Dosage Calculations INTRODUCTION

Copy and paste this link to your website, so they can see this document directly without any plugins.


Keywords

________________, dosage, many, dose, What, Dosage, appropriate, quantity, should, information, Calculations, Page, 2:39, 8/31/07, Joh_Ch05.qxd, doses, Five, Chapter, solve, days, Pediatric, weight, will, this, prescription, patient, pediatric, following, total, Disp.

Transcript

Dosage Calculations
After completing this chapter, you
should be able to:
• Solve one-step pharmaceutical
dosage calculations.
• Set up a series of ratios and
proportions to solve a single
dosage calculation.
• Determine what information
you will need to solve for, in
addition to any given
information, to properly
calculate dosages.
• Convert pediatric weights from
pounds to kilograms.
• Accurately determine dosages
based on mg/kg/day.
• Define common sig (signa)
codes used on prescriptions.
INTRODUCTION
Proper dosing of medications is important to ensure patient
safety. Calculating dosages, dosage regimens, and
compounding formulas involves the use of simple math
principles. You can solve many of these problems by setting
up ratios and proportions using the information given in the
question and keeping like units consistent.
CHAPTER
5
2
L earning Objectives
Joh_Ch05.qxd 8/31/07 2:39 PM Page 2
Chapter Five Dosage Calculations 3
Sig Refresher
The sig portion of the prescription order, meaning signa, is where the instructions for the patient are written. Pharmacy technicians enter the information
from the prescription order into the computer. The sig is an important value
to remember in order to properly determine pediatric dosages. The following
are some of the more common sigs you will find on prescriptions:
qd every day
qod every other day
d daily bid twice a day
tid three times a day
qid four times a day
q4h every 4 hr
q6h every 6 hr
q8h every 8 hr
q4–6h every 4–6 hr
prn as needed
Depending on the workplace, you may also see sigs such as the following:
q3d every three days
qmwf every Monday, Wednesday, and Friday
qw every week
Dosage Calculations
Dosage calculations include calculating the number of doses, dispensing
quantities, and ingredient quantities; these calculations are performed in the
pharmacy on a daily basis. The pharmacy technician must have a full working knowledge of how to perform these calculations.
To perform dosage calculations, you will utilize the information and
principles introduced in the previous chapters of this book. You can solve
these calculations by setting up ratios and proportions, keeping like units
consistent, and cross-multiplying.
CALCULATING THE NUMBER OF DOSES
To calculate the number of doses, you should first determine which information presented is actually applicable to the question. Too often mistakes are
made on dosage calculations because we overcomplicate them.
EXAMPLE 5.1 How many 1-tsp doses are in a 4 oz bottle of Prozac® Liquid
Solution 20 mg/5 mL?
Rx Prozac® Solution
tsp. po qd
Disp. # 4 oz
..
TT
=
=
=
=
=
=
=
=
=
=
==
=
=
Joh_Ch05.qxd 8/31/07 2:39 PM Page 3
4 Chapter Five Dosage Calculations
Let’s look at the information that has been provided:
✓ tsp po—the dose
✘ qd—the frequency
✓ 4 oz—the quantity dispensed
✘ Prozac® Solution 20 mg/5 mL—the drug name and strength
✘ 120 mL—the quantity of the stock bottle
The question is simply asking how many doses make up the total amount
being dispensed. The strength of the drug, frequency of dosage and quantity
of the stock bottle have no relevance in performing this calculation.
So now we know that we are working with 1 tsp. doses and a total quantity of 4 oz, but to solve this calculation using a ratio/proportion we have to
have similar units of measure—in this case mL.
We know that 1 tsp = 5 mL and we should also know that 4 oz. = 120 mL,
but if you didn’t that could also be solved by using a ratio/proportion.
Cross-multiply and solve the equation for .
Now that you have both quantities converted to units in mL, we can set
up our ratio/proportion and solve.
Cross-multiply
5 * x = 5x and 1 * 120 = 120
1 dose
5 mL
=
x doses
120 mL
(1)x = 120
30 * 4 = 120 and 1 * x = (1) x
x 1 oz
30 mL
=
4 oz
x mL
..
TT
Figure 5-1 Drug label for Prozac.
(Courtesy of Eli Lilly and Company.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 4
Chapter Five Dosage Calculations 5
Now set up your equation and solve for x.
To solve for x, divide both sides by 5.
So, there are 24 doses (of 5 mL) in a 4 oz (120 mL) bottle.
CALCULATING THE NUMBER OF DOSES
EXAMPLE 5.2 How many doses are provided in the prescription below?
Rx—Ibuprofen 400 mg
- po q 6 hr prn pain
Disp. # 120
Let’s look at the information that has been provided:
✓ - po—the dose
✘ q 6 hr prn pain—the frequency
✓ 120—the quantity dispensed
✘ Ibuprofen 400 mg—the drug name and strength
Workplace Wisdom Always use the higher dosage amount when performing dosage calculations on prescriptions that have a range for the dose, as in
Example 5.2. This will provide the most conservative solution and ensure
the most accurate potential for days supply.
Using the information provided, set up the ratio/proportion and solve.
Cross-multiply
Now set up your equation and solve for .
To solve for , divide both sides by 2.
So, there is a minimum of 60 doses prescribed.
x = 60
120 , 2 = 60
2x 2
=
120
2
x 2x = 120
x 2 * x = 2x and 1 * 120 = 120
1 dose
2 tabs
=
x doses
120 tabs
..
TT
.
T
..
TT
.
T
x = 24
120 , 5 = 24
2x 2
=
120
2
5x = 120
Joh_Ch05.qxd 8/31/07 2:39 PM Page 5
6 Chapter Five Dosage Calculations
PRACTICE PROBLEMS 5.1
1. How many dosages are provided in the prescription listed below?
________________
Rx—Cardura® 2 mg
po qd
Disp. # 90
2. How many droppersful (a 2.5 mL dosage) are in a 50 mL bottle of
EryPed® Drops? ________________
..
TT
3. How many dosages are provided in the prescription listed below?
_____________________
Rx—Vicodin® 5/500
po q8hr
Disp. # 50
4. How many 1 tsp doses are in each bottle of Zithromax® 200 mg/5 mL as
listed below, when mixed? ________________
..
TT
5. How many dosages are provided in the prescription listed below?
________________
Rx—Regular Insulin U-100 (100 units/mL)
Inject 20 units qAM
Disp. # 1 vial (10mL)
Figure 5-2 Drug label for EryPed Drops.
(Reproduced with permission of Abbott Laboratories.)
Figure 5-3 Drug label for Zithromax.
(Registered Trademark of Pfizer Inc. Reproduced with permission.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 6
Chapter Five Dosage Calculations 7
CALCULATING THE QUANTITY TO DISPENSE
EXAMPLE 5.3 How many Biaxin® 250 mg tablets should be dispensed?
Rx—Biaxin® 250 mg
po BID  10d
..
TT
Figure 5-4 Drug label for Biaxin.
(Reproduced with permission of Abbott Laboratories.)
Again, to solve this dosage calculation it is important to first determine
which information is necessary; it is also critical to know the common SIG
codes to perform dosage calculations.
Let’s look at what information that has been provided:
✓ po—the dose
✓ BID—the frequency
✓ x 10d—the duration
✘ Biaxin® 250 mg—the drug name and strength
✘ 100 tablets—the quantity of the stock bottle
To calculate the appropriate quantity to dispense, use the following
formula:
dose  frequency  duration  quantity to dispense
Using the information provided in the prescription, you can set up the
calculation as such:
1  2  10  x
dose frequency duration quantity to dispense
1  2  10  20
20  x
So, 20 tablets of Biaxin® 250 mg should be dispensed.
..
TT
Joh_Ch05.qxd 8/31/07 2:39 PM Page 7
8 Chapter Five Dosage Calculations
CALCULATING THE QUANTITY TO DISPENSE
EXAMPLE 5.4 How much Promethazine w/Codeine syrup should be dispensed?
Rx—Promethazine w/Codeine Syrup 6.25/10
tsp. po QID  4d
Let’s look at what information has been provided:
✓ tsp. po—the dose
✓ QID—the frequency
✓ x 4d—the duration
✘ Promethazine w/Codeine Syrup 6.25/10—the drug name and strength
To calculate the appropriate quantity to dispense, use the following formula:
dose  frequency  duration  quantity to dispense
Using the information provided in the prescription, you can set up the
calculation as such:
1tsp  4  4  x
dose frequency duration quantity to dispense
1  4  4  16
16  x
So, 16 teaspoonsful, or 80 mL, of promethazine w/codeine should be
dispensed.
PRACTICE PROBLEMS 5.2
1. What quantity should be dispensed for the prescription listed below?
________________
Rx—Zoloft® 50 mg
po qd
Disp. 1 mo. supply
2. What quantity should be dispensed, using the stock medication below,
to provide 20 mg of diazepam prior to the procedure and 10 mg
following? ________________
..
TT
..
TT
..
TT
Figure 5-5 Drug label for
Diazepam.
(Used with permission of
Roxane Laboratories, Inc.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 8
Chapter Five Dosage Calculations 9
5. What quantity should be dispensed for a 30-day supply of the following
prescription? ________________
Rx—Soma® 350 mg
po BID – TID prn muscle spasms
CALCULATING THE QUANTITY OF INGREDIENT
EXAMPLE 5.5 How much codeine is in each dose of Codeine Phosphate Oral
Solution 15 mg/mL?
Rx—Codeine Oral Soln. 15 mg/mL
tbsp po prn pain
Disp. # 4 oz
..
TT
..
TT
Figure 5-7 Drug label for
Codeine Phosphate Oral
Solution.
(Used with permission of
Roxane Laboratories, Inc.)
3. What quantity should be dispensed for a three-month supply of the
following prescription? ________________
Rx—furosemide 20 mg
po QOD
4. What quantity should be dispensed if 50 mg of amitriptyline has been
prescribed daily for 3 weeks, if the medication listed below is all that is
available? ________________
..
TT
Figure 5-6 Drug label for Amitriptyline HCL.
(Courtesy of Geneva Pharmaceuticals.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 9
10 Chapter Five Dosage Calculations
Let’s first look at all of the information provided to determine which will
be used in solving the problem:
✓ tbsp po—the dose
✘ prn—the frequency
✘ 4 oz—the quantity to dispense
✓ Codeine Phosphate Oral Solution 15 mg/mL—the drug name
and strength
✘ 500 mL—the quantity of the stock bottle
To solve this problem, we need to set up a ratio/proportion using the dose
and strength, but again remember that units of measure must be the same.
The dose (1 tbsp) is equivalent to 15 mL—which you should know.
Now we can set up the ratio/proportion.
Cross-multiply and then set up the equation to solve for x.
Now divide both sides by 5 to solve for x.
So, the answer is 45 mg of codeine in each 1 tbsp dose.
PRACTICE PROBLEMS 5.3
Perform the following dosage calculations.
1. Promethazine with codeine syrup contains 6.25 mg promethazine and
10 mg codeine per 5 mL. How many milligrams of promethazine are in
2 tsp? ________________
2. Rx hydroxycobalamine 10,000 mcg/cc 30 cc Sig: 1 cc IM hs
How many milligrams are in each dose?________________
3. Rx acetaminophen with codeine#3 acetaminophen 300 mg/codeine
30 mg 30 tablets
How many grains of codeine are in each tablet? ________________
CALCULATING THE QUANTITY OF INGREDIENT
EXAMPLE 5.6 How many mL of stock Dopamine must be added to the IV solution?
Rx—Dopamine 400 mg added to 500 mL of NS
Stock: Dopamine HCl Injection 80 mg/mL
x = 45
5x 5
=
225
5
5x = 225
15 * 15 = 225 and 5 * x = 5x
15 mg
5 mL
=
15 mg
1 mL
..
TT
Joh_Ch05.qxd 8/31/07 2:39 PM Page 10
Let’s first look at all of the information provided to determine which will
be used in solving the problem:
✓ 400 mg—the dose
✘ 500 mL—the quantity to dispense
✓ Dopamine HCl Injection 80 mg/mL—the drug name and strength
To solve this problem, we must determine how many milliliters of the stock
Dopamine will need to be added to the normal saline IV solution bag.
We must set up a ratio/proportion.
Cross-multiply and then set up the equation to solve for x.
Now divide both sides by 80 to solve for x.
So, the answer is 5 mL of the stock Dopamine HCl Injection must be
added to the IV solution.
PRACTICE PROBLEMS 5.4
1. Z-Pak®s contain 6 tablets of azithromycin 250 mg, which is taken over
the course of five days. How many total mg of active ingredient are
contained in a Z-Pak®? ________________
2. How many mcg of Fentanyl® would be contained in 1.5 mL?
________________
x = 5
400
80
=
80x
80
400 = 80x
1 * 400 = 400 and 80 * x = 80x
80 mg
1 mL
=
400 mg
x mL
Chapter Five Dosage Calculations 11
Figure 5-8 Drug label for
Fentanyl.
(Courtesy of ESI Lederle, a Business
Unit of Wyeth Pharmaceuticals,
Philadelphia, PA.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 11
3. How many milligrams of acetaminophen are contained in 2 Lortab 2.5
(2.5 mg hydrocodone/500 mg acetaminophen)® tablets? ____________
4. How many milligrams of dexamethasone are contained in the stock
bottle (500 mL) below? ________________
12 Chapter Five Dosage Calculations
5. How many mg of hydrocortisone are found in 1 tbsp of Cortef ®
10 mg/5 mL? ________________
Figure 5-10 Drug label for
Cortef.
(Courtesy of Pharmacia
Corporation.)
Figure 5-9 Drug label for
Dexamethasone Oral Solution.
(Used with permission of Roxane
Laboratories, Inc.)
CALCULATING THE CORRECT DAYS SUPPLY
EXAMPLE 5.7 How many days should the following prescription last?
Rx—Pamelor® 75 mg
po BID
Disp. # 50
..
TT
Joh_Ch05.qxd 8/31/07 2:39 PM Page 12
Chapter Five Dosage Calculations 13
Figure 5-11 Drug label for Pamelor.
(Copyright Novartis Pharmaceuticals Corporation. Reprinted with permission.)
Let’s determine which information provided will be needed to solve the
problem.
✓ po—the dose
✓ BID—the frequency
✓ 50—the quantity to dispense
✘ Pamelor® 75 mg—the drug name and strength
✘ 100 capsules—the quantity of the stock bottle
To calculate the appropriate days supply, use the following formula:
Using the information provided, set up the formula as below.
This becomes . . .
So, this prescription should last for 25 days.
CALCULATING THE CORRECT DAYS SUPPLY
EXAMPLE 5.8 How many days should the following prescription last?
Rx—Kaletra® 133.3 mg/33.3mg
po BID food.
Disp. # 360
..
TT
x =
50
2
or x = 25
x =
50 (qty. dispensed)
(1 * 2) (Dose * Frequency)
Days Supply =
Qty. Dispensed
(Dose * Frequency)
..
TT
Joh_Ch05.qxd 8/31/07 2:39 PM Page 13
Let’s determine which information provided will be needed to solve the
problem.
✓ po—the dose
✓ BID—the frequency
✓ 360—the quantity to dispense
✘ Kaletra® 133.3 mg/33.3mg—the drug name and strength
To calculate the appropriate days supply, use the following formula:
Using the information provided, set up the formula as below.
This becomes. . .
So this prescription should last for 3 months, or 90 days.
PRACTICE PROBLEMS 5.5
1. How many days will the following prescription last? ________________
Rx—Diabinese® 100 mg
po qAM
Disp. # 45
2. How many days will a 150 mL bottle of Ceclor® last, if the
patient is to take 2 teaspoonsful three times daily? ________________
125 mg>5 mL
..
TT
x =
360
4
or x = 90
x =
360 (qty. dispensed)
(2 * 2) (Dose * Frequency)
Days Supply =
Qty. Dispensed
(Dose * Frequency)
..
TT
14 Chapter Five Dosage Calculations
Figure 5-12 Drug label for Ceclor.
(Courtesy of Eli Lilly and Company.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 14
Chapter Five Dosage Calculations 15
3. How many days will the following prescription last? ________________
Rx—Valium® 5 mg
po BID
Disp. # 60
4. How many days should 10 tablets of Cialis® 5 mg last, if the
prescribed directed to use is a maximum of one tablet q3
days?________________
5. How many days will the following prescription last? ________________
Rx—Keflex® 250 mg
po TID
Disp. # 42
PRACTICE PROBLEMS 5.6
1. Rx—Amoxil 250 mg/5 mL
tsp TID  10d
a. What is the appropriate quantity to dispense? ________________
b. How many total doses are to be dispensed? ________________
c. What is the total amount of amoxicillin, in mg, to be dispensed?
________________
d. How many days should this prescription last? ________________
2. Rx—Dexamethasone Oral Soln.
Give 0.25 mg QOD
Disp. 6 mg
0.5 mg>5 mL
..
TT
..
TT
..
TT
Figure 5-13 Drug label for
Dexamethasone Oral
Solution.
(Used with permission of
Roxane Laboratories, Inc.)
Joh_Ch05.qxd 8/31/07 2:39 PM Page 15
16 Chapter Five Dosage Calculations
a. What is the appropriate quantity to dispense?________________
b. How many total doses are to be dispensed? ________________
c. What is the total amount of dexamethasone, in mg, to be dispensed?
________________
d. How many days should this prescription last? ________________
3. Rx—Proventil® Inhaler 17gm (200 inhalations)
Use puffs BID
Disp. # 1
a. What is the appropriate quantity to dispense? ________________
b. How many total doses are to be dispensed? ________________
c. What is the total amount of albuterol, in mcg, per inhalation?
________________
d. How many days should this prescription last? ________________
4. Rx—Xanax 0.25 mg
- TID prn  14d
a. What is the appropriate quantity to dispense? ________________
b. What is the maximum number of doses available if 60 tablets are
dispensed? ________________
c. What is the maximum amount of alprazolam, in mg, to be taken
daily? ________________
d. How many days could this prescription last, if 60 tablets are
dispensed? ________________
Pediatric Dosing
Pediatric patients, which include both infants and children, require special dosing that is adjusted for their body weight. A number of formulas
have been used throughout the years to determine the best dose for pediatric patients, but the most commonly used method is stated as mg/kg of
body weight.
Pediatric Formulas Children need lower dosages of medication compared to adults. Three formulas are used to help calculate a pediatric
dosage based on whatever information is available. In some children’s hospitals the pharmacy may have a preferred formula. However, the pharmacy
technician should be able to calculate the correct pediatric dosage using
each formula.
..
TT
.
T
..
TT
Joh_Ch05.qxd 8/31/07 2:39 PM Page 16
CALCULATING PEDIATRIC DOSAGES
USING FRIED’S RULE
EXAMPLE 5.9 An infant, 15 months old and weighing 20 pounds, needs
Streptomycin Sulfate, which is usually administered to adults as
1 gm (1000 mg), as a daily IM injection. What is the appropriate
dosage for the infant?
To calculate the pediatric dosage based on a child’s age in months, simply
use the formula for Fried’s Rule. Using the information provided, you can set
up the calculation as follows:
So, according to Fried’s Rule, the pediatric dosage appropriate for a
15-month-old would be 100 mg.
PRACTICE PROBLEMS 5.7
1. A child, 24 months old, needs acetaminophen, and the normal adult
dose is 650 mg. What is the appropriate dosage for the
child?________________
2. An 18-month-old needs amikacin sulfate, and the normal adult dose is
250 mg. What is the appropriate dosage for the child? ________________
3. A child, 30 months old, needs erythromycin, and the normal adult dose
is 250 mg QID. What is the appropriate dosage for the child?
________________
Pediatric Dose = 100 mg
Pediatric Dose = 0.1 * 1000
Pediatric Dose =
15
150
* 1000
Pediatric Dose =
15 (Age in months)
150
* 1000 mg (Adult Dose)
Chapter Five Dosage Calculations 17
FORMULA Pediatric Dosing
Fried’s Rule
Young’s Rule
Clark’s Rule
Child’s dosage =
Child’s weight in pounds
150
* Adult dosage
Child’s dosage =
Age of child in years
Age of child in years + 12
* Adult dosage
Child’s dosage =
Age in months
150
* Adult dosage
Joh_Ch05.qxd 8/31/07 2:39 PM Page 17
CALCULATING PEDIATRIC DOSAGES
USING YOUNG’S RULE
EXAMPLE 5.10 Now, let’s reexamine Example 5.9 using Young’s Rule, which uses
the child’s age in years. The age of a 15-month-old could be
expressed as 1.25 years old, since he or she has lived for 12 months
(1 year)  3 months (1/4 or 0.25 of a year).
Using an age of 1.25 years and the information provided in Example 5.5,
set up the calculation, using Young’s Rule, as follows:
So, according to Young’s Rule, the pediatric dosage appropriate for a
15-month-old would be 94 mg.
PRACTICE PROBLEMS 5.8
1. A 2-year-old child is prescribed amoxicillin, and the normal adult dose is
500 mg. What is the appropriate dosage for the child?________________
2. A 7-year-old needs propylthiouracil, and the normal adult daily dose is
150 mg. What is the appropriate dosage for the child?________________
3. A child, 10 years old, is prescribed Tavist® syrup, and the normal adult
dose is 1.34 mg BID. What is the appropriate dosage for the
child?________________
CALCULATING PEDIATRIC DOSAGES
USING CLARK’S RULE
EXAMPLE 5.11 Now, let’s reexamine Example 5.9 using Clark’s Rule, which uses
the child’s weight in pounds.
Using a weight of 20 pounds and the information provided in Example
5.5, set up the calculation, using Young’s Rule, as follows:
Pediatric Dose = 133 mg
Pediatric Dose = 0.133 * 1000
Pediatric Dose =
20
150
* 1000
Pediatric Dose =
20 (Weight in pounds)
150
* 1000 mg (Adult Dose)
Pediatric Dose = 94 mg
Pediatric Dose = 0.094 * 1000
Pediatric Dose =
1.25
13.25
* 1000
Pediatric Dose =
1.25 (Age in years)
13.25 (Age of child + 12)
* 1000 mg (Adult Dose)
18 Chapter Five Dosage Calculations
Joh_Ch05.qxd 8/31/07 2:39 PM Page 18
So, according to Clark’s Rule, the pediatric dosage, appropriate for a
15-month-old, weighing 20 pounds, would be 133 mg.
PRACTICE PROBLEMS 5.9
1. A child, weighing 85 pounds, is prescribed hydrochlorothiazide, and
the normal adult dose is 50 mg. What is the appropriate dosage for the
child?________________
2. A child, weighing 70 pounds, is prescribed quinine sulfate, and the
normal adult dose is 325 mg TID. What is the appropriate dosage for
the child?________________
3. A child, weighing 112 pounds, is prescribed Kaletra®, a protease
inhibitor combination therapy. The normal adult dose is 400 mg
lopinavir/100 mg ritonavir. What is the appropriate dosage for the
child?________________
Converting Pediatric Weight
To solve pediatric dosing calculations using the mg/kg method, you must
first determine the patient’s weight in kilograms. To convert weight in
pounds to kilograms, use the following formula:
Chapter Five Dosage Calculations 19
FORMULA Weight Conversion
1 kg = 2.2 lb
CONVERTING WEIGHT FROM POUNDS TO KG
EXAMPLE 5.12 If the infant weighs 20 pounds, what is his or her weight in kg?
Using the weight conversion formula, you divide the patient’s weight,
which in this case is 20, by 2.2 to convert the weight from pounds to kg.
So, the infant weighs 9.09 kg.
EXAMPLE 5.13 If a person weighs 180 lb., divide by 2.2 to find weight in
kilograms.
So 180 lb. equals 81.82 kg.
180
2.2 = 81.82 kg
20 , 2.2 = 9.09
Joh_Ch05.qxd 8/31/07 2:39 PM Page 19
PRACTICE PROBLEMS 5.10
Convert the following.
1. 115 pounds = ________________ kg
2. 18 kg = ________________ pounds
3. 74 pounds = ________________ kg
4. 50 kg = ________________ pounds
5. 41 kg = ________________ pounds
6. 60 pounds = ________________ kg
7. 24 kg = ________________ pounds
8. 100 pounds = ________________ kg
Mg Kg Day
When the dose is stated in the manufacturer information as mg/kg/day, this
means we can calculate the patient’s weight in kilograms, multiply the recommended dose, and take into account the number of times per day the dose
is to be given. The goal is to determine how many milligrams can be given in
each dose.
Step 1: Determine weight in kilograms.
Step 2: Multiply by the recommended dose.
Step 3: Divide by the number of doses given daily.
CALCULATING DOSAGES USING MG/KG/DAY
EXAMPLE 5.14 Using the infant from Example 5.9, determine the pediatric dosage
if it is recommended to administer 20 mg/kg/day (maximum of
1gm) of Streptomycin Sulfate.
The infant’s weight in kg has already been calculated as 9.09, so now we
will multiply the recommended number of milligrams by her weight in kilograms to calculate the appropriate daily pediatric dosage.
So, according to mg/kg/day, the patient should be given 181.8 mg of
Streptomycin Sulfate as a daily IM injection.
181.8 = Pediatric Daily Dosage
20 * 9.09 * 1 = Pediatric Daily Dosage
20 mg * 9.09 kg * 1 day = Pediatric Daily Dosage
//
20 Chapter Five Dosage Calculations
Joh_Ch05.qxd 8/31/07 2:39 PM Page 20
Using the patient from Example 5.13, an order is given for a dose stated
as 20 mg/kg tid.
Step 1: The weight has been determined to be 81.82 kg.
Step 2: Multiply 81.82 by 20 mg, which equals 1634 mg.
Step 3: Divide the total number of milligrams for the day by the number of
doses for the day: .
Based on his weight, the patient should receive 544 mg of drug per dose.
The patient used in the preceding example weighs 180 lb. and is probably
an adult. The same principles apply to calculating appropriate dosages for a
child based on body weight in kilograms.
PRACTICE PROBLEMS 5.11
1. A dose of 4 mg/kg/day of Plaquenil® can be recommended for certain
children suffering from lupus. What would be the appropriate dosage
for a patient weighing 47 kg? ________________
2. The daily dose of Omnicef®, in children, is 14 mg/kg, up to a maximum
dose of 600 mg/day. What is the appropriate daily dosage for a patient
who weighs 98 pounds? ________________
3. The recommended dosage of fluconazole is 6 mg/kg on day one,
followed by 3 mg/kg/day for oropharyngeal candidiasis. What are the
appropriate dosages for a child weighing 30 kg? ________________
4. A child, weighing 76 pounds, is prescribed the antibiotic, Cefaclor. It is
recommended for children to receive 20 mg/kg/day in divided doses
every 8 hours. How many mg should the child take per dose?
________________
5. Acute lymphatic leukemia in children can respond well to methotrexate
given 2.5 mg/kg every 14 days by IV. What would be the appropriate
dosage of methotrexate to administer biweekly to a child weighing
110 pounds? ________________
PRACTICE PROBLEMS 5.12
Perform the following pediatric dosage calculations.
1. Rx tetracycline 25 mg/kg in four equal doses
Your patient is 10 years old and weighs 88 lb.
a. What is the patient’s weight in kilograms? ________________
b. What is the total dosage for this prescription?________________
c. How much is each dose? ________________
1634 mg>3 = 544 mg
Chapter Five Dosage Calculations 21
Joh_Ch05.qxd 8/31/07 2:39 PM Page 21
2. Rx amoxicillin/potassium clavulanate 45 mg/kg/day q12h
Your patient is 6 years old and weighs 68 lb.
a. What is the patient’s weight in kilograms? ________________
b. What is the total dosage per day? ________________
c. How much is each dose? ________________
3. Rx furosemide daily
Your patient is 3 years old and weighs 22 lb.
a. What is the patient’s weight in kilograms? ________________
b. What is the daily dose? ________________
4. Rx albuterol oral syrup 2 mg/5 mL 0.2 mg/kg/day in three divided
doses
Your patient is 5 years old and weighs 62 lb.
a. What is the patient’s weight in kilograms? ________________
b. What is the total dosage per day? ________________
c. How much is each dose? ________________
5. Rx amantadine 6.6 mg/kg/day in two doses, not to exceed 150 mg
per day
Your patient is 6 years old and weighs 54 lb.
a. What is the patient’s weight in kilograms? ________________
b. What is the total dosage per day? ________________
c. How much is each dose? ________________
SUMMARY
Dosage calculations are varied, and more than likely will be the pharmacy
calculations you perform most often. Dosage calculations include determining the number of doses, dispensing quantities, and ingredient quantities, for
both adult and pediatric patients.
1 mg>kg
22 Chapter Five Dosage Calculations
Joh_Ch05.qxd 8/31/07 2:39 PM Page 22
Chapter Five Dosage Calculations 23
CHAPTER REVIEW QUESTIONS
CHAPTER
5
MULTIPLE CHOICE
1. How many 1-tsp doses are in 1 qt. of lactulose
solution, USP 10 g/15 mL?________________
a. 32 doses c. 128 doses
b. 64 doses d. 192 doses
2. How many milligrams of estradiol are delivered
over 72 hours by one 0.075 mg/day
patch?________________
a. 0.225 mg c. 8 mg
b. 1.6 mg d. 0.075 mg
3. You are asked to compound maldroxyl 60 mL,
diphenhydramine elixir 60 mL, and viscous lidocaine 2%, qs to 200 mL. How much viscous
lidocaine 2% will you need to prepare the
order?________________
a. 60 mL c. 80 mL
b. 4 mL d. 200 mL
4. The recommended pediatric dose of ampicillin
is 25 mg/kg/day q8h. Your patient is a 4-weekold infant who weighs 8.7 pounds. Which is the
best dose for this patient? ________________
a. 15 mg c. 33 mg
b. 25 mg d. 45 mg
5. How many days will 4 oz. of clemastine fumerate syrup 0.5 mg/5 mL last if the dose is tsp
daily?________________
a. 24 days c. 30 days
b. 48 days d. 60 days
6. How many grams of drug are in 480 mL of
docusate sodium syrup 60 mg/15 mL?
________________
a. 28.8 g c. 1920 g
b. 1.92 g d. 2.88 g
1/2
7. How many milligrams are in a 2-mL dose of
prochlorperazine injection 5 mg/mL given IM
for severe nausea and vomiting?
________________
a. 10 mg c. 2.5 mg
b. 5 mg d. 15 mg
8. How many milliliters of chloral hydrate syrup
500 mg/5 mL are required for a dose of
100 mg?________________
a. 2.5 mL c. 2 mL
b. 5 mL d. 1 mL
9. The recommended pediatric dose for promethazine is 0.25 mg/kg qid. What is the best
dose for a 12-year-old male who weighs
95 lb?________________
a. 2.5 mg c. 12.5 mg
b. 10 mg d. 15 mg
10. How many total grams of active ingredient are
in five syringes of testosterone 4 g/100 g topical
gel containing 3 g of gel each? What is the
percent strength of the final product?
________________
a. 15 g, 0.4% c. 2.4 g, 40%
b. 0.6 g, 4% d. 60 g, 0.04%
TRUE OR FALSE
11. When solving dosage calculations, it is helpful
to look for the given. ________________
a. true b. false
12. When setting up ratios and proportions to solve
dosage calculations, it is best to keep like units
consistent. ________________
a. true b. false
Joh_Ch05.qxd 8/31/07 2:39 PM Page 23
24 Chapter Five Dosage Calculations
13. The unknown, x, will always be located in the
upper left corner when setting up dosage
calculations. ________________
a. true b. false
14. When choosing the answer in a multiple-choice
question, you should find the numerical answer
regardless of units. ________________
a. true b. false
15. You can solve most dosage calculations by
cross-multiplying. ________________
a. true b. false
SHORT ANSWER
16. Describe why proper dosing of medications is
important to ensure patient safety.
________________
17. Name three types of dosage forms.
________________ ___________ ___________
18. Which dose is larger, 4 mg/mL or 1 mL of 4%
gel? ________________
19. How many milligrams of drug are in 0.5 mL of
a cream that is 4 mg/mL? ________________
20. How many milliliters will be required to provide the necessary dose of albuterol oral syrup
2 mg/5 mL to be given 0.2 mg/kg/day tid for a
patient who weighs 88 lb.? ________________
Joh_Ch05.qxd 8/31/07 2:39 PM Page 24

PDF Document reader online

This website is focused on providing document in readable format, online without need to install any type of software on your computer. If you are using thin client, or are not allowed to install document reader of particular type, this application may come in hand for you. Simply upload your document, and Docureader.top will transform it into readable format in a few seconds. Why choose Docureader.top?

  1. Unlimited sharing - you can upload document of any size. If we are able to convert it into readable format, you have it here - saved for later or immediate reading
  2. Cross-platform - no compromised when reading your document. We support most of modern browers without the need of installing any of external plugins. If your device can oper a browser - then you can read any document on it
  3. Simple uploading - no need to register. Just enter your email, title of document and select the file, we do the rest. Once the document is ready for you, you will receive automatic email from us.

Previous 10

Next 10