NUPC 107

NURSING PHARMACOLOGY

COURSE MODULES

Jerome Molina
CCHAMS Faculty
2020

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 MODULE 2
REGULATIONS & CALCULATIONS

COURSE CONTENT
LESSON 1 Significant Personalities

LESSON 2 Laws and Legal Aspects

LESSON 3 Computation of Drugs

REFERENCES

Books:
Pharmacology for Nurses by Blaine Templar Smith & Diane F. Pacitti; Second Edition 2019
Nursing 2020 Drug Handbook by Walters Kluwer; Philippine Edition 2020
Davis’s Drug Guide for Nurses by Judith Hopper Deglin, et al, Thirteenth Edition, 2015
Essentials of Pharmacology for Nurses by Paul Barber & Deborah Robertson Third Edition, 2015
Nurses! Test yourself in Pharmacology by Katherine M.A. Rogers & William N. Scott, Faculty of
Nursing Chiangmai Univeristy, 2014.
Karch A.,(2011)Focus on Nursing Pharmacology 5th Edition. Lippincott Williams and Wilkins.
Adam, M.P., L,N. Bostwick, P. (2007). Pharmacology for Nurses: A Pathophysiologic Approach
2nd Edition. Pearson Education Inc.
Clayton, Bruce D. and Y. Stock, Basic Pharmacology for Nurses

Websites: [Link]
[Link]
[Link] [Link]/category/nclex-cgfns/ [Link]
[Link]

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 SIGNIFICANT PERSONALITIES
IN THE HISTORY OF PHARMACOLOGY

1. HIPPOCRATES (400 BC)

- The father of medicine
- He freed medicine from mysticism & Philosophy

2. FRIEDRICH SERTURNER (1805)

- He isolated the first alkaloid from opium which was then named morphine

3. OSWALD SCHMIEDEBERG (1869)

- The founder of modern pharmacology
- He studied the pharmacology of chloroform & chloral hydrate
- Showed that muscarin evoked the same effect on the heart as electrical
stimulation of the vagus nerve.
- He also introduced urethane as hypnotic.

4. JOHN JACOB ABEL (1890)

- isolated epinephrine from adrenal extracts

5. REID HUNT (1906))

- discovered acethylcholine in adrenal extracts

6. Sir JOHN VANE (1971)

- discovered action of aspirin
- Nobel Prize for Medicine in 1981

LEGAL ASPECTS & DRUG LEGISLATIONS

NURSE PRACTICE ACT OF 2002

 Understanding of the Nurse Practice Act & the rules & regulations established by the BON
(Board of Nursing) is a solid foundation for a beginning nurse to practice its profession
 The nurse must understand the individual patient's diagnosis & symptoms that correlated
with the rationale for drug use
 It is the first legal responsibility of a nurse in drug therapy is to administer medications
safely & accurately. The nurse is held liable if this aspect is not carried out.

PURE DRUG ACT OF 1906

 an act for preventing the manufacture, sale or transportation of adulterated or
misbranded or poisonous or deleterious foods, drugs, medicines, & liquors, & for regulating
traffic therein, & for other purposes
 all drugs sold had to meet strength & purity standards

FEDERAL FOOD, DRUG & COSMETIC ACT OF 1938

 extending control to cosmetics & therapeutic devices
 requiring new drugs to be shown safe before marketing
 providing that safe tolerances be set for unavoidable poisonous substances
 authorizing standards of identity, quality, & fill-of-container for foods
 authorizing factory inspections

DURHAM-HUMPHREY AMENDMENT OF 1951

 until this law, there was no requirement that any drug be labelled for sale by prescription
only. The amendment defined prescription drugs as those unsafe for self-medication &
which should therefore be used only under a doctor's supervision

 1st law to recognize class of drugs that could be sold OTC

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
KEFFAUVER-HARRIS DRUG AMENDMENTS OF 1962
 tighten control over drugs
 before marketing a drug, firms now had to prove not only safety, but also effectiveness for
the product's intended use
 firms were required to send adverse reaction reports to FDA, & drug advertising in medical
journals was required to provide complete information to doctors including the risks as well
as the benefits

CONTROLLED SUBSTANCES ACT OF 1970

 is designed to limit & control access to drugs that can make you “high” or intoxicated in a
pleasant way, & also is now used to control certain other drugs of abuse such as anabolic
steroids used by athletes to increase muscle mass.
 Replaced the Harrison Narcotic Act

HARRISON NARCOTIC ACT

 first federal law aimed at curbing drug addiction & dependence 
established the word narcotic as a legal term

DRUG REGULATION & REFORM ACT OF 1978

 it amplifies & redefines the investigative process to facilitate & promote research while
protecting patient's rights. It also divides the commercial investigation process into 2
phases: drug innovation investigations & drug development investigations

ORPHAN DRUG ACT OF 1983

 “orphans” are drugs & other products for treating rare diseases. They may offer little or
no profit to the manufacturer, but may benefit people with the rare diseases. To foster
orphan product development, this law allows drug companies to take tax deductions for
about 3 quarters of the cost of their clinical studies
 firms also are given exclusive marketing rights for 7 years for any orphan products that are
approved

RA 6675 ( Generics Act of 1988 )

 states that only validly registered medical, dental, & veterinary practitioners whether in
private institution or in the government are authorized to prescribe drugs.
 An act to promote, require & ensure the production of an adequate supply, distribution,
use & acceptance of drugs & medicines identified by their generic names

RA 2382 ( Medical Act of 1959 )

 this act provides for & shall govern
a) the standardization & regulation of medical education
b) the examination for registration of physicians
c) the supervision, control & regulation of the practice of medicine in the Philippines.

RA 4419 ( Dental Act of 1965 )

 this act provides for
a) the regulation, control & supervision of the practice of dentistry in the Philippines.
b) the giving of licensure exam to graduates of recognized dental schools for the purpose
of registration
c) the regulation & standardization of dental education
d) promotion & development of dental research in the country

RA 382 ( Veterinary Act )

 regulating the practice of veterinary medicine & surgery

RA 5921 ( The Pharmacy Act )

 an act regulating the practice of pharmacy & setting standards of pharmaceutical education
in the Phils.

RA 3720 ( Food, drug, & Cosmetic Act )

 an act to ensure the safety & purity of foods, drugs, & cosmetics being made available to the
public by creating the food & drug administration which shall administer & enforce the
laws pertaining thereto.

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 FDA PREGNANCY CATEGORIES

FDA CLASSIFICATION according to PROBABLE RISK to FETUS

Category A Adequate studies in pregnant women have not demonstrated a risk to the
fetus in the first trimester of pregnancy, & there is no evidence of risk in
later trimester.

Remote risk of fetal harm Example:

levothyroxine, folic acid, liothyronine

Category B Animal studies have not demonstrated a risk to the fetus but there are no
adequate studies in pregnant women, or animal studies have shown an
adverse effect, but adequate studies in pregnant women have not
demonstrated a risk to the fetus during the first trimester of pregnancy, &
there is no evidence of risk in the later trimester.

Slightly more risk than A

Example:metformin, hydrochlorothiazide, cyclobenzaprine, amoxicillin

Category C Animal studies have shown an adverse effect on the fetus but there are no
adequate studies in humans; the benefits from the use of the drug in
pregnant women may be acceptable despite its potential risks, or there are
no animal reproduction studies & no adequate studies in humans

Greater risk than B Example:

gabapentin, amlodipine, trazodone

There is evidence of human fetal risk, but the potential benefits from the
use of the drug in pregnant women may be acceptable despite its potential
risks.

Proven risk of fetal harm (risk may be acceptable) Example:

Category D Losartan

Category X Studies in animals or humans demonstrate fetal abnormalities or adverse

reaction; reports indicate evidence of fetal risk. The risk of use in a pregnant
woman clearly outweighs any benefit.

Proven risk of fetal harm (risk of use outweighs potential benefits)

Example: atorvastatin, simvastatin, methotrexate, finasteride

NOTE: regardless of the designated Pregnancy Category or presumed safety,

NO DRUG should be administered during pregnancy unless it is clearly needed.

But this (old) five-letter system left patients and health care providers
illinformed and resulted in false assumptions about the actual meaning of the
letters. So the FDA decided to update and make it better.

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
The new labeling system allows better patient-specific counseling and informed
decision making for pregnant women seeking medication therapies. While the new
labeling improves the old format, it still does not provide a definitive “yes” or “no”
answer in most cases. Clinical interpretation is still required on a case-by-case basis.

The new FDA Update

a. Pregnancy (includes Labor and Delivery):
• Pregnancy Exposure Registry
• Risk Summary
• Clinical Considerations
• Data

b. Lactation (includes Nursing Mothers)

• Risk Summary
• Clinical Considerations
• Data

c. Females and Males of Reproductive Potential

• Pregnancy Testing
• Contraception
• Infertility

UPDATE further explained…

The Pregnancy subsection will provide information about dosing and

potential risks to the developing fetus and registry information that collects
and maintains data on how pregnant women are affected when they use
the drug or biological product. Information in drug labeling about the
existence of any pregnancy registries has been previously
recommended but not required until now. Contact information for the
registries will also be included, and pregnant women are encouraged
to enroll to help provide data on the effects of drug use or biologics
in pregnancy.

If information for the subsections of Pregnancy Exposure Registry, Clinical Considerations, and
Data is not available, these subsections will be excluded. The Risk Summary subheadings are
always required, even if no data is available.

The Lactation subsection will replace the “Nursing Mothers” subsection of the old label.
Information will include drugs that should not be used during breastfeeding, known human or
animal data regarding active metabolites in milk, as well as clinical effects on the infant. Other
information may include pharmacokinetic data like metabolism or excretion, a risk and benefit
section, as well as timing of breastfeeding to minimize infant exposure.

In the subsection entitled Females and Males of Reproductive Potential, relevant information
on pregnancy testing or birth control before, during or after drug therapy, and a medication’s
effect on fertility or pregnancy loss will be provided when available.

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
REASON FOR CHANGE or UPDATE
In reality, many women require drug treatment
during pregnancy due to chronic conditions such as
epilepsy, diabetes, hypertension (high blood pressure), or asthma.

To withhold drug treatment would be dangerous for both mother and baby. In addition, women
are having babies at a later age, which can boost the number of women with chronic conditions.
Accessible and understandable pregnancy and lactation information is important for women
and their health care provider’s to assess risk versus benefit.

When using the DRUG HANDBOOK,

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 DEA SCHEDULES
OF CONTROLLED SUBSTANCES

The Controlled Substances Act of 1970 regulates the manufacturing, distribution, & dispensing
of drugs that are known to have abuse potential. The Drug Enforcement Agency is responsible
for the enforcement of these regulations. The controlled drugs are divided into 5 DEA schedules
based on their potential for abuse & physical & psychological dependence.

Schedule I ( C-I )
• high abuse potential & no accepted medical use
• ex. heroin, marijuana, LSD (Lysergic acid diethylamide)

HEROIN

Schedule II ( C-II )
• high abuse potential with severe dependence liability
• ex. narcotics, amphetamines, barbiturates
•

Schedule III ( C-III )

• less abuse potential than schedule II drugs & moderate dependence liability
• ex. nonbarbiturate sedatives (benzodiazepines—diazepam, nitrozepam)
nonamphitamines stimulants

Schedule IV ( C-IV )
• less abuse potential than C-III & limited dependence liability ex. sedatives,
antianxiety agents, nonnarcotic analgesics

Schedule V ( C-V )
• limited abuse potential. Primarily small amounts of narcotics (codeine) used as
antitussive or antidiarrheals.

Under federal law, limited quantities of certain schedule V drugs may be purchased without
a prescription directly from a pharmacist. The purchaser must be at least 18 years of age &
must furnish suitable identification. All such transactions must be recorded by the
dispensing pharmacist.

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
Let us check your addiction level. Match Column A with Column B. Write the letter from
column B that is described in column A. The first item is already answered as example.
Write your answers in the space provided. Have Fun!

Column A Column B
1. discovered action of aspirin A. Generics Act of 1988

2. first legal responsibility of a nurse in drug B. Category X

therapy is to administer medications safely &
accurately
3. gabapentin, amlodipine, trazodone C. Medical Act of 1959

4. simvastatin, methotrexate, finasteride D. The Pharmacy Act

5. discovered acethylcholine in adrenal extracts E. Category C

6. introduced urethane as hypnotic F. Durham-Humphrey

Amendment
7. RA 5921 G. Oswald Schmiedeberg

8. RA 2382 H. Sir John Vane

9. RA 6675 I. Nurse Practice Act

10. 1st law to recognize class of drugs that could be J. Reid Hunt
sold OTC
11. Remote risk of fetal harm K. Federal Food, Drug &
Cosmetic Act Of 1938

12. It extends the control of drugs to cosmetics & L. Hippocrates

therapeutic devices

13. Nobel Prize for Medicine in 1981 M. Sir John Jacob Vane

14. Replaced the Harrison Narcotic Act N. Controlled Substances Act

of 1970

15. He freed medicine from mysticism & Philosophy O. Category A

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NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 DRUG COMPUTATION

A. NONPARENTERAL MEDS

Capsules and unscored tablets are rounded to the

nearest whole tablet. Scored tablets are rounded to
the nearest 1/2 tablet. Liquid medications are
rounded to one decimal place (tenths).

1. RATIO & PROPORTIONS

Ratios indicate a relationship between two numbers

with a colon between the numbers. The colon
represents division. For example 3:4 = 3/4.

Proportions are equations containing ratios of equal value.

For example 3:4 = 6:8. This may also be written as fractions, 3/4=6/8.

Means are the two inner numbers, in this case 4 & 6.

Extremes are the two outer numbers, 3 and 8.
3:4=6:8
The product of the means (4 X 6) must equal the product of the extremes (3 X 8).

Therefore when you do not know one value (x), you can determine it, if the other three
values are known.. When setting up a ratio, the known factor (on hand) is stated first, the
desired is stated second. H = D x

3:4=x: 8 multiply the means and

4x = 3 X 8 the extreme
4x = 24 x=
24 4 = 6

If you set this up as a fraction:

3 =x cross multiply to obtain

4 8 the product of the means
4x = 3 X 8 = 24 and extremes

x = 24

Example: Ordered: 600,000 units of penicillin per orem every 6hours

Available: 400,000 units per scored tablet

How many tablets will you administer?

400,000 units : 1 tablet = 600,000 units : x

600,000 = 400,000x

600,000 = x = 1.5 tablets

400,000

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
OR set it up as a fraction

400,000 = 600,000
1 x

400,000x = 600,000

x = 600,000 = 1.5 tablets

400,000
When working with a complex fraction - either a fraction in the numerator or
denominator - it helps to simplify the fraction. When dividing by a fraction,
remember to invert and multiply.

2. THE FORMULA METHOD:

D/S x Q = X

D - dosage desired or ordered

S – stock or what is on hand (available)
Q - unit of measure that contains the available dose.

When using solid products (tablets, capsules) Q is always 1 and can be eliminated.
Q varies when using liquid measure.

X - the unknown dosage you need to administer

Example: Order: Potassium Chloride 20 mEq added to the IV solution

Available: 40 mEq per 10cc.
How much potassium will you add?

D = 20 mEq
S = 40 mEq
Q = 10 cc

20 mEq X 10 cc = X
40 mEq

0.5 X 10 X = 5 cc or 5 ml

Points to remember:

1. The maximum number of tablets and capsules administered to achieve a desired dose
is usually 3.
2. No more than 10% variation should exist between the dose ordered and the dose
administered.
3. Make sure your answer seems reasonable. Think about whether the dose should be
larger or smaller than what is available.

EXERCISES:
1. A client is ordered 50 mg of Amitriptyline.
25 mg tablets are available. How many tablets will you give?

50 mg/25 mg = 2 tabs

2. A client is ordered 0.5 mg of Digoxin.

250 mcg tablets are available. How many tablets will you give?

0.5 mg/0.25 mg = 2 tabs

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 3. A client is ordered 1 mg of Diazepam.
2 mg tablets are available. How many tablets will you give?

1 mg/2 mg = ½ tab

TRY ANSWERING THESE PROBLEMS. You may need a separate sheet of paper for your
solutions. Goodluck!

4. A client is ordered 2.5 grams of Neomycin Sulphate. 500 mg tablets are available. How
many tablets will you give?

5. A client is ordered 1.25 mg of Clonazepam. 0.5 mg tablets are available. How many
tablets will you give?

6. Order: Codeine gr. I, PO, STAT

Available: 30 mg

7. A client is ordered 35 mg of Codeine phosphate by subcutaneous injection.

50 mg in 1 mL of liquid for SC Injection is available. How many mL will you administer?

8. A client is ordered 22 mg of Gentamicin Sulphate by intramuscular injection. 20 mg in

2 mL of liquid for IM Injection is available. How many mL will you administer?

9. A client is ordered 200 mg of Amoxicillin trihydrate orally. 250 mg in 5 mL of Syrup is

available. How many mL will you administer?

10. Order: Atropine 0.3 mg IM now

Label: Atropine 400 mcg/mL
How many mL would be administered?

11. Order: Chloromycetin 800 mg IV q8h.

The vial reads: 1g per mL. How many cc would you give?

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 B. PARENTERAL MEDICATIONS

 Injectable medication guidelines:

1. Intradermal - the volume to be administered is 0.1 ml or less

2. Subcutaneous - the volume to be administered is 1.0 ml or less
3. Intramuscular - depends upon the size of the person

a. A healthy well developed person can tolerate 3.0 ml in large muscles – this does
NOT include the deltoid.
b. For elderly, thin clients or children the total amount should not exceed 2.0 ml.
c. No more than 1.0 ml should be given to young children and older infants.

 Calculating dosages in units (insulin, heparin, pitocin, vitamins, some antibiotics)

Ex: Ordered: Heparin 8000 units sq q12h

Available: Heparin 10,000 units/ml
How much will you administer?

Formula: 8000 units X 1 ml = 0.8 ml

10,000 units

Ratio: 10,000 units : 1 ml = 8000 units : x

8000 units X 1 ml = 10,000 units x
8000 / 10,000 = x
0.8 ml = x

If the answer is greater than 1, you probably calculated the problem incorrectly. Rarely, the
desired dose is large and you will have to administer it in more than one site.

Reconstituting powdered drugs:

Read the label for the amount of fluid to add, the type of fluid and the final concentration of
the reconstituted fluid. The label will also tell you how long the mixture may be stored and
what conditions are required for storage. The final volume will be larger than the amount of
fluid you add because the powder will take up some room when diluted. If you are not given a
final volume calculate the concentration based on the amount of fluid you added. You will
calculate the amount to administer from the final concentration.

Insulin

Insulin is administered only using an insulin syringe. Most insulin vials contain 100 units/ml.
Insulin may be administered subcutaneously, intramuscularly (rarely used) and intravenously.

Regular insulin is the only type that may be given IV since it does not contain any additives to
prolong the action. Regular insulin is clear. If the vial is cloudy, it has been contaminated
and should be discarded.

Long acting insulin is cloudy and may have a precipitate on the bottom of the vial. Be sure
to mix the vial well by rotating it between the hands.

WHEN mixing regular insulin and a longer acting insulin in the same syringe.
• Inject air into the longer acting insulin vial first - don't let the tip of the needle
touch the surface of the fluid.
• Using the same syringe, inject air into the regular insulin then invert the bottle and
withdraw the correct amount of regular insulin. Remove air bubbles.
• Still using the same syringe, withdraw the correct amount of the longer acting
insulin. You cannot return any extra fluid withdrawn. If you withdraw too much, you
must start over.

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
Intravenous calculations
Drop factor - IV tubing has a drip chamber
that is used to count drops (gtts) per minute.
Each tubing is labeled with the number of
drops per milliliter (drop factor).

Macrodrop tubing - has a drop factor of 10, 15 or 20 gtts/ml (drops per milliliter).

Microdrip tubing - has a drop factor of 60 gtts/ml.

FLOW RATE FORMULA:

R= V x DF
T

Where:
R = rate ; expressed in gtts/min
V = volume ; amount to be infused
expressed in mL or cc
DF = drop factor; expressed in gtts/mL
; either macro (10,15,20) or
micro (60)
T = time or duration of infusion ;
expressed in minutes

Ex: Ordered: D5W 1000 ml to infuse in 6 hours.

The DF of your tubing is 10 gtts/ml.
How many gtts/min will you infuse?

R = 1000 mL x 10 gtts/mL
6 hr or 360 mins

= 10000 gtts
360 mins

= 27.77 gtts/min
= 27.8 gtts/min
R= 27-28 gtts/min

The same formula may be used to calculate drop rates for fluids
administered in less than 1 hour:

Ex: Ordered: Gentamycin 40 mg/100 ml IVPB q 6h

Drop factor 15 gtts/ml
Your drug book says you can give this
in 45 min
How many gtts/min will you infuse
the Gentamycin?

R = 100 mL x 15 gtts/mL
45 mins
R = 15000gtts
45 mins
R = 33 gtts/min

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
When using an IV pump, the rate is in ml/hr. Therefore, you do not need to determine a
drop factor.

Example:
Infuse Ancef 1 g/50 ml IVPB q6h. The IV handbook states this can be given in 20 minutes.

What rate will you set on the IV pump?

• 50 ml X 60 min = 50 X 3 = 150 ml/hr

20 min 1 hr
• You need to give 50 ml in 20 minutes. But you have to convert the minutes to hours.

OTHER FORMULA:

T = V x DF
R

V = RxT
DF

DF = R x T
V

EXERCISES:

1. Calculate the drip rate for 100 mls of IV Fluids to be given over a half hour via a giving
set which delivers 10 drops/ml.

R = 33.33 0r 33-34 gtts/mL

2. Calculate the drip rate for 500 mls of Normal Saline to be given over 4.5 hours via a
giving set which delivers 15 drops/ml.

R = 27.77 or 27-28 gtts/mL

3. Three litres of Hartmans (Lactated Ringer's) is charted over 12 hours. The drop factor
is 15. The IV has been running for 9 hours. 800 mls remain. How many drops per
minute are needed so that the IV finishes in the required time?

800 x 15 / 180 = 66-67 gtts/mL

4. Ordered : 1000mL of D5W to infuse over 12h Available: macrodrip set with 10 gtts/mL
&a microdrip set with 60 gtts/mL
a) Would you use macro or micro IV set?
b) Calculate the IV flow rate in gtts/min according to IV set you selected

1000 mL x 10 gtts/mL / 720 mins = 13-14gtts/mL

or

1000 mL x 60 gtts/mL / 720 mins = 83-84 gtts/mL

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
Uses
1. Adult I.V. solution to keep vein open.
2. Vehicle for mixing medications for I.V. delivery for all age groups.
3. It may be the primary adult I.V. fluid for medical emergencies, though many services use
only L.R. or N.S.

The fluid is isotonic when in the container. After administration, the dextrose is quickly
metabolized in the body, leaving only water - a hypotonic fluid.

5. A D10W IVF regulated at 24 gtts/min was hooked to an adult client at 1 PM yesterday.

How much fluid would the patient consume until tomorrow at 3 PM? Express your
answer in liters.

6. How long will it take for a 750 mL IVF to be consumed if it is infusing at 33 gtts/min.
The client is a preschooler suffering from mild dehydration related to diarrhea
secondary to ingestion of contaminated “tokneneng”. The IVF was started 30 minutes
before the 3-11 shift. Find out when a follow-up IVF is to be given.

7. One litre of Dextrose 5% in water is charted over 8 hours. The drop factor is 10.
Calculate the number of drops per minute

8. Calculate the drip rate for 100 mls of IV Fluids to be given over 2 hours via a giving set
which delivers 60 drops/ml.

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NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
PEDIATRIC CALCULATIONS

Accurate doses are especially important in giving medications to infants and children because
even small errors can be dangerous due to their small body size.

Two methods are used to calculate pediatric dosages:

According to the weight in kilograms (kg)

According to the child's body surface area (BSA)

A. BASED ON BODY WEIGHT

1. The first step is to convert the child's body weight into kg. The formula is
2.2 lb. = 1 kg.

2. The second step is to calculate the medication dose.

a. Calculate the daily dose
b. By Dividing the daily dose by the number of doses to be administered
c. Use either the ratio-proportion or formula method to calculate the number of
tablets/capsules or volume to be administered with each dose.

Example: A child weighing 76 lbs. is ordered to receive 150 mg of Clindamycin q6h. The
pediatric drug handbook states the recommended dose is 8-20 mg/kg/day in four divided
doses. The Clindamycin is supplied in 100 mg scored tablets.

1. What is the weight in kg?

76 lbs. ÷ 2.2/kg/lb. = 34.5 kg

2. What is the safe total daily dose?

Minimum: 8 mg/kg/day X 34.5 kg = 276 mg/day

Maximum: 20 mg/kg/day X 34.5 kg = 690 mg/day

Total safe dose is 276mg to 690mg per day

3. check if the dose is safe.

150 mg/dose X 4 doses/day = 600 mg/day

This is within the recommended safe range.

4. Calculate the number of tablets to give.

100 mg : 1 tablet = 150 mg : x

100 x = 150

x = 1.5 tablets

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 B. BASED on BODY SURFACE AREA (BSA)
BSA is determined from a nomogram using the child's height and weight.
When you know the child's BSA the dosage is determined by multiplying the BSA by the
recommended dose.
To determine whether the dose is safe, compare the ordered dose and the calculation based
upon the BSA.
The formula for calculating child's dosage is

Child's BSA X adult dosage

1.7 M2

Example: The child has a BSA of 0.67 M2. The adult dose is 40 mg. The physician ordered 8mg.
Is the dosage correct?

0.67 X 40 = 26.8 = 15.8 mg No, the dose is

1.7 1.7 too small.

OTHER FOMULA:

1. FRIED’S RULE – used for patients below 1 year old

Dose = age in months X average adult dose

150 months

The adult dose of tincture of digitalis is 1 mL. What should a 10 month old child receive?

Solution: 10/150 x 1mL = 0.07 mL

2. YOUNG’S RULE – used for patients 1 to 12 years old

Dose = age in years X average adult dose

age in years + 12

An adult dose of drug is 500mg, what is the dose for a 2-year old child ?

Solution: 2/2+12 x 500 mg = 71.4 or 70 mg

3. CLARK’S RULE

Dose = weight in pounds X average adult dose

150 lbs

If an adult dose of drug is 750mg, what is the dose for child weighing 20 lbs ?

Solution: 20/150 x 750 mg = 100mg

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University
 Conversion Guide
*1 Kilogram = 1000 grams

* 1 Gram = 1000 milligrams = 15 grain 2 fluid dram = 8 cc

60 mg = 1 grain 240 cc = 8 fluid oz (f oz viii)

* 1 Milligram = 1000 micrograms

30 cc = 1 fluid oz (f oz i) = 2 tbsp
* 1 Microgram = 0.001 milligrams
15-16 cc = 4 oz = 3 tsp = 1 tbsp
* 1 Milligrams = 0.001 grams
* 1 Litre = 1000 cc
* 1 Microgram = 10 -6 grams
* 1 OZ = 30 cc
* 1 Nanogram = 10 -9 grams
* 16 OZ = 480 cc = 1 Pint
* 1 Grain = 65 milligrams
16 oz = 1 lb
60 Grain = 1 dram
* 1 Pint = 480 cc
8 dram = 1 oz
* 1 Quart = 960 cc = 2 Pints
1 fluid dram = 60 minim
* 1 Gallon = 3840 cc = 4 Quarts = 8
1 cc = 15-16 minim Pints

1 min = 0.06 cc * 2.2 lbs = 1 kg

8 fluid dram = 1 fluid oz * 1 Teaspoonful = 5 cc = 60 gtts

* 1 Tablespoonful = 15 cc

* 1 Teacupful = 120 cc

* 1 Wineglassful = 60 cc

* 1 Tumblerful = 240 cc

End of Module 2

NUPC 107 Nursing Pharmacology Don Mariano Marcos Memorial State University