PHARMACOLOGY REVIEWER

DRUG DOSE CALCULATIONS Body Weight

• Allows for individualizing the drug
dose and these involves 3 steps:
Dose
𝒅𝒆𝒔𝒊𝒓𝒆𝒅 𝒅𝒐𝒔𝒆 (𝑫) Step 1:
× 𝑸𝒖𝒂𝒏𝒕𝒊𝒕𝒚 (𝑸)
𝑶𝒏𝒉𝒂𝒏𝒅 𝑫𝒐𝒔𝒆 (𝑯)
• Convert lbs to kgs if necessary
Ratio & Proportion o Kg to lbs = multiply 2.2
o Lbs to kg = divide 2.2
H:V::D:X
Step 2:
H = drug on hand available
• Determine drug dose per body weight
V = drug form (tablet, capsule, fluid)
by multiplying:
D = dose ordered o Drug dose x body weight =
client dose per day
X = Unknown amount to give
Step 3
:: = stands for “as” or “equal to”
• Follow the base formula or ratio and
• Multiply means and extremes.
proportion method to calculate drug
• Solve for x; x is the divisor
dosage.
𝐻𝑥 𝑉𝐷
× Example:
𝐻 𝐻
Example: 1. Order: Flourouracil (5 - FV),
12mg/kg/day intravenously not to
Order: amoxicillin 100mg PO, qid exceed 800mg/day. Adult weighs
Available: 250mg/5mL 132lbs
a. Convert lbs – kgs
Amoxicillin, for oral,
132 ÷ 2.2 = 60𝑘𝑔
Suspension
b. mg x kg = client dose
H = 250mg , V = 5mL, D =100mg X= ?
12mg/kg/day x 60kg = 720mg/day
250𝑚𝑔 𝑥 5𝑚𝐿 𝑥 100𝑚𝑔
=
250𝑚𝑔 250𝑚𝑔
500𝑚𝐿/𝑚𝑔 Pediatric Dosage
𝑥=
250𝑚𝑔 CLARK’S RULE
𝑥 = 2𝑚𝐿 • Uses weight in lbs NEVER in kg
So, amoxicillin 100mg = 2mL Formula: Adult dose x (weight ÷ 150) =
child’s dose
Note that 150 is constant
 PHARMACOLOGY REVIEWER

Example: Intravenous Fluid (IVF)

• 11 year-old/70lbs 𝑻𝒐𝒕𝒂𝒍 𝒗𝒐𝒍𝒖𝒎𝒆 𝒐𝒇 𝒇𝒍𝒖𝒊𝒅 (𝒎𝑳) × 𝑫𝒓𝒐𝒑 𝑭𝒂𝒄𝒕𝒐𝒓 (𝒈𝒕𝒕)
𝑻𝒐𝒕𝒂𝒍 𝒕𝒊𝒎𝒆 𝒐𝒇 𝒊𝒏𝒇𝒖𝒔𝒊𝒐𝒏 (𝒎𝒊𝒏𝒔)
500𝑚𝑔 (𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒) 𝑥 (70 (𝑤𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑙𝑏𝑠)
or
÷ 150) = 𝑐ℎ𝑖𝑙𝑑′ 𝑠𝑑𝑜𝑠𝑒
𝑻𝒐𝒕𝒂𝒍 𝑽𝒐𝒍𝒖𝒎𝒆 (𝒎𝑳)
500𝑚𝑔 𝑥 (0.466) = 𝑐ℎ𝑖𝑙𝑑′ 𝑠 𝑑𝑜𝑠𝑒
# 𝒐𝒇 𝒉𝒐𝒖𝒓𝒔
500𝑚𝑔 𝑥 0.466 = 233𝑚𝑔 (𝑐ℎ𝑖𝑙𝑑′ 𝑠𝑑𝑜𝑠𝑒)

Microdrip = 60gtts/mL
YOUNG’S RULE Macrodrip = 20, 50gtts/mL
• Uses age Example:
Formula Order: 1000mL q8h with a gtt factor of
20gtts/mL
𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 𝑥 𝐴𝑔𝑒 𝑜𝑓 𝐶ℎ𝑖𝑙𝑑 𝑖𝑛 𝑦𝑒𝑎𝑟
÷ (𝐴𝑔𝑒 + 12) = 𝐶ℎ𝑖𝑙𝑑′ 𝑠 𝑑𝑜𝑠𝑒 1000𝑚𝐿 𝑥 200𝑔𝑡𝑡𝑠/𝑚𝐿
8ℎ𝑟 𝑥 60𝑚𝑖𝑛𝑠/ℎ𝑟
Note that 12 is constant
20,000𝑔𝑡𝑡𝑠
Example: = 41.66𝑔𝑡𝑡𝑠/ min = 42𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
480𝑚𝑖𝑛
11y.o. girl. Weight is 70lbs
mL/hr
500𝑚𝑔 𝑥 [11 ÷ (11 + 12)] 1000𝑚𝐿
= 125𝑚𝐿/ℎ𝑟
= 𝑥 (𝑐ℎ𝑖𝑙𝑑′ 𝑠 𝑑𝑜𝑠𝑒) 8ℎ𝑟𝑠

500𝑚𝑔 𝑥 (11 ÷ 23) = 𝑥

500𝑚𝑔 𝑥 0.478 = 𝑥 Medication ticket – used in Zanorte
Hospital & Corazon
x = 239mg
Medication Sheet – Abroad
OD – once a day – white – 8am
FRIED’S RULE
BID – twice a day – yellow – 8am, 6pm
𝐴𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠
𝑥 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 = 𝑐ℎ𝑖𝑙𝑑′ 𝑠 𝑑𝑜𝑠𝑒 QID – four times a day – 4am, 8am
150
150 is constant TID – three times a day – pink – 8am, 1pm,
6pm
Example:
HS – night time – orange 9pm
8 𝑚𝑜𝑛𝑡ℎ𝑠
𝑥 500𝑚𝑔 = 26.7𝑚𝑔/𝑑𝑜𝑠𝑒
150
 PHARMACOLOGY REVIEWER

HOUSEHOLD EQUIVALENTS IN FLUID c. SMART: Specific, Measurable,

VOLUME Attainable, Realistic, Time-
bound
• 1 measuring cup = 8 ounces (oz)
d. Follow ABC for prioritizing
• 1 medium size glass (tumbler size) =
patients
8 ounces (oz)
4. Implementation
• 1 coffee cup (c) = 6 ounces (oz)
a. Allows the nurse to complete
• 1 ounce (oz) = 2 tablespoon (tbsp)
the action of medication
• 1 tablespoon (tbsp) = 3 teaspoons
administration and follow
(tsp)
through with the interventions
• 1 teaspoon (tsp) = 60 drops (gtt)
designed during the planning
• 1 drop (gtt) = 1 minim (min)
phase
b. Proper drug administration by
using 10 rights to medication
NURSING PROCESS IN
c. Health teaching
PHARMACOLOGY
d. Monitor patient’s blood
pressure
• ADPIE e. MDR: Multi-Drug Resistant
1. Assessment
a. The nurse should obtain
baseline information prior to TYPES OF DRUG ORDER
the administration of any
• STAT ORDER (Emergency cases)
medication
• SINGLE ORDER (Certain time
b. History taking (Subjective)
only/one time)
c. Objective Data
• STANDING ORDER (specified time)
2. Diagnosis
• PRN (PRO RE NATA) (as needed)
a. Allows the nurse to identify
potential and actual problems
related to medication
VERBAL & TELEPHONE ORDERS
administration
b. “risk for” = adverse effect • Medication orders given orally than in
3. Planning writing
a. Nurse develops goals, • The physician must cosign and date
priorities, and interventions the order, usually within 24 hours
specific to the medication(s) • It should be avoided because
administered miscommunications can occur and
b. The overall goal of medication you’ll lack a written record of the
administration is to achieve order
maximum benefit with • “Read back and repeat back”
minimum harm to client
 PHARMACOLOGY REVIEWER

o Repeat the order aloud so the document approved by your

prescriber can verify that you healthcare facility.
understood it o Example: MAR, Kardex,
o The danger zone – the danger medication card/tickets. Or a
of miscommunication rises computer print-out.
even higher when a prescriber • Stepping away from ERRORS:
gives a verbal medication o Read the order carefully
order over the telephone. o Concentrate on copying it
o If possible, use fax machines correctly
to obtain a written order, o Check it when you finish
instead of taking a verbal order • Don’t rely on memory
over the phone. o Never prepare a medication
o Patient’s chart: Doctor’s Order: from memory or from your
o Medication ticket/Carde personal worksheets or notes.
(depending on the facility) o Periodically check all MARS
o NCP, only subj. data written in against the original order
BISAYA sheets
TELEPHONE ORDER ACCURACY
• Have another nurse listen in on the MEDICATION ERRORS
call to confirm that she heard the
• Any errors in the medication process,
same order you did.
including prescribing errors,
• Repeat the name of the ordered drug
transcription/order communication
to the prescriber to verify that you
errors, dispensing errors,
heard it correctly. Have the prescriber
administration errors, and errors of
spell the drug name, if necessary.
monitoring or education for proper
• Repeat the individual digits of the
use.
dose ordered.
• Write out the order, noting that it was
a telephone order, then sign and
1. Prescribing errors
date.
a. Ex.
• The prescriber must cosign your
i. Suboptimal drug
written order within the time allotted
therapy decisions
by the facility
ii. Drug for patient w/
known allergy or
intolerability
ORDERS INTO ACTION
iii. Incorrect dose for
• After you receive a written medication diagnosis
order, transcribe it onto a working iv. Unauthorized drug
prescribed.
 PHARMACOLOGY REVIEWER

2. Transcription errors • Provide with drug information in

a. Ex. writing
i. Misinterpretation/misun • Asks if the patient takes OTC at home
derstanding of drug in addition to his prescribed drugs
ordered or directions • Ask about herbal remedies and other
ii. Illegible handwriting nutritional supplements
iii. Unapproved • Inform what kinds of drug-related
abbreviations problems warrant a call to his doctor
iv. Emission of orders • Urge the patient to report anything
3. Dispensing errors about this therapy that concerns or
a. Ex. worries him
i. Wrong drug or dose
sent to nursing unit
ii. Wrong formulation or GUIDELINES FOR DRUG
dosage form ADMINISTRATION
4. Administration errors
1. Wash hands before preparing
a. Ex.
medications
i. Incorrect strength
2. Check for drug allergies; check the
(dose) given
assessment history and Kardex,
ii. Extra dose given or
3. Check for medication order w/
missed dose
healthcare provider’s order, Kardex,
iii. Wrong administration
medicine sheet, and medicine card
technique
4. Check on label on drug container 3x
iv. Incorrect administration
technique Multi-dosed drugs
5. Monitoring errors
• Recording
a. Ex.
o Charting: record drug given,
i. Suboptimal monitoring
dose, time, route, and your
ii. Suboptimal
initials.
assessments of drug
response/revision of
regimen
5. Evaluation
iii. Suboptimal patient
a. The nurse should conduct an
education
evaluation following
medication administration
Reducing Medication Error Through
Client Teaching
• Teach the patient about his diagnosis
and the purpose of his drug therapy