Brush up on Your Drug Calculation Skills

Louise Diehl, RN, MSN, ND, ACNS-BC, NP-C

Nurse Practitioner - Owner
Doctor of Naturopathy
Lehigh Valley Wellness Center
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.

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

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 = 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 50mg p.o. TID
Drug available-Dilantin 125 mg/5ml

II. Ratio & Proportion: Oldest method used in calculating dosage.

Left side are known quantities

Right side is desired dose and amount to give
Multiply the means and the extremes

Example: Order-Keflex 1 gm p.o. BID

Drug available-Keflex 250 mg per capsule

III. Fractional Equation

H
V= D
X
Cross multiply and solve for X.

Example: Order - Digoxin 0.25 mg p.o. QD

Drug Available - 0.125 mg per tablet

IV. Intravenous Flow Rate Calculation (two methods)

Two Step

Step 1 - Amount of fluid divided by hours to administer = ml/hr

One Step

Example: 1000 ml over 8 hrs

IV set = 15 gtts/ml
Two Step
Step 1 - 1000 divided by 8 = 125

Step 2 -

One Step

IV. How to Calculate Continuous Infusions

B. mcg/min (For example - Nitroglycerin)

C. mcg/kg/min (For example - Dopamine, Dobutamine, Nipride, etc.)

1.

To calculate cc/hr (gtts/min)

Example: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min.

Patients weight is 190 lbs.

2. To calculate mcg/kg/min

Example: Nipride 100mg/250 cc D W was ordered to decrease your patients blood pressure.
The patients weight is 143 lbs, and the IV pump is set at 25 cc/hr. How many mcg/kg/min of
Nipride is the patient receiving?
5

V. How to calculate mcg/kg/min if you know the rate of the infusion

For example:
400mg of Dopamine in 250 cc D W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min
5

26.6 is the dosage concentration for Dopamine in mcg/cc/min based on having 400mg in 250cc 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!

NOW DO THE REST!

(If you have a 75 kg patient for example...)

= 3.5 mcg/kg/min (rounded down)

B. How to calculate drips in cc per hour when you know the mcg/kg/min that is ordered or desired

For example:
400 mg Dopamine in 250 cc D W = 26.6 mcg/cc/min
5

ALWAYS WORK THE EQUATION BACKWARDS AGAIN TO DOUBLE CHECK YOUR MATH!

For example:
400mg of Dopamine in 250 cc D W = 1600 mcg/cc 60 min/hr = 26.6 mcg/cc/min
5

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!
NOW DO THE REST!!
(If you have a 75 kg patient for example)

Now do some practice exercises to check what you learned

A. Practice Problems:
1.
2.
3.
4.
5.
6.
7.
8.

2.5 liters to milliliters

7.5 grams to milligrams
10 milligrams to micrograms
500 milligrams to grams
7500 micrograms to milligrams
2800 milliliters to liters
165 pounds to kilograms
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:
1. Order-1000 ml over 6 hrs

IV set 15 gtts/ml

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 D W to infuse at 5 mcg/kg/min. The patients weight is 200
pounds. How many
cc/hour would this be on an infusion pump?
5

2. 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?
3. A Nitroglycerin drip is ordered for your patient to control his chest pain. The concentration is
100 mg in 250 cc
D W. The order is to begin the infusion at 20 mcg/min. What is the rate you would begin the
infusion on the
infusion pump?
5

4. A Nitroglycerin drip (100mg in 250 cc D W) is infusing on your patient at 28 cc/hour on the

infusion pump. How
many mcg/min is your patient receiving?
5

5. 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.
6. A Lidocaine drip is infusion on your 90 kg patient at 22 cc/hour. The Lidocaine concentration
is 2 grams in 250 cc
of D W. How many mg/min is your patient receiving?
5

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 lifethreatening 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

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