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CHAPTER
5
Dosage Calculations
L earning Objectives
After completing this chapter, you
should be able to:
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.
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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
q46h = every 46 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.
Dosage Calculations
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Figure 5-1
..
TT
qdthe frequency
4 ozthe quantity dispensed
Prozac Solution 20 mg/5 mLthe drug name and strength
120 mLthe 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 measurein this case mL.
We know that 1 tsp = 5 mL and we should also know that 4 oz. = 120 mL,
but if you didnt that could also be solved by using a ratio/proportion.
4 oz
1 oz
=
30 mL
x mL
Cross-multiply and solve the equation for x.
30 * 4 = 120 and 1 * x = (1) x
(1)x = 120
Now that you have both quantities converted to units in mL, we can set
up our ratio/proportion and solve.
1 dose
x doses
=
5 mL
120 mL
Cross-multiply
5 * x = 5x and 1 * 120 = 120
4
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Dosage Calculations
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po q 6 hr prn pain
Disp. # 120
. ..
T -TT
pothe dose
Dosage Calculations
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Figure 5-2
Figure 5-3
Chapter Five
Dosage Calculations
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po BID 10d
..
TT
pothe dose
BIDthe frequency
x 10dthe duration
Biaxin 250 mgthe drug name and strength
100 tabletsthe 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.
Chapter Five
Dosage Calculations
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EXAMPLE 5.4
tsp. po QID 4d
..
TT
QIDthe frequency
x 4dthe duration
Promethazine w/Codeine Syrup 6.25/10the 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
dose
frequency
4
x
duration
quantity to dispense
1 4 4 16
16 x
So, 16 teaspoonsful, or 80 mL, of promethazine w/codeine should be
dispensed.
po qd
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po QOD
Disp. # 4 oz
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Lets first look at all of the information provided to determine which will
be used in solving the problem:
..
10
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Lets first look at all of the information provided to determine which will
be used in solving the problem:
400 mgthe dose
500 mLthe quantity to dispense
Dopamine HCl Injection 80 mg/mLthe 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.
400 mg
80 mg
=
1 mL
x mL
Cross-multiply and then set up the equation to solve for x.
1 * 400 = 400 and
400 = 80x
80 * x = 80x
Chapter Five
Dosage Calculations
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po BID
Disp. # 50
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..
TT
pothe dose
BIDthe frequency
50the quantity to dispense
Pamelor 75 mgthe drug name and strength
100 capsulesthe quantity of the stock bottle
To calculate the appropriate days supply, use the following formula:
Days Supply =
Qty. Dispensed
(Dose * Frequency)
50 (qty. dispensed)
(1 * 2) (Dose * Frequency)
This becomes . . .
x =
50
or x = 25
2
po BID
food.
Disp. # 360
Chapter Five
Dosage Calculations
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TT pothe dose
BIDthe frequency
360the quantity to dispense
Kaletra 133.3 mg/33.3mgthe drug name and strength
To calculate the appropriate days supply, use the following formula:
Days Supply =
Qty. Dispensed
(Dose * Frequency)
This becomes. . .
360
or x = 90
4
So this prescription should last for 3 months, or 90 days.
x =
po qAM
Disp. # 45
2. How many days will a 150 mL bottle of Ceclor 125 mg>5 mL last, if the
patient is to take 2 teaspoonsful three times daily? ________________
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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? ________________
RxKeflex 250 mg
..
TT
po TID
Disp. # 42
Chapter Five
Dosage Calculations
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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 childrens hospitals the pharmacy may have a preferred formula. However, the pharmacy
technician should be able to calculate the correct pediatric dosage using
each formula.
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FORMULA
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Pediatric Dosing
Frieds Rule
Childs dosage =
Age in months
* Adult dosage
150
Youngs Rule
Childs dosage =
Clarks Rule
Childs dosage =
Dosage Calculations
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Now, lets reexamine Example 5.9 using Youngs Rule, which uses
the childs 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 Youngs Rule, as follows:
Pediatric Dose =
Pediatric Dose =
1.25
* 1000
13.25
Now, lets reexamine Example 5.9 using Clarks Rule, which uses
the childs weight in pounds.
Pediatric Dose =
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Weight Conversion
1 kg = 2.2 lb
Using the weight conversion formula, you divide the patients weight,
which in this case is 20, by 2.2 to convert the weight from pounds to kg.
20 , 2.2 = 9.09
So, the infant weighs 9.09 kg.
EXAMPLE 5.13
= 81.82 kg
Dosage Calculations
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Mg / Kg / Day
When the dose is stated in the manufacturer information as mg/kg/day, this
means we can calculate the patients 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.
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.
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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: 1634 mg>3 = 544 mg.
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.
Chapter Five
Dosage Calculations
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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.
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CHAPTER
5
CHAPTER REVIEW QUESTIONS
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 1/2 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
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
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SHORT ANSWER
16. Describe why proper dosing of medications is
important to ensure patient safety.
________________
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Chapter Five
Dosage Calculations