Oral and Parenteral Medication - health.prenhall.comhealth.prenhall.com/olsen/pdf/Olsen_ch6.pdf ·...

Oral and ParenteralMedication

Unit

Chapter 6

Calculating Oral Medication Doses

Chapter 7

Syringes

Chapter 8

Preparation of Solutions

Chapter 9

Parenteral Medications

103

(Photodisc/Getty Images)

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Chapter

104

Learning Outcomes

After completing this chapter, you will be able to

1. Calculate simple problems for oral medications in solid and liquid form.

2. Calculate complex problems for oral medications in solid and liquid form.

3. Calculate doses for medications measured in milliequivalents. 4. Interpret drug labels in order to calculate doses for oral medication.5. Calculate doses based on body weight.6. Calculate doses based on body surface area (BSA) using a formula or a

nomogram.

I n this chapter you will learn how to calculate doses of oral medications in solid or liq-

uid form.You will also be introduced to problems that utilize body weight or body sur-

face area (BSA) to calculate dosages.

Calculating Oral Medication Doses

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Simple Problems 105

Simple Problems

In the calculations you have done in previous chapters, all the equivalents havecome from standard tables, for example, 60 mg gr 1. In this chapter, theequivalent used will depend on the strength of the drug that is available; forexample 1 tab 15 mg. In the following examples, the equivalent is found onthe label of the drug container.

Medication in Solid Form

Example 6.1The order reads Cymbalta (duloxetine HCl) 120 mg PO daily.Read the drug label shown in � Figure 6.1. How many capsules of thisantidepressant drug will you administer to the patient?

=

=

Convert 120 mg to capsules.

Cancel the milligrams and calculate the equivalent amount in capsules.

Because the label indicates that each capsule contains 30 mg, you use the

unit fraction

So, you would give 4 capsules by mouth once a day to the patient.

Example 6.2The prescriber orders Diovan (valsartan) 120 mg PO once daily for a pa-tient with hypertension. Read the drug label shown in � Figure 6.2 anddetermine how many tablets you would give to the patient.

1204

mg *1 cap

301

mg= 4 cap

1 cap30 mg

120 mg *

? cap? mg

= ? cap

120 mg = ? cap

� Figure 6.1Drug label for Cymbalta.

(Copyright Eli Lilly and Company. Usedwith permission).

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106 Chapter 6 Calculating Oral Medication Doses

Convert 120 mg to tablets.

Cancel the milligrams and obtain the equivalent amount in tablets.

Because 1 tab 40 mg, the unit fraction is

So, you would give 3 tablets by mouth daily to the patient.

Example 6.3Read the label in � Figure 6.3. The physician’s order is Lotrel 5 mg/20 mgPO daily. How many capsules of this antihypertensive drug should beadministered per day?

1203

mg *1 tab

401

mg= 3 tab

1 tab40 mg

=

120 mg *

? tab? mg

= ? tab

120 mg = ? tab

.PX

ET

OL 3N1

50-4040-8700

100 capsulesRx only

NDC 0078-0404-05

Lotrel® 2.5/10amlodipine besylate(equivalent to amlodipine 2.5 mg)benazepril HCl 10 mg

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(Reproduced with the permission of Novartis Pharmaceuticals.)

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� Figure 6.2Drug label for Diovan.


Lotrel is a combination drug (see Figures 2.16 and 2.17 in Chapter 2)composed of amlodipine and benazepril; therefore, for computationalpurposes we need only address the first listed drug (amlodipine).

Since the order requires 5 mg of amlodipine, convert the 5 mg to capsules.

Cancel the milligrams and obtain the equivalent amount in capsules.

The label indicates that 1 capsule contains 2.5 mg of amlodipine.

5 mg *

? cap? mg

= ? cap

5 mg = ? cap

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Simple Problems 107

Therefore, the fraction is

So, you would give 2 capsules by mouth daily to the patient.

Example 6.4The order is codeine sulfate grain q4h prn pain. The label reads per tablet. How many tablets should you give a patient?In this problem you want to convert the grain to tablets.

Cancel the grain and determine the equivalent amount in tablets.

Because the fraction is

Since 2 tablets contain grain of codeine sulfate, you would give 2 tabletsby mouth every 4 hours as necessary for pain.

Medication in Liquid FormSince pediatric and geriatric patients, as well as patients with neurological con-ditions, may be unable to swallow medication in tablet form, sometimes oralmedications are ordered in liquid form. The label states how much drug iscontained in a given amount of liquid.

Example 6.5The physician orders Lexapro (escitalopram oxalate) 10 mg POonce daily. Read the label in � Figure 6.4 and determine the number ofmilliliters you would administer to the patient.

Convert 10 milligrams to milliliters.

Cancel the milligrams and calculate the equivalent amount in mL.

10 mg *

? mL? mg

= ? mL

10 mg = ? mL

12

gr12

*1 tab

gr14

=1 tab

24

= 1 tab ,24

= 1 tab *42

= 2 tab

1 tab

gr 14

1 tab = gr 14 ,

gr 12

= ? tab

12

gr 14

12 PO

52

mg *1 cap

2.51

mg= 2 cap

1 cap2.5 mg

NOTE

Some liquid oralmedications are suppliedwith special calibrateddroppers or oral syringesthat are used only for thesemedications (e.g., digoxinand Lasix).

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� Figure 6.4Drug label for Lexapro.

(Courtesy of Forest Pharmaceuticals, Inc.)

� Figure 6.5Drug label for Omnicef.

(Reproduced with Permission of Abbott Laboratories.)

Because the label indicates that every 5 mL of the solution contains

5 mg of Lexapro, use the unit fraction

So, you would give 10 mL by mouth once a day to the patient.

Example 6.6The physician orders Omnicef (cefdinir) 500 mg PO q12h. Read thelabel in � Figure 6.5. Determine the number of mL you would adminis-ter to the patient.

10 mg *5 mL5 mg

= 10 mL

5 mL5 mg

Convert 500 milligrams to mg.

Cancel the milligrams and calculate the equivalent amount in milliliters.

500 mg *

? mL? mg

= ? mL

500 mg = ? mL

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Simple Problems 109

Because the label indicates that every 5 mL of the solution contains

123 mg of Omnicef, use the unit fraction

So, you would give 20 mL by mouth every 12 hours to the patient.

Medications Measured in MilliequivalentsSome drugs are measured in milliequivalents, which are abbreviated as mEq. Phar-maceutical companies label electrolytes in milligrams as well as milliequivalents.

Example 6.7The physician orders K-Tab (potassium chloride) 30 mEq PO daily.Read the label in � Figure 6.6 and determine how many tablets of thiselectrolyte supplement you should administer.

5004

mg *5 mL

1251

mg= 20 mL

5 mL125 mg

� Figure 6.6Drug label for K-Tab.

(Reproduced with Permission of Abbott Laboratories.)

In this problem you want to change 30 mEq to tablets.

You can do this on one line as follows:

Because the label indicates that each tablet contains 10 mEq, the unit

fraction is

So, you would administer 3 tablets of K-Tab by mouth once daily.

303

mEq *1 tab

10 mEq= 3 tab

1 tab10 mEq

30 mEq *

? tab? mEq

= ? tab

30 mEq ¡ ? tab

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Complex Problems

Sometimes dosage calculations will require that multiplication by unitfractions be repeated one or more times. Recall that we examined complexproblems in Chapter 3.

For example, if each tablet of a drug contains 2.5 mg, how many tablets wouldcontain 0.0025 gram?It helps to organize the information you will need for the computation as follows:

Given quantity: 0.0025 mgStrength:Quantity you want to find: ? tab

You do not know the direct equivalence between grams and tablets.This is a complex problem because you need to convert 0.0025 g to

milligrams and then convert milligrams to tablets.

So the problem is First, you want to cancel grams (g). To do this you must use an equivalencecontaining grams to make a unit fraction with grams in the denominator.

From the equivalence the unit fraction is

After the grams are cancelled, only milligrams remain on the left side.Now you need to change the milligrams to tablets. From the strength

2.5 mg 1 tab, the unit fraction is

After cancelling the milligrams, only tablets remain on the left side.Now complete your calculation by multiplying the numbers.

So, 1 tablet contains 0.0025 g.

Example 6.8The physician’s order is aspirin (acetylsalicylic acid) 600 mg PO stat. Thelabel reads gr 5 per caplet. How many caplets of this antipyretic drugshould be given to the patient?

0.0025 g *1,000 mg

1 g*

1 tab2.5 mg

=2.5 tab

2.5= 1 tab

0.0025 g *1,000 mg

1 g*

1 tab2.5 mg

= ? tab

1 tab2.5 mg

=

0.0025 g *1,000 mg

1 g= ? tab

1,000 mg1 g

1 g = 1,000 mg,

0.0025 g = ? tab

0.0025 g ¡ ? mg ¡ ? tab

1 tab = 2.5 mg

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Complex Problems 111

Given quantity: 600 mgStrength:Quantity you want to find: ? cap

There is no direct equivalence between milligrams and caplets.This is a complex problem because you need to convert 600 mg to grainsand then convert grains to caplets.

First change milligrams to grains. To do this, you must use an equiva-lence containing milligrams to make a unit fraction with milligrams inthe denominator. From the equivalence the

unit fraction is

After the milligrams are cancelled, only grains remain on the left side. Now you need to change the grains to caplets. From the strength

the unit fraction is

Now complete your calculation.

So, you should give 2 caplets by mouth immediately to the patient.

Example 6.9The order is Diflucan (fluconazole) 0.4 gram PO daily. Read the labelshown in � Figure 6.7 and calculate the number of tablets of this anti-fungal drug that should be given to the patient.

Given quantity: 0.4 gStrength:Quantity you want to find: ? tab

In this problem you want to convert 0.4 gram to milligrams and thenconvert milligrams to tablets.

0.4 g ¡ ? mg ¡ ? tab

1 tab = 100 mg

600

10 mg *

gr 1 60

1 mg

*

1 cap gr 5

=

10 cap5

= 2 caplets

600 mg *gr 1

60 mg*

1 capgr 5

= ? cap

1 capgr 5

.gr 5 = 1 cap,

600 mg *gr 1

60 mg= ? cap

gr 160 mg

.

gr 1 = 60 mg,

600 mg ¡ gr? ¡ ? cap

1 cap = gr 5

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� Figure 6.8Drug label for Tikosyn.

(Reg.Trademark of Pfizer Inc. Reproducedwith permission.)


Because 1,000 mg 1 g, the first unit fraction is

Because 100 mg 1 tab, the second unit fraction is

So, you should give 4 tablets by mouth once a day to the patient.

Example 6.10The order is Tikosyn (dofetilide) 0.5 mg PO b.i.d. Read the labelshown in � Figure 6.8. Calculate how many capsules of this antifungaldrug should be given to the patient. Although there are two strengthson the label (mcg and mg), calculate the problem using microgramstrength.

Given quantity: 0.5 mgStrength:Quantity you want to find: ? cap

1 tab = 125 mcg

0.4 g *1,000

10mg

1 g*

1 tab100

1mg

= 4 tab

1 tab100 mg

=

1,000 mg1 g

=

0.4 g *

? mg? g

*

? tab? mg

= ? tab

� Figure 6.7Drug label for Diflucan.

(Reg.Trademark of Pfizer Inc. Reproducedwith permission.)

NOTE

Although Example 6.10would be simpler using themilligrams, we will do thecalculation usingmicrograms in order topractice complex problems.For safety purposes, drugmanufacturers often placeboth microgram andmilligram concentrations ondrug labels.

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Complex Problems 113

In this problem you want to convert 0.5 milligrams to microgramsand then convert micrograms to capsules.


Because 1,000 mcg 1 mg, the first unit fraction is

Because 1 cap 125 mcg, the second unit fraction is

So, you should give 4 capsules by mouth twice a day to the patient.

Example 6.11The order is Daypro (oxaprozin) 1.8 g PO once daily each morning. Thedrug is supplied as 600 mg per caplet. How many caplets of this anti-arthritic drug should be given the patient?

Given quantity: 1.8 gStrength:Quantity you want to find: ? cap

In this problem you want to convert 1.8 grams to milligrams and thenconvert milligrams to caplets.



Because 1 cap 600 mg, the second unit fraction is

So, you should give 3 caplets by mouth to the patient once a day in themorning.

1.8 g *1,000 mg

1 g*

1 cap600 mg

=18

6 cap

= 3 cap

1 cap600 mg

=

1,000 mg1 g

=

1.8 g *

? mg? g

*

? cap? mg

= ? cap

1.8 g ¡ ? mg ¡ ? cap

1 cap = 600 mg

0.5 mg *1,000

8mcg

1 mg*

1 cap125

1mcg

= 4 cap

1 cap125 mcg

=

1,000 mcg1 mg

=

0.5 mg *

? mcg? mg

*

1 cap? mcg

= ? cap

0.5 mg ¡ ? mcg ¡ ? cap

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� Figure 6.10Drug label for Indocin.

(The labels for the products Indocin 25mgper 5mL are reproduced with permission ofMerck & Co., Inc., copyright owner.)

Example 6.12The physician orders Norvir (ritonavir) 0.6 g PO q12 hours. Read thelabel in � Figure 6.9 and determine the number of mL of this protease in-hibitor your patient would receive.

Given quantity: 0.6 gStrength:The quantity you want to find: ? mL

In this problem you want to convert 0.6 grams to milligrams and thenconvert milligrams to milliliters.



Because 1 mL 80 mg, the second unit fraction is

So, you would give 7.5 mL by mouth to the patient every 12 hours.

Example 6.13The order is Indocin (indomethacin) 75 mg PO daily in 3 divided doses.Read the label in � Figure 6.10 and determine the number of teaspoonsof this antiinflammatory drug you should administer.

0.6 g *1,000 mg

1 g*

1 mL80 mg

=608

mL = 7.5 mL

1 mL80 mg

=

1,000 mg1 g

=

0.6 g *

? mg? g

*

? mL? mg

= ? mL

0.6 g ¡ ? mg ¡ ? mL

80 mg>mL

Given quantity: 75 mgStrength:The quantity you want to find: ? t

In this problem you want to convert 75 milligrams to milliliters and thenconvert mL to teaspoons.

75 mg ¡ ? mL ¡ ? t

25 mg per 5 mL

� Figure 6.9Drug label for Norvir.

(Reproduced with Permission of AbbottLaboratories.)

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Calculating Dosage by Body Weight 115


Because 25 mg 5 mL, the first unit fraction is

Because 5 mL 1 t, the second unit fraction is

Because the order specifies “3 divided doses”, the 3 t must be dividedinto 3 equal amounts over 24 hours. Therefore, each dose would be 1teaspoon (25 mg), and you would give 1 teaspoon of Indocin by mouthto the patient every 8 hours.

Calculating Dosage by Body Weight

Sometimes the amount of medication is prescribed based on the patient’s bodyweight. A patient who weighs more will receive a larger dose of the drug, anda patient who weighs less will receive a smaller dose of the drug.

Example 6.14The prescriber orders 15 milligrams per kilogram of a drug for a patientwho weighs 80 kilograms. How many milligrams of this drug should thepatient receive?

Body weight: 80 kgOrder:Find: ? mg

Convert body weight to dosage.

Since the order is 15mg/kg, you use the unit fraction

Therefore, the patient should receive 1,200 mg of the drug.

Example 6.15The prescriber orders Klonopin (clonazepam) 0.05 mg/kg PO daily in threedivided doses for a patient who weighs 60 kilograms. If each tablet contains1 mg, how many tablets of this anticonvulsant drug should the patient re-ceive per day? How many tablets would the patient receive per dose?

80 kg *

15 mg1 kg

= 1,200 mg

15 mg1 kg

80 kg (of body weight) *

? mg (of drug)? kg (of body weight)

= ? mg (of drug)

80 kg (of body weight) ¡ ? mg (of drug)

15 mg>kg

75 mg *5 mL25 mg

*1 t

5 mL=

7525

t or 3 t

1 t5 mL

=

5 mL25 mg

=

75 mg *

? mL? mg

*

? t? mL

= ? t

NOTE

In Example 6.13, the orderstates “in three divideddoses.”This instructs thepractitioner to separate thetotal daily dose into 3 equalparts over a 24-hour period.To ensure even distributionof the medication, thefrequency of the dosesshould also be regular andconsistent, so the drug isadministered every 8 hours.

NOTE

The expression 15 mg/kgmeans that the patient is toreceive 15 milligrams of thedrug for each kilogram ofbody weight.Therefore, youwill use the equivalent15 mg (of drug) 1 kg (of body weight).

=

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Body weight: 60 kgOrder:Strength:Find: ? tab

When drugs are prescribed based on body weight, you generally start theproblem with the weight of the patient. You first change the single unit ofmeasurement, kilograms (kg of body weight), to another single unit of mea-surement, milligrams (mg of drug), and then convert the milligrams to tablets.

Because the order is for 0.05 mg per kg, the first unit fraction is

Since each tablet contains 1 mg, the second unit fraction is

The patient should receive 3 tablets of Klonopin by mouth per day in 3 di-vided doses, and therefore the patient should receive 1 tablet every 8 hours.

Example 6.16The physician orders Biaxin (clarithromycin) 7.5 milligrams per kilo-gram PO b.i.d. If the drug strength is 250 milligrams per 5 mL, howmany mL of this antibiotic drug should be administered to a patient whoweighs 70 kilograms?

Body weight: 70 kgOrder:Strength:Find: ? ml

Convert body weight to dosage.

Since the order specifies 7.5 mg per kg, the first fraction is

Since the strength is 250 mg per 5 mL, the second fraction is

The patient should receive 10.5 mL of Biaxin by mouth 2 timesper day.

70 kg *7.5 mg

kg*

5 mL250 mg

= 10.5 mL

5 mL250 mg

7.5 mLkg

70 kg *

? mg? kg

*

? mL? mg

= ? mL

70 kg ¡ ? mg ¡ ? mL

250 mg>5 mL7.5 mg>kg

60 kg *0.05 mg

1 kg*

1 tab1 mg

= 3 tabs

1 tab1 mg

0.05 mg1 kg

.

60 kg(of body weight)

*

? mg (of drug)? kg (of body weight)

*

? tab? mg (of drug)

= ? tab

60 kg (of body weight) ¡ ? mg (of drug) ¡ ? tab

1 tab = 1 mg0.05 mg>kg

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Calculating Dosage by Body Surface Area 117

Calculating Dosage by Body Surface Area

In some cases, body surface area (BSA) may be used rather than weight indetermining appropriate drug dosages. This is particularly true when calcu-lating dosages for children, those receiving cancer therapy, burn patients,and patients requiring critical care. A patient’s BSA can be estimated by usingformulas or nomograms.

BSA FormulasBody surface area can be approximated by formula using either a hand-held calculator or an online website. BSA, which is measured in squaremeters can be determined by using either of the following twomathematical formulas:

Formula for metric units:

Formula for household units:

Example 6.17Find the BSA of an adult who is 183 cm tall and weighs 92 kg.Because this example has metric units (kilograms and centimeters), weuse the following formula:

At this point we need a calculator with a square root key.

Therefore, the BSA of this adult is

Example 6.18What is the BSA of a man who is 4 feet 10 inches tall and weighs142 pounds?First you convert 4 feet 10 inches to 58 inches.

2.16 m2.

= 2.16256

= 24.6767

= A92 * 1833,600

BSA = Aweight in kilograms * height in centimeters3,600

BSA = Aweight in pounds * height in inches3,131

BSA = Aweight in kilograms * height in centimeters3,600

1m22,

NOTE

In Example 6.17, the metricformula for BSA was used,and in Example 6.18, thehousehold formula for BSAwas used. However, eachformula provided the BSAmeasured is square meters(m2 ). In this book, we willround off BSA to twodecimal places.

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Because the example has household units (pounds and inches), we usethe following formula:

Therefore, the BSA of this adult is

NomogramsBSA can also be approximated by using a chart called a nomogram (� Figure 6.11).The nomogram includes height, weight, and body surface area. If a straight lineis drawn on the nomogram from the patient’s height (left column) to the patient’sweight (right column), the line will cross the center column at the approximateBSA of the patient. Before handheld calculators were used, the nomogram wasthe best tool available for determining BSA. Since electronic technology hasbeen incorporated into most health care settings to ensure more accurate mea-surements, nomograms are becoming obsolete.

In Example 6.17 we used the formula to calculate the BSA of an 183 cm,92 kg patient to be 2.16 m2. Now let’s use the adult nomogram to do thesame problem. In � Figure 6.12, you can see that the line from 183 cm to 92kg intersects the BSA column at about 2.20 m2.

In Example 6.18, by using the formula we calculated the BSA of a 4 ft10 in, 142 lb patient to be 1.62 m2. If we use the adult nomogram todetermine the BSA (� Figure 6.13), we get 1.59 m2.

Example 6.19The physician orders of a drug PO once daily. How many mil-ligrams of the drug would you administer to an adult patient weighing88 kg with a height of 150 cm?

The first step is to determine the BSA of the patient. This can be done byformula or nomogram.

Using the formula, you get

Using the adult nomogram, you get 1.81 m2. So, you can use either1.91 m2 or 1.81 m2 as the BSA. If you choose to use 1.81 m2, you wantto convert BSA to dosage in mg.

BSA:Order:Find: ? mg

1.81 m2*

? mg

m2 = ? mg

1.81 m2= ? mg

40 mg>m21.81 m2

= 1.91 m2 = 23.6667

BSA = A88 * 1503,600

40 mg>m2

1.62 m2. = 1.62187

= 226,305

= A142 * 583,131

BSA = Aweight in pounds * height in inches3,131

NOTE

Whether formulas ornomograms are used toobtain body surface area,the results are onlyapproximations.Thisexplains why we obtainedboth 2.16 m2 (using theformula) and 2.20 m2 (usingthe nomogram) as the BSAfor the same patient inExample 6.17. This alsooccurred in Example 6.18,where the BSA was 1.62 m2

(using the formula) and 1.59 m2 (using thenomogram).

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cm 200 79 inch78777675747372

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HEIGHT

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2.70

2.60

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2.30

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2.10

2.001.951.90

1.85

1.80

1.75

1.70

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1.00

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BODY SURFACE AREA

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WEIGHT

� Figure 6.11Adult nomogram.

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cm 200 79 inch78777675747372

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1.80

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1.70

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130

120

110

105

100

95

90

85

80

75

70

66 lb

WEIGHT

� Figure 6.12Nomogram for Example 6.17.

OLSEMC06_103-137hr2 6/12/06 2:53 PM Page 120


cm 200 79 inch78777675747372

7170

69

68

67

66

6564

63

62

61

60

59

58

57

56

55

54

53

52

51

50

49

48

47

46

45

44

43

42

41

40

39 in

195

190

185

180

175

170

165

160

155

150

145

140

135

130

125

120

115

110

105

cm 100

HEIGHT

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2.70

2.60

2.50

2.40

2.30

2.20

2.10

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1.80

1.75

1.70

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1.30

1.25

1.20

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0.90

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BODY SURFACE AREA

330 lbkg 150

145140

135

130

125

120

115

110

105

100

95

90

85

80

75

70

65

60

55

50

45

40

35

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320310300290

280270

260

250

240

230

220

210

200

190

180

170

160

150

140

130

120

110

105

100

95

90

85

80

75

70

66 lb

WEIGHT

� Figure 6.13Nomogram for Example 6.18.

OLSEMC06_103-137hr2 6/12/06 2:53 PM Page 121


Since the order is the unit fraction is

If you use the BSA of 1.91 m2, the calculations are similar.

So, if you use 1.81 m2, you would administer 72.4 mg. However if youuse 1.91 m2, you would administer 76.4 mg of the drug to the patient.

Example 6.20The prescriber ordered of a drug PO stat for a patient whohas a BSA of 1.65 m2. The “safe dose range” for this drug is 20 to 40 mgper day. Calculate the prescribed dose in milligrams and determine if it iswithin the safe range.

BSA:Order:Find: ? mg

You want to convert the BSA of 1.65 m2 to the number of milligrams ordered.

Because the order is 30 mg per m2, the unit fraction is

The safe dose range is 20–40 mg per day.

So, the dose prescribed, 49.5 mg, is higher than the upper limit (40 mg) ofthe daily “safe dose range.” Therefore, the prescribed dose is not safe, andyou would not administer this drug. You would consult with the prescriber.

Example 6.21The order is Trexall (methotrexate) PO q12h for three doses.How many scored 5 mg tablets of this antineoplastic drug would you ad-minister to patient with a BSA of 2.29 m2?

BSA:Order:Strength:Find: ? tab

Convert the body surface area to tablets.

2.29 m2*

? mg

m2 *

? tab? mg

= ? tab

2.29 m2¡ ? mg ¡ ? tabs

1 tab = 5 mg3.3 mg>m2

2.29 m2

3.3 mg>m2

1.65 m 2

*

30 mg

m 2 = 49.5 mg

30 mg

m2

1.65 m2*

? mg

m2 = ? mg

1.65 m2= ? mg

30 mg>m2

1.65 m2

30 mg>m2

1.91 m 2

*

40 mg

m 2 = 76.4 mg

1.81 m 2

*

40 mg

m 2 = 72.4 mg

40 mg

m240 mg>m2,ALERT

Before a medication isadministered, it is theresponsibility of the healthcare practitioneradministering themedication to check thesafe dosage andadministration range for thedrug in the Physicians’ DeskReference (PDR), in adesignated drug book, orwith the pharmacist.

OLSEMC06_103-137hr2 6/12/06 2:53 PM Page 122

Case Study 6.1 123

Because the order is the first unit fraction is

Because 1 scored tablet contains 5 mg, the second unit fraction is

The patient should receive scored tablets of Trexall by mouth every12 hours for 3 doses.

112

2.29 m 2 *3.3 mg

m 2 *1 tab5 mg

= 1.51 tabs

1 tab5 mg

.

3.3 mg

m2 .3.3 mg>m2,

SummaryIn this chapter, you learned the computations nec-essary to calculate dosages of oral medications inliquid and solid form.

Calculating doses for oral medications in solidand liquid form■ The label states the strength of the drug

(e.g., ).■ Sometimes oral medications are ordered in

liquid form for special populations such aspediatrics, geriatrics, and patients withneurological conditions.

■ Special calibrated droppers or oral syringes that are supplied with some liquid oral medica-tions may be used to administer only those medications.

■ Some drugs, such as electrolytes, are measured inmilliequivalents (mEq).

Calculating doses by body weight■ Dosages based on body weight are generally

measured in milligrams per kilogram ■ Start calculations with the weight of the patient.■ Medications may be prescribed by body weight in

special populations such as pediatrics and geriatrics.■ It is crucial to ensure that every medication adminis-

tered is within the recommended safe dosage range.

Calculating doses by body surface area■ Body surface area (BSA) is measured in square

meters (m2).■ Start calculations with the BSA of the patient.■ BSA is determined by using either a formula or a

nomogram.■ BSA may be utilized to determine dosages for spe-

cial patient populations such as those receivingcancer therapy, burn therapy, and for patients re-quiring critical care.

(mg/kg).

15 mg/mL10 mg/tab,

Mr. M. is a 68-year-old male patient with a pastmedical history of diabetes mellitus Type II andsevere ischemic cardiomyopathy. He reportedthat for 6 weeks he had been experiencingshortness of breath and fatigue with moderateactivity, difficulty sleeping at night, and has aweight gain of 5 lbs, even though he describedhis appetite as poor. There is no evidence ofsmoking or illegal drug use. Upon examination,the practitioner noted periorbital edema and bi-

lateral pitting edema in both lower extremi-ties. His present weight is 154 lb and his vitalsigns are BP T 98.4, P 104, and R 28.Mr. M. was admitted for intravenous supportand aggressive diuresis.

His orders are as follows:■ Complete CBC and SMA18■ Coronary angiogram; ECG; stress perfusion

scan; chest X-ray.

160>100,

4+

Case Study 6.1

OLSEMC06_103-137hr2 6/12/06 2:53 PM Page 123


Practice Reading LabelsCalculate the following doses using the labels shown. You will find the answers in Appendix A in the backof the book.

1. Lopressor (metoprolol) 0.05 gram __________ tab 2. Wellbutrin (bupropion hydrochloride) 200 mg ________ tab==

PX

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410-1500-8200

100 tablets

Rx only

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■ Low-salt diet (2 g day)■ Lasix (furosemide) 80 mg PO stat■ Lasix (furosemide) 60 mg PO q12h to begin

12 hours after the stat dose■ Digoxin 0.25 mg PO once daily■ Micro-K 10 Extencaps (potassium chloride)

20 mEq PO daily■ Diabinese (chlorpropamide) 125 mg PO each

morning with breakfast■ Colace (docusate sodium) 100 mg PO t.i.d.■ Ativan (lorazepam) 3 mg PO HS■ Fluid restriction 1,500 mL 24 h■ Strict intake and output■ Foley catheter to bedside drainage

1. The patient drank 650 mL of H2O, 150 mL ofcranberry juice, and 200 mL of ginger ale dur-ing the 7 A.M. to 7 P.M. shift. How many mL offluid may the patient can be given over thenext 12 hours?

2. At 8 P.M., Mr. M.’s wife fed him cups of anorganic brand of chicken broth, which con-tains 390 mg salt in each 1 cup serving.(a) How many mL of chicken broth did the

patient receive? (b) How many grams of salt did he consume?(c) How much more salt should Mr. M. con-

sume for the remainder of the day?

3. The diuretic drug Lasix (furosemide) is avail-able in 20 mg tablets.(a) How many tablets will you administer for

the stat dose?(b) How many tablets will the patient have re-

ceived within the first 20 hours?4. How many milliequivalents of the electrolyte

supplement micro-K will the patient have re-ceived after 5 days of therapy?

5. Colace (docusate sodium), a stool-softeningdrug, is supplied as an oral liquid, 20 mg 5 mL.(a) How many times a day does the patient re-

ceive this medication?(b) How many mL would the patient receive

in two days?6. The available strength of Ativan (lorazepam)

is 1 mg tab. How many tablets of this sedativecontain the prescribed dose?

7. The cardiac drug digoxin is supplied in the fol-lowing strengths: 50 mcg, 100 mcg, and 200 mcgtablets. Which combination of tablets wouldyield the least number of tablets that woulddeliver the prescribed dose?

8. Mr. M. remains hospitalized for one week.(a) How many milligrams of Diabinese (chlor-

propamide) would he have received by theend of the first seven days?

(b) The Diabinese is available in 250 mg scoredtablets. How many tablets would Mr. M.have received by the end of the seven days?

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OLSEMC06_103-137hr2 6/12/06 2:54 PM Page 124

Practice Reading Labels 125

3. Cymbalta (duloxetine HCl) 0.04 g ____________ cap

4. Prozac (fluoxetine) 40 mg ____________ mL

5. Ery-Tab (erythromycin) 0.666 g ____________ cap

6. Gleevec (amatinib mesylate) 800 mg ____________ tab

7. Symbyax (olanzapine fluoxetine) 12mg 50mg ________ cap

8. quinidine gluconate 20 mg ____________ mL

9. Epivir (lamivudine) 0.6 g ____________ tab

10. Retrovir (zidovudine) 100 mg ____________ mL

11. Lanoxin (digoxin) 125 mcg ____________ mL

12. Lanoxicap (digoxin) 0.2 mg ____________ cap=

®

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Store at 15˚ to 25˚C (59˚ to 77˚F).

GlaxoSmithKlineResearch Triangle Park, NC 27709Made in Canada

4153827 A000747 Rev. 3/03 240 mL

=

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Each tablet contains 300 mg of lamivudine.

See prescribing information for Dosage and Administration.

Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature].

Manufactured under agreement from Shire PharmaceuticalsGroup plcBasingstoke, UK

GlaxoSmithKlineResearch Triangle Park, NC 27709 Made in England

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OLSEMC06_103-137hr2 6/12/06 2:54 PM Page 125


13.Toprol –XL (metoprolol succinate) 0.4 g ____________ tab

14. Plendil (felodipine SR) 5 mg ____________ tab

15. Atacand HCT (candesartan cilexetil) 16 mg ___________ tab

16. Prilosec (omeprazole) 80 mg ____________ cap

17. Lopressor (metoprolol) 0.05 mg ____________ mL

18. Lotrel (amlodipine) 5/20 mg ____________ cap

19. Sandostatin (octreotide) 0.1 mg ____________ mL

20. Diovan (valsartan) 0.08 g ____________ mL

21. Norvir (ritonavir) 130 mg ____________ mL

22. Zonegran (zonisamide) 75 mg ____________ cap=

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100 capsulesRx only

NDC 0078-0404-05

Lotrel® 2.5/10amlodipine besylate(equivalent to amlodipine 2.5 mg)benazepril HCl 10 mg

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metoprolol tartrate injection, USP5 mg per 5 mLFor Intravenous Use Rx only(5 mL ampul)Mfd. by: Novartis Pharma Stein AGStein, Switzerland forNovartis Pharmaceuticals Corp.East Hanover, NJ 0793685052702 © Novartis484270 US 484275

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OLSEMC06_103-137hr2 7/12/06 2:29 PM Page 126


23. Avandia (rosiglitazone) 8 mg ____________ tab

24. Lanoxin (digoxin) injection 400 mcg ____________ mL

25. Epivir (lamivudine) 300 mg ____________ tab

26.Valtrex (valocyclovir) 2 grams ____________ caplets

27. Clorazil (clozapine) 150 mg ____________ tab

28. Halcion (triazolam) 0.25 mg ____________ tab

29. Clozaril (clozapine) 75 mg ____________ tab

30.Vibramycin 100 mg ____________ mL

31. Cipro (ciprofloxacin) 0.5 g ____________ tab

32. Lithium Carbonate 900 mg ____________ tab

33. Levitra (vardenafil) 2500 mcg ____________ tab=

=

=

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.PX

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CLOZARIL®

(clozapine)

25 mgRx only

Novartis Pharmaceuticals CorporationEast Hanover, New Jersey 07936

NDC 0078-0126-05

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100 TABLETS

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=

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Manufactured under agreement from Shire PharmaceuticalsGroup plcBasingstoke, UK

GlaxoSmithKlineResearch Triangle Park, NC 27709 Made in England

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OLSEMC06_103-137hr2 7/12/06 2:29 PM Page 127

34. Zometa (zoledronic acid) 4 mg ____________ mL

35. Norvasc (amlodipine) 10 mg ____________ tab

36. Detrol (tolterodine) 4 mg ____________ tab

37. Zyvox (linezolid) 400 mg ____________ mL

38. Provera (medroxyprogesterone) 20 mg ____________ tab

39. Zyvox (linezolid) 0.6 g ____________ tab

40. Zoloft (sertraline) 200 mg ____________ tab

41. Glucotrol XL (glipizide) 10 mg ____________ tab

42. Norvasc (amlodipine) 5 mg ____________ tab

43. OxyContin (oxycodone) 80 mg ____________ tab=

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OLSEMC06_103-137hr2 7/12/06 2:30 PM Page 128


44. Strattera (atomoxetine) 75 mg ____________ cap

45. Zithromax (azithromycin) 1,000 mg ____________ mL

46. Atarax (hydroxyzine) 50 mg ____________ tab

47.Terramycin (oxytetracycline HCl) 500 mg ____________ tab

48. Cardura (doxazosin) 16 mg ____________ tab

49. Rimadyl (carprofen) 75 mg ____________ tab

50. Biaxin (clarithromycin) 0.5 gram ____________ tab

51. Celexa (citalopram) 20 mg ____________ tab

52. naproxen 375 mg ____________ mL

53. methadone HCl 8 mg ____________ mL=

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54. torsemide 20 mg ____________ tab

55.Vistaril 75 mg ____________ mL

56. prednisone 80 mg ____________ tab

57. diclofenac 100 mg ____________ tab

58. Avelox (moxifloxacin HCl) 0.4 g ____________ tab

59. Emend (aprepitant) 0.08 g ____________ cap

60. Crixivan (indinavir sulfate) 0.8 g ____________ cap=

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OLSEMC06_103-137hr2 6/12/06 2:55 PM Page 130

Practice Sets 131

Practice Sets

The answers to Try These for Practice, Exercises, and Cumulative Review ap-pear in Appendix A at the end of the book. Ask your instructor for answers tothe Additional Exercises.

Try These for PracticeTest your comprehension after reading the chapter.

1. The order is Accupril (quinapril HCl) 30 mg PO b.i.d.(a) Read the label in � Figure 6.14 to determine how many tablets of this

antihypertensive drug you will administer.(b) Express the daily dose in grams.

� Figure 6.15Drug label for Erythromycin.

(Reproduced with Permission of AbbottLaboratories.)

2. The physician orders Trexall (methotrexate) PO twice per weekto treat leukemia. How many milligrams would you administer in oneweek if the patient is 150 centimeters tall and weighs 70 kg?

3. The physician ordered E.E.S (erythromycin ethylsuccinate) 300 mg POq6h. Read the label in � Figure 6.15. How many mL of this antibacterialdrug will the patient receive in 24 hours?

25 mg>m2

4. A physician’s order reads: Lyrica (pregabalin) 50 mg PO t.i.d. The bottlecontains 25-mg capsules. How many capsules of this anticonvulsive med-ication would you administer in 24 hours?

5. The physician orders Mellaril (thioridazine HCl) 80 mg PO t.i.d. for a pa-tient with schizophrenia. If you have 10, 15, and 50 mg nonscored tabletsto chose from, which combination of tablets would contain the exactdosage with the smallest number of tablets?

Workspace

� Figure 6.14Drug label for Accupril.

(Reg.Trademark of Pfizer Inc. Reproduced withpermission.)

OLSEMC06_103-137hr2 6/12/06 2:55 PM Page 131


ExercisesReinforce your understanding in class or at home.

1. Paxil (paroxetine HCl) 40 mg PO daily has been ordered for your patient.Each tablet contains 0.02 gram. How many tablets of this antidepressantwill you prepare?

2. The physician prescribes 500 mcg of Baraclude (entecavir) per day via NG(nasogastric tube) for a patient with chronic hepatitis B virus infection.The oral solution contains 0.05 mg of entecavir per milliliter. How manymL of this antiviral medication would you deliver?

3. The order reads Prilosec (omeprazole) 40 mg PO once daily for 4 weeks.Read the drug label in � Figure 6.16 and determine the total number ofdelayed-release capsules of this antacid drug you would administer to thepatient over the entire treatment period.

4. The prescriber ordered Precose (acarbose) 75 mg PO t.i.d. with meals. The medication is available in 25 mg tablets. How many tablets of this

glucosidase inhibitor (antidiabetic agent) will you give your patient in 24 hours?

5. Toprol-XL (metoprolol succinate) extended-release tablets 200 mg POdaily has been prescribed for a patient. After reading the label in� Figure 6.17, how many tablets of this antihypertensive drug would thepatient have received after 7 days?

a

� Figure 6.17Drug label for Toprol-XL.

(Courtesy of AstraZeneca Pharmaceuticals LP.)

6. Keftab (cephalexin) is prescribed for an elderly patient who weighs 40 kilograms. The order is 50 milligrams per kilogram PO in two equallydivided doses. Each tablet contains 500 mg. How many tablets of thiscephalosporin antibiotic will the patient receive per dose?

Workspace

� Figure 6.16Drug label for Prilosec.

(Courtesy of AstraZeneca Pharmaceuticals LP.)

OLSEMC06_103-137hr2 6/12/06 2:55 PM Page 132

Practice Sets 133

Workspace7. Zyvox (linezolid) 600 mg PO q12h has been prescribed for an elderly pa-

tient with pneumonia. Read the label in � Figure 6.18 and determine howmany milliliters of the antibacterial suspension you would administer.

� Figure 6.18Drug label for Zyvox.

� Figure 6.19Drug label for Antivert.

(Reg.Trademark of Pfizer Inc. Repro-duced with permission.)

8. A patient is scheduled to receive 0.015 g of a drug by mouth every morn-ing. The drug is available as 7.5 mg tablets. How many tablets would youadminister?

9. A patient with osteoarthritis is ordered Voltaren (diclofenac sodium) 150 mgPO per day in 3 divided doses. There are 25-milligram tablets available.How many tablets will you give in a single dose?

10. An elderly patient with depression is ordered Aventyl (nortriptyline HCl) 25 mgPO t.i.d. The label reads Aventyl Oral Solution How many mLwill you administer?

11. Antivert (meclizine HCl) 25 mg PO once daily for three days has been or-dered for a patient with a history of motion sickness who is planning ex-tensive traveling. Read the information on the label in � Figure 6.19 andcalculate the number of scored tablets that the patient will receive whenthe prescription is completed at the end of the three days.

10 mg>5 mL.

12. The physician orders 7.5 mg of Tranxene SD (clorazepate dipotassium) POt.i.d. for an elderly patient with extreme anxiety. This drug is availablein 15 mg scored tablets. How many tablets would the patient receive in24 hours?

13. A patient develops a mild skin reaction to a transfusion of a unit of packedred blood cells and is given 75 milligrams of Benadryl (diphenhydramineHCl) PO stat. The only drug strength available is 25 mg capsules. Howmany capsules will you give?

14. The physician orders two Tylenol #3 (codeine 30 mg, acetaminophen300 mg) PO every 6 hours for a postpartum patient experiencing discom-

OLSEMC06_103-137hr2 7/12/06 2:41 PM Page 133


fort from afterpains. How many milligrams of acetaminophen will thepatient have received by the end of the day?

15. The physician orders Detrol LA (tolterodine tartrate) 4 mg PO daily for apatient with an overactive bladder. Read the label in � Figure 6.20 anddetermine how many tablets you will give this patient.

� Figure 6.20Drug label for Detrol LA.

16. A patient with difficulty sleeping is medicated for insomnia with 0.25 g POat bedtime of a sedative drug. The drug is available as 500 mg per scoredtablet. How many tablets will you administer to your patient?

17. The physician orders Coumadin (warfarin sodium) 6.5 mg PO every otherday from Monday through Sunday. How many milligrams of Coumadinwill your patient receive in that week?

18. A physician is treating a patient for H. influenzae. He writes the followingprescription:

Vantin (cefpodoxime proxetil) 200 mg PO q12h for 14 days

Read the label in � Figure 6.21 and determine how many mL you will givethis patient.

� Figure 6.21Drug label for Vantin.

19. The physician orders Deltasone (prednisone) PO daily as partof the treatment protocol for a patient with leukemia.(a) How many milligrams of this steroid drug would you administer if the

patient is 5 feet 6 inches tall and weighs 140 pounds?(b) The drug is supplied in 50 mg per tablet. How many tablets will you

administer?20. The antibiotic, Zithromax (azithromycin), is ordered to treat a patient

with a bacterial exacerbation of Chronic Obstructive Pulmonary Disease(COPD). The order is:

Zithromax (azithromycin) 500 mg PO as a single dose on day one, followed by 250 mg once daily on days 2 through 5

How many milligrams will the patient receive by the completion of theprescription?

60 mg>m2

Workspace

OLSEMC06_103-137hr2 7/12/06 2:42 PM Page 134

Practice Sets 135

WorkspaceAdditional ExercisesNow, test yourself!

1. A drug (40 mg PO daily) has been ordered for your client. Each tablet con-tains 0.02 grams. How many tablets of this drug will you prepare?

2. The physician ordered a drug (0.55 mg kg PO). The patient weighs 32kilograms. The drug is supplied with a strength of Calculatethe number of milliliters you would administer.

3. Glucophage (metformin) 850 mg PO ac breakfast and dinner has been pre-scribed for your client. What is the patient’s daily dose expressed in grams?

4. Prescriber’s order:

Micronase (glyburide) 5 mg PO with breakfast

Each tablet contains 2.5 mg. How many tablets will you prepare?

5. Ditropan XL (oxybutynin chloride) 20 mg per day PO for 5 days has beenprescribed for a patient. Each tablet contains 5 mg. How many tablets ofthis anticholinergic medication will the patient receive by the end of thetreatment?

6. Norvasc (amlodipine) 5 mg PO once daily for 7 days has been ordered fora patient with angina. Each tablet contains 0.0025 grams. How manytablets will you administer to this patient for the week?

7. Vasotec (enalapril maleate) 7.5 mg PO daily has been prescribed. Tabletsavailable are 2.5 mg, 5 mg, 10 mg, and 20 mg. Which combination oftablets would yeld the least number of tablets that would deliver this ACE-inhibiting antihypertensive drug?

8. Alprazolam 0.5 mg PO t.i.d. has been prescribed for your client. Read theinformation on the label in � Figure 6.22. How many mL of this antianxi-ety drug will you administer to your patient?

30 mg>mL.>

9. A patient is to receive 0.01 g PO qhs of a drug. Each tablet contains 0.005 g.How many tablets will you administer to your patient?

10. Order:

Coumadin (warfarin sodium) 2.5 mg PO Monday, Wednesday, and Friday and 1 mg PO Tuesday, Thursday, Saturday, and Sunday

How many milligrams of Coumadin will your patient receive in one week?

� Figure 6.22Drug label for Alprazolam Intensol.

(Courtesy of Roxane Laboratories Inc.)

OLSEMC06_103-137hr2 6/12/06 2:56 PM Page 135


11. A drug (0.5 g PO stat) has been ordered for your patient. Each tabletcontains 0.25 gram. How many tablets of this drug will you give toyour patient?

12. Decadron (dexamethasone) 3 mg PO q12 h has been ordered for a patient.The drug is supplied in 1.5 mg tablets. Calculate the number of tablets ofthis steroid that the patient will receive in 24 hours.

13. Physician’s order:

furosemide 80 mg PO daily

The drug is supplied in 20 mg tablets. What would the patient’s daily dosebe if it were expressed in grams?


Pavabid (papaverine) 300 mg PO q12h

Each tablet contains 0.15 g. How many tablets would you administer?

15. Prescriber’s order:

Motrin (ibuprofen) 600 mg PO q8h for five days only

Each caplet contains 200 mg. How many caplets will you give this patientin the 5 days?

16. The antigout medication colchicine 1.2 mg PO q1h for 8 doses has beenordered. Each tablet contains 0.6 mg. How many milligrams of colchicinewill the patient receive in eight hours?


Cytovene (ganciclovir) 500 mg PO q3h while awake

The drug is available in 250 mg capsules. How many capsules will youadminister?

18. The physician ordered Retrovir (zidovudine) PO, an antiviral drug usedfor the treatment of CMV retinitis. The order is every 8 hours.The patient weighs 60 kg and is 140 cm in height. How many milligramsof this drug will you give the patient per day? (Use the formula for BSA.)

19. Physician’s order: Cytoxan (cyclophosphamide) 3 mg kg twice weekly.The client weighs 148 lb. The drug is supplied in 50 mg tablets. Howmany tablets will you prepare?

20. Physician’s order: prednisone 40 mg PO q12h for 5 days for a patient withacute asthma. The drug is supplied in 20 mg tablets. How many tabletswill you give this patient?

Cumulative Review Exercises

Review your mastery of earlier chapters.

1. Physician’s order: atropine sulfate gr PO now

Each tablet contains 0.4 mg. How many tablets will you prepare for yourpatient? _________

1/150

>

160 mg>m2

Workspace

OLSEMC06_103-137hr2 6/12/06 2:56 PM Page 136

Cumulative Review Exercises 137

Workspace2. Lorabid (loracarbef) 400 mg PO q12h. The label reads 200 mg in 5 mL.

How many mL will you give your patient? _________

3. Azithromycin 0.2 g PO has been ordered. Convert this dose to grains._________

4. 0.4 g _________ mg

5. 2.5 liters _________ milliliters

6. 7 lb 11 oz _________ g

7. 1 pint _________ cups

8. The order reads of a drug PO. The patient weighs 72 kg and is70 in tall. The label reads How many mL will you administerto this patient? Use the nomogram to estimate the BSA.

9. A physician orders Tylenol (acetamenophen) 650 mg PO q8h. The labelreads as follows: Each capsule contains 325 mg. How many capsules willyou give this patient?

10. The order reads Tenormin (atenolol) 100 mg PO daily. Each tablet con-tains 0.025 g. How many tablets will you prepare?

11. The physician orders Parlodel (bromocriptine mesylate), 7.5 mg PO b.i.d.with meals. Each tablet contains 2.5 mg. How many tablets of this anti-Parkinsonian drug will you prepare?

12. A patient must receive 60 mEq of potassium chloride PO stat. Each tabletis labeled How many tablets will you prepare?

13. 200 mg _________ g

14. A patient must receive Videx (didanosine) PO. The patientweighs 90 kg. How many tablets will the patient receive if each tablet con-tains 100 mg?

15. 1 t _________ mL=

2.2 mg>kg

=

20 mEq>tab.

50 mg>mL.267 mg>m2

=

=

=

=

Animated examples, interactive practice questions with animated solutions, and challenge tests for thischapter can be found on the Prentice Hall Dosage Calculation Tutor that accompanies this text.Addi-tional, unique, interactive resources and activities can be found on the Companion Website.

MediaLinkwww.prenhall.com/olsen

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