questions I

Please answer the following:

1. Convert 350mg to g

2. Convert 0.5g to mg

3. Convert 300mcg to mg

4. Convert 50 ml to litres

5. Convert 0.125g to mg

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Dosage Calculations for Medication

Formulae is:

The number of tablets = amount prescribed

amount in each tablet

eg. Patient is prescribed 120mg of Verapamil, tablets available as 40mg each.

120mg = 3 tablets
40mg

But suppose a patient is prescribed 1.5g of a drug that is available in 500mgs

tablets. How many tablets do you give now?

A very important point about performing drug calculations is that the

prescribed amount and the availability must be in the same units. In this case
we could either convert the 500milligrams into grams, or we could convert the
1.5 grams into milligrams.

It is probably easier to convert the milligrams; 1.5g is the same as 1500mg.

So the problem is now 1500mg divided by 500mg = 3 tablets

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Drug Calculations Questions II

Please answer the following:

1. 500mg is prescribed, tablets are 250mg each: how many will you give?

2. 50mg is prescribed, tablets are 12.5mg each: how many will you give?

3. 1mg is prescribed, tablets are 500 microgram: how many tablets will
you give?

4. 625mg prescribed, tablets are 1.25g each: how many will you give?

5. 3 tablets each contain 250mg. What is the total dose in milligrams?

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Drugs in Liquid Form

When drugs are in liquid form, the availability is given in terms of the
concentration of the solution or suspension. As an example, pethidine
hydrochloride is available as 50mg/ml. This means that 50 milligrams of
pethidine hydrochloride are dissolved in every millilitre of liquid.

The formula to be used is:

Volume to be given = amount prescribed x unit volume

Amount per unit volume

E.g. A drug is available as 25mg/ml and 75mg are required. What volume
would be given?

A. 75x 1 = 3ml
25

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Drug Calculations Questions III
Please answer the following:

1. An injection of morphine 8mg is required. Ampoules on hand contain

10mg in 1ml. What volume is drawn up for injection?

2. Digoxin ampoules on hand contain 500 microgram in 2ml. What

volume is needed to give 350 microgram?

3. A child is ordered 9mg of gentamicin by IM injection. Stock ampoules

contain 20mg in 2ml. What volume is needed for the injection?

4. A patient is to be given erythromycin 120mgs by injection. Stock vials

contain 300mg/10ml. Calculate the required volume.

5. Stock heparin has strength of 5000 units per ml. What volume must be
drawn up to give 6500units?

6. Pethidine 85mg is to be given IM. Stock ampoules contain pethidine

100mg in 2ml. Calculate the volume of stock required.

7. A patient is to receive an injection of gentamicin 60mg IM. Ampoules

on hand contain 80mg/2ml. Calculate the volume required.

8. A patient is prescribed bumetanide 0.8mg IM. Stock ampoules contain

2mg/4ml. What volume would be drawn up

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

IV Drip Rates

The rate of flow down intravenous infusion lines must be regulated and this is
often controlled by a device known a volumetric pump.

A volumetric infusion pump receives fluid from a giving set. The pump has an
adjustable rate of flow and converts fluid into very fine drops, within the
machine before delivering the fluid to a patient.

An infusion pump can be accurately set and is designed to maintain a steady

flow rate. However, the patient receiving the infusion must still be checked at
regular intervals.

Flow Rate = volume in mls

duration in hours

E.g. If a patient requires 1 Litre in 8 hours, the flow rate is;

1000 = 125 ml/hr

8

Giving Sets with drop factor

A drip chamber is part of a giving set or administration set. It has a fixed drop
size and an adjustable rate of flow. There are four main types of giving set in
general use- these break fluid into either 10, 15, 20 or 60 drops per ml ( drop
factor).

Drop Rate = drop factor x volume in ml

60 x time in hours

If a patient is to be given 500ml by IVI using a drip factor of 20drops/ml over 6

hours

Drop rate = 20x 500 = 27.77 or 28 drops/min to nearest decimal place

360

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Drug Calculations Questions IV
Please answer the following:

Drip Rates
1. A patient is to receive half a litre of dextrose 5% over 4 hours. The
giving set delivers 20drops/ml. Calculate the required drip rate in
drops/min. (round to the nearest number)

2. If a patient is to be given 750ml by IVI using a giving set with a drip

factor of 20drops/ml over 12 hours, what would you set the drip rate to
(round to the nearest number)

3. 300mls of blood is to be transfused over 4 hours using an

administration set which gives 10drops/ml. Calculate the drip rate in
drops/min

Fluids to be given through infusion pump- flow rates

4. A patient requires 1000mls in 12 hours what is the flow rate (give your
answers to two decimal places) in mls/hr

5. 500mls of Hartmans solution is to be given to a teenager over 7 hours.

What is the flow rate on ml/hr?

6. Over the next 15 hours, a patient is to receive 2 litres of dextrose 4%.

What is the flow rate in ml/hr?

7. A patient is to receive 500ml of normal saline. The drip chamber is

adjusted to deliver 25ml/h. How long will the fluid last?

8. A patient is to receive half a litre of fluid IV over 6 hours using an

infusion pump. At what rate (in ml/h) should the pump be set?

9. Calculate the required flow rate of an infusion pump- one litre of fluid to
be given over 4 hours

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

Test Yourself- mixed selection!
Please answer the following:

1. Calculate the volume to be given: ordered penicillin 500mg, on hand

syrup 125mg/5ml

2. Calculate the volume to be given: ordered chloramphenicol 750mg, on

hand suspension 125mg/5ml

3. An infusion pump is to be used to give 1 L of fluid over 11 hours. At

what rate should the pump be set?

4. A female patient is to receive a litre of Hartmans solution over 12

hours. Calculate the drip rate if the administration set gives 15drops/ml

5. A child is to be given 180mg of paracetamol. Stock elixir contains

120mg/5ml. Calculate the volume to be given orally.

6. A patient is prescribed penicillin 400mg orally. Stock syrup has a

strength of 125mg/5ml. Calculate the volume of mixture to be given.

7. A girl is ordered cortisone 15mg. Stock ampoules on hand contain

50mg in 2ml. What volume must be withdrawn for injection?

8. Ordered erythromycin 800mgs, on hand mixture 125mg/5ml Calculate

the volume to be given

9. How much morphine must be drawn up for a 10mg dose if a stock

ampoule contains 15mg in 1ml

10. Digoxin ampoules on hand contain 500 microgram in 2ml. What

volume is needed for an injection of 275 microgram?

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.

References

Coben D. Atere-Roberts E. (1996)

Carefree Calculations for Health Care Students
McMillan Publisher

Hutton M (2005)
Calculation Skills
Paediatic Nursing March Vol17, no. 2

Gatford JD, Anderson RE (1998)

Nursing Calculations
Churchill Livingstone

Baxter (2014) Good Practice for Drug Calculations. A Step by Step for
Nurses, Doctors and all other health professionals
http://www.baxterhealthcare.co.uk/downloads/healthcare_professionals/th
erapies/pharmacy_services/ps_calc_guide.pdf (Accessed November
2015)

Joanne Carling, Senior Clinical Lecturer, JCUH, 2015.