Drug Calculations

Inver Hills Community College Paramedic Program

I. Kevin Johnson, AS,BS, NREMT-P

The new system of weights and measures will be a stumbling block and the source of difficulties for several generations Its just tormenting the people with trivia!!
Napoleon I

Converting from one System to Another

Units of Weight
Metric 60 Milligrams (mg) 1 gram (g) = = Apothecary grains (gr) 1 grains (gr) 15

Units of Volume
Metric 1 ml = 5 ml = 30 ml = Apothecary 1 minum 15 - 16 m 1 dram 1 ounce = = = = Household 1 gtt 15 gtts 1 teaspoon 1 ounce

Converting mg to Grains
Convert 300 mg to grains We want to cancel the mg and end up with grains

?gr 300 mg ?mg

Since 60 mg = gr 1, the fraction is:

gr1 60mg

gr1 gr 300 300mg = = gr 5 60mg 60

The Metric System

1000 g = 1 mg 1000 mg = 1 g 1000 g = 1 kg 1000 mL = 1 L 1000 L = 1 kL 1 mL = 1 cc = 1 cm3

To convert from one multiple to the other, move the decimal point 3 places in the direction indicated.

Kg

mg

Converting lbs to kg
Convert 200 lb to kg Known = 1kg = 2.2 lb

1kg 200 200lbs = = 90.9kg 2.2lbs 2.2

Two AM Rule: Divide the weight in pounds by 2 Multiply by 10% Subtract the % from the quotient

200lb 2 100
100 10% 10

100 10 = 90kg

Finding the Ordered Dose

The Doctors Order
amount of medication and the route

Concentration
how much drug is in a given amount of fluid worded as on Hand Break it down to per mL values
100mg/5mL = 20mg/mL

What are You looking For?

Identify unit of measurement to be administered to the patient

The Key
Organization
identify key components of problem

The Order Whats on Hand Looking for:

Find the Ordered Dose

Dr. Kool orders 2 mg of Valium IV to a patient with seizure activity. You have a 5 mL vial that contains 10 mgs of Valium. (10mg/5mL). How many mLs are you going to draw up into a syringe?

Order: 2 mg Valium IV On Hand: 10 mg/5 mL Valium Hand Looking for: mL to be given

Ordered Dose
Formula Method
volume on hand ordered dose volume to be given ( X ) = concentration (mg)

5mL 2mg X= 10mg

10 X = ml 10

X = 1mL

Ordered Dose
Ratio & Proportion Method
On the left side of the proportion, put the known ratio:

10 mg : 5 mL ::
On the right side, put the ration that is unknown:

10 mg : 5 mL :: 2 mg : X mL
Multiply the extremes then multiply the means

10 X = 5 x 2 X = 1 mL

10 X = 10

Titrated Drugs
Specific dose of Drug given in small increments to effect
Dose usually repeated Q 3 5 minutes

Example
2- 10 mg Versed for seizure control 2 10 mg MS for pain and B/P >100

Example of Titrated Med

Standing orders:
2 10 mg Versed IV for seizure control

On Hand:
10mg in 2 mL or 5 mg/mL

Problem
How to give 2 mg increments accurately IVP

Answer
Dilute to 10 mL of solution
2 mL of Versed with 8 cc of NS = 1 mg/mL

Find the Units per Kilogram

Recognize the order is based upon weight Utilize the Key = Organization Solve the problem
Convert Pounds to Kilograms Order by Weight to a Basic Order Find the Ordered Dose

Units per Kilogram

You are to give 10 mg/kg of Bretylium to 198 pound patient You have premixed syringes with 500 mg/10 mL. How many mLs will you administer? Order: 10 mg/kg On Hand: 500mg/10 mL Looking For: mL Pts Weight: 198 lbs

Organize your pertinent Information

Units Per Kilogram

Step 1 - Convert lbs to Kg
198lb 2.2 = 90kg Step 2 - Convert to Basic Order
ordered dose weight(kg) X= 1kg
X= 10mg 90kg 1kg

X = 900mg

Step 3 - Find the ordered Dose

500mg :10mL :: 900mg : XmL 500X = 9000

9000 X= mL 500

X = 18 mL

Concentration
Goal
to find out how many mg, mcg, or grams of a drug there are in 1 mL of solution
usually mg/mL

Formula
Solute (grams or milligrams of drug) X= Solvent (liters or milliliters of volume)

Calculating Concentration
Formula Method
One gram of lidocaine has been added to a 250 mL bag of Normal Saline. What is the concentration? Step 1 - set up the formula
1g lidocaine X= 250 mL D5W
X= Solute (grams or milligrams of drug) Solvent (liters or milliliters of volume)

Step 2 - Convert grams to milligrams 1000mg X= 250mL Step 3 - Do the math

1000mg 250 4mg X= = = 4mg / mL 250mL 250 1mL

Calculating Concentration
Ratio & Proportion Method
One gram of lidocaine has been added to a 250 mL bag of Normal Saline. What is the concentration? Step 1 - Place known concentration on the left 1000mg : 250 mL :: Step 2 - Place unknown concentration on the right 1000mg : 250mL :: (X)mg : 1mL Step 3 - Multiply the Means and Extremes

250 X = 1000
Step 4 - Write as: 4:1

1000 X= = 4mg 250

Calculate an IV Drip Rate

To determine how many drops per minute are needed to infuse a desired volume of IV solution over a given time period Example:
how many gtts/min are needed to infuse 1000 mL of NS over 2 hrs using a Macro IV set?

Formula
volume to be infused drip set rate gtts / min = infusion time in minutes

IV Drip Rate Calculation

Dr. Feelgood orders 2 L of D5W1/2NS to be infused over 4 hours. Using a Macro tube drip set of 15gtts/mL, how many gtts/min will you adjust your IV set to deliver? Step 1: Set up the formula
2L 15gtt/mL gtts/min = 4 hrs

Step 2: Convert to Proper Units & solve

2000 15 200 5 1000 gtts / min = = = = 125gtt / min 240 8 8

3

IV Drip with Medication

Usually ordered to administer a certain number of mgs or mcgs or drug per minute. May involve drawing up medication from a vial and injecting it into a bag of solution. You need to figure how much drug is contained in 1 mL of the solution

IV Drip Rate
Dimensional Analysis
You are to administer lidocaine at a rate of 2 mg/min to a patient with an arrhythmia. You have a vial of Lidocaine that contains 1 g in 5 mL. You also carry a 250 mL bag of Normal Saline. Your administration set is a microdrip with a rate of 60 gtts/mL. How many drops/min will you set your IV set to drip? Step 1: Organize the information. Order: 2 mg lidocaine/min IV On Hand: 1 g lidocaine/5 mL Bag: 250 mL NS Adm set: 60 gtt/mL Looking for: gtt/min

IV Drip Rate
Formula
X= IV bag volume(mL) mg ordered adm set(gtt) Drug in Bag 1 min 1 mL

250mL 2mg 60 gtt x= 1000mg 1 min 1mL

25 2 60 gtt X= 10 1 min 1mL 300 gtt X= = 30 gtts / min 10 min

IV Drip Rate
Rule of Fours
Using the same problem, we calculate the following: & 60gtt = 1 mL 4mg=1mL 4 mg 60 3 mg 45
Gtts/min

Desired Dose 1 mg

15 30 2 mg

IV Drips based on Patient Weight

Example: An order is given to administer 10 mcg/kg/min of Dopamine. You have a vial that contains 200mg/10mL. Of Dopamine. You also have a 250 cc bag of NS & a microdrip IV set. Your Patient weighs 176 pounds. How will you set your drip rate? Order: On Hand Bag: Adm. Set Pts Weight: Looking for: 10mcg/kg/min 200 mg/10mL 250 cc NS 60 gtts 176 lbs gtts/min

IV Drips based on Patient Weight

Calculation
Step 1: Convert the patients weight to kg & calculate dose

176lb 1kg 10mcg = 800mcg / min 1 2.2lb 1kg

Step 2: Calculate Drip Rate

250mL 800mcg 60 gtt X= 200000mcg 1 min 1mL

120 X= = 60 gtts / min 2

IV Drips based on Patient Weight

Calculation Alternative
Step1:Calculate the concentration 200 mg = 200000mcg 200000mcg : 250mL :: Xmcg ; 1 mL 250 X = 200000 200000 X= = 800mcg / mL 250 Step 2: Convert lbs to Kg 176/2.2 = 80kg Kg ordered Dose gtt set Step 3: Calculate Drip rate X=

80 10 60 X= = 60 gtt / min 800

concentration of drip

Solutions
A solution given as a percentage always refers to this concentration
Grams of drug in 100 mL of solution

Therefore:
D5W =
5% Dextrose solution 5 grams of Dextrose for every 100 mL solution 500 mL bag = 25 grams of Dextrose

Solutions (continued)
Example #2
2% Lidocaine
2 grams of Lidocaine in 100 mL solution 2000 mg in 100 mL solution 20 mg/mL

Example #3
20% Lidocaine
20 grams in 100 mL 20000 mg in 100 mL 200 mg.mL