A Brief Overview of Pharmacy Calculations for Pharmacy Technicians

Roman Numerals Ratio & Proportion Decimals Rounding Numbers Systems of Measurement IV Calculations

Rhomell Calara, PharmD, CPh Kevin McCarthy, RPh

Copyright PharmCon Inc 2010

A Brief Overview of Pharmacy Calculations for Pharmacy Technicians

Speaker: Rhomell Calara has built a solid reputation as Central Florida's premiere Consultant Pharmacist. Rhomell received his Doctorate of Pharmacy from Nova Southeastern University in1997. After he graduated with high honors, he did a residency in Primary Care/Ambulatory care at the Bay Pines VA Medical Center. Rhomell is currently employed by the Department of Veterans Affairs as a Clinical/Consultant Pharmacist for the Florida Department of Veterans Affairs and is currently the President of Consultant Pharmacists of Central Florida (http://www.ConsultantRx.com).

Speaker Disclosure: Rhomell Calara has no actual or potential conflicts of interest in relation to this program

This program has been brought to you by PharmCon

PharmCon, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the companies that support educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product discussed. Participants should verify all information and data before treating patients or employing any therapies described in this educational activity.

A Brief Overview of Pharmacy Calculations for Pharmacy Technicians

Accreditation: Technicians: 0798-0000-09-094-L01-T Target Audience: Technicians CE Credits: 1.0 Continuing Education Hour or 0.1 CEU for technicians Expiration Date: 11/17/2012

Program Overview: Accurately performing pharmaceutical calculations is a critical component in providing patient care in every pharmacy practice environment and a vital part of any pharmacy technicians duty. Although most pharmaceutical calculations are not overly difficult, they do require flawless accuracy. Correct calculations contribute as much to patient outcomes as the newest methods and guidelines for diagnosis, treatment, and prevention; and errors in calculations can turn the best attempts at optimal patient care catastrophic. This session will present an overview of pharmacy calculations for technicians. Objectives: Describe examples of common systems of measurement Explain the process of percentage, ratio, and proportion and show how they apply to pharmacy calculations Solve common pharmacy calculations using mathematical skills reviewed in this activity

This program has been brought to you by PharmCon

Introduction
Speakers credentials and expertise or experience in this topic. State/review the importance of basic math in the practice of pharmacy

Program Objectives
Define the common systems of measurement Explain the process of percentage, ratio, and proportion and show how they apply to pharmacy calculations Be able to solve practical problems using mathematical skills discussed in this talk

Roman Numerals
Used in writing prescriptions. Used to specify the amounts of ingredients or quantity to be dispensed. Used in the directions to the patient.

Roman Numeral Symbols

ss = one-half I = one V = five X = ten L = fifty C = one hundred M = one thousand

Roman Numerals
Three Cardinal Rules:
#1 If a symbol follows another symbol of equal or greater value, the two symbols are added together #2 If a symbol follows another symbol of lower value, the lower value is subtracted from the higher value #3 First perform any necessary subtraction, then add the resulting values together to get the final answer
ss= one-half I = one V = five X = ten L = fifty C = one hundred

Roman Numerals
QUESTION 1: IX = ?

QUESTION 2:

CXXII = ?

QUESTION 3:

20 = ?

Roman Numerals
QUESTION 1: IX = 9

QUESTION 2:

CXXII = 122

QUESTION 3:

20 = XX

Roman Numerals - Real Life

Ratio and Proportion

Proportions will be your most used pharmacy calculation Solve most dosage calculations Numerous applications in everyday life Used when two expressions are directly related to one another
For instance, if 1 kg of drug cost us $5, how much 2 kg cost? will

both expressions contain cost per weight if they are set up as ratios, once the problem is solved, both ratios should be equal

Ratio and Proportion

A ratio is the relation between like numbers or values, or a way to express a fractional part of a whole. Ratios may be written: As a fraction: 2/3 With the ratio or colon sign: 2:3 Using "per": 2 milliliters per 3 hours (2ml/3hr)

Ratio and Proportion

The strength or concentration of various drugs can be expressed as a ratio. First, read the label of the drug and find the strength or concentration. Express this strength as a ratio in fractional form, as in the following examples: Tolnaftate solution, 10 mg per ml = 10 mg/1 ml Kanamycin injection, 1.0 gm/3 ml = 1.0 gm/3 ml Isoproterenol inhalation, 1:200 = 1/200

Ratio and Proportion

A proportion consists of two equal ratios and is essentially a statement of equality between two ratios. For example: 2 --5 4 --10

Ratio and Proportion

Example 2. You have a 10-ml vial of aminophylline labeled "25 mg per ml". How many milliliters must be injected to administer a dose of 125 mg?

Ratio and Proportion

Example 1.
You have a 10-ml vial of aminophylline labeled "25 mg per ml". How many milliliters must be injected to administer a dose of 125 mg? 25 mg 125 mg -------- = ----------1 ml X ml
25mg (X) = (1 ml) (125 mg) X = 5 ml

Ratio and Proportion

Example 2. How many milliliters must be injected
from an ampule of Prochlorperazine labeled "10 mg/2 ml" in order to administer a dose of 7.5 mg?

Ratio and Proportion

Example 2. How many milliliters must be injected from an
ampule of Prochlorperazine labeled "10 mg/2 ml" in order to administer a dose of 7.5 mg? 10 mg -------2 ml = 7.5 mg ----------X ml

10mg (X) = (2 ml) (7.5 mg) X = 1.5 ml

Ratio and Proportion

A formula calls for 42 capsules of 300mg of drug. How many milligrams would be required to make 24 capsules?

Ratio and Proportion

A formula calls for 42 capsules of 300mg of drug. How many milligrams would be required to make 24 capsules?

300mg = x 42 caps 24 caps

7,200 = 171.4 mg 42

Ratio and Proportion Real Life

One person's error killed Elisha Crews Bryant, hospital officials said: a miscalculation overdosed the pregnant 18-yearold with a magnesium sulfate meant to slow her labor. She got 16 grams when she should have gotten 4 grams. The young mother began having trouble breathing, went into cardiac arrest and could not be revived.

Ratio and Proportion Real Life

Patient received 16 gms Mag. Sulfate, fatal dose. Patient should have received 4 gms.
How many ML @ 25 gm/50 ml should she have received?

Ratio and Proportion Real Life

How many ML @ 25 gm/50 ml should she have received to obtain 4 gms??
25 gm -------- = 50 ml 4 gm ----------X ml

25gm X = 200 gm/ml X = 8 ml

Percentage Preparations
Three types of percentage preparations Percent weight-in-weight (wt/wt) X Grams / 100 Grams Percent volume-in-volume (v/v) X Milliliters / 100 Milliliters Percent weight-in-volume (wt/v)* X Grams / 100 Milliliters Most Common

Percentage Preparations
Example 1. How much Potassium Chloride
in grams is needed to prepare a 1 Liter solution of 3% KCl solution?

Percentage Preparations
Example 1. How much Potassium Chloride
in grams is needed to prepare a 1 Liter solution of 3% KCl solution?
Answer: 3% = 3 grams / 100mls 1 Liter = 1000 mls Next: 3 grams X grams ---------- = ----------100 mls 1000 mls

Finally: x = 30 grams

Decimals
Three general rules when working with decimals
#1 Never leave a decimal point uncovered - too easy to misread and make a mistake #2 Unless working with money, Never add zeros to the right of the decimal point -the end signifies the accuracy of the number #3 The answer you get can be only as accurate as the least accurate number used in the calculation

Rounding Numbers

If the number following the place you are rounding to is 5 or higher, you round up If the number following the place you are rounding to is 4 or lower, you round down

Try some rounding

10.359 to tenths 10.4 0.143 to hundredths 0.14 9.9982 to thousandths 9.998

Systems of Measurement
THREE SYSTEMS Avoirdupois
-(household system)

Metric Apothecary
-(rarely used)

Metric System
CONVERSION FACTORS Micro one millionth Milli one thousandth Centi one hundredth Deci one tenth Kilo one thousand

Metric System
1000mcg = 1mg 1000mg = 1g 1000g = 1kg 1000ml = 1L
Metrics are expressed in the form of decimals ie.) 300ml = 0.3L

Avoirdupois Conversion Factors

3 tsp = 1 tbsp 2 tbsp = 1 oz 16 oz = 1 pt 2 pt = 1 qt 4 qt = 1 G 16oz = 1 lb

Conversion Factors Between Systems

1 tsp = 5 ml 1 tbsp = 15 ml 1 oz = 30 ml (29.57ml) 1 pt = 480 ml (473ml) 1 G = 3840 ml(3784ml)
1 g = 15.4 gr 1 gr = 60 mg (64.8mg) 1 kg = 2.2 lb 1 lb = 454 g 1 oz = 30 gm

Conversions
6.3 oz = ? ml
Arrange the units so they will cancel and solve
Value x Conversion Factor = Answer

6.3 oz

30ml 1oz

189 ml

The units of ounces cancel, and you are left with milliliters

Try This One

1.3 kg = ? grams
Value x Conversion Factor x Conversion Factor = Answer

1.3 kg

2.2 lb 1kg

454g = 1,298g 1lb

Or Approximatley 1,300 gm

Conversion
You receive a prescription for Cefzil 250mg/5mls with directions to take 1 teaspoonful by mouth twice daily for 10 days.
How much drug in milligrams, is in one teaspoonful? How much Cefzil in milliliters do you have to give the patient to last the full 10 days?

Parenteral (IV) Calculations

Parenteral calculations deal with administration of IV fluids Two main concepts you will learn
- Flow Rate - Dose per Time

Flow Rate Calculations

Flow rate is the speed at which an IV solution is delivered Function of Volume per Time
- usually reported in milliliters per hour

The magical formula

volume time = flow rate
Always be sure which time and volume units you are being asked to solve for Is it ml/min ? Or l/hr? Something else?

Flow Rate Calculations

A patient receives 1 L of IV solution over a 3 hour period. Calculate the flow rate in ml/hr. Note: the volume given is in liters, but the answer asks for milliliters. If the conversion wasnt so obvious, we would first need to do a conversion of L ml. volume time = flow rate

1000 ml 3 hours = 333 ml/hr

Another Rate Problem

A patient receives 0.75L of IV solution over a 4 hour period. Calculate the flow rate in ml/hr

Another Rate Problem

A patient receives 0.75L of IV solution over a 4 hour period. Calculate the flow rate in ml/hr Now the conversion is a bit harder, so we do the math

0.75 L 1

1000ml = 1L

750ml

750 ml 4 hours = 188 ml/hr

Solve for Time

By manipulating the rate formula, we can solve for time The equation becomes:
volume rate = time

Solving for Time

If an IV is run at 125ml/hr, how long will 1 L last?

Solving for Time

If an IV is run at 125ml/hr, how long will 1 L last?

volume rate = time

1000 ml = 8 125ml/hr

hours

Milliliters cancel and you are left with the units of hours

Solving for Volume

Play with the formula some more, and now we can solve for volume The equation becomes:

rate x time = volume

Solving for Volume

How many ml of IV solution would be required to run an IV for 12 hours at a rate of 60 ml/hr?

Solving for Volume

How many ml of IV solution would be required to run an IV for 12 hours at a rate of 60 ml/hr?

rate x time = volume

ITS REALLY JUST A CONVERSION PROBLEM!

60 ml 1hr

x 12 hr 1

= 720 ml

Solving for Volume

What volume would we need to have on hand if an IV solution is to be run for 100 ml/hr for 8.3 hrs?

Solving for Volume

What volume would we need to have on hand if an IV solution is to be run for 100 ml/hr for 8.3 hrs?

100 ml 1 hr

8.3 hr

830 ml

Any Questions?
ARE YOU READY FOR THE

PHARMACY TECHNICIAN MATH CONTEST

ON-LINE COMPETITION!

This is Pope John the 22nd, what would that be in Roman Numerals?

This is Pope John the 22nd, what would that be in Roman Numerals?

Pope John XXII

Question: What number super bowl is illustrated below, and, what team won the game?

Question: What number super bowl is illustrated below, and, what team won the game?

Super Bowl 43, won by the Pittsburgh Steelers

What is the sum of XLVI + IX in Roman Numerals?

What is the sum of XLVI + IX in Roman Numerals?

46 + 9 = 55 or LV

 If a customer asked to buy 10 packages of Sudafed, containing 20 tablets of 30 mg Pseudoephedrine, how many milligrams of Pseudoephedrine is she purchasing? Why would she want so much Sudafed?

If a customer asked to buy 10 packages of Sudafed, containing 20 tablets of 30 mg Pseudoephedrine, how many milligrams of Pseudoephedrine is he purchasing?

10 Packs X 20 Tabs X 30 mg = 6000 mg Why would she want so much Sudafed?

Key ingredient in the making of methamphetamine

 Your customer now has 6000 mg of Pseudoephedrine. If it takes 1800 mg of Pseudoephedrine to make 6 gm of crystal meth, how many grams can she make?

 Your customer now has 6000 mg of Pseudoephedrine. If it takes 1800 mg of Pseudoephedrine to make 6 grams of crystal meth, how many grams can she make? 1800 mg PSE ----------------6 gm Crys Meth Meth 6000 mg PSE = --------------------X gm Crys

(1800mg PSE)( X )=( 6000 mg PSE)(6gm Cry Meth)

1800 mg X = 36000 mg/gm X = 20 gm

 Your Meth addict now has 20 gm of drug. She wants to make a nasal solution containing 25% crystal meth. How many ml of normal saline solution does she need to make a 25% solution?

 Your Meth addict now has 20 gm of drug. She wants to make a nasal solution containing 25% crystal meth. How many ml of normal saline solution does she need to make a 25% solution?
25 gm ----------------100 ml = 20 gm PSE --------------------X ml Saline

(25 gm( X )=( 20 gm PSE)(100 ml) X = 80 ml

Pharmacy Technician Josh is traveling in Europe. He needs to fill up his rental car. Gas cost only $1.25 per liter. Technician Josh is excited that gas is so cheap. What would the cost of gas be in gallons? Hint: 1 pint = 473 milliliters

Pharmacy Technician Josh is traveling in Europe. He needs to fill up his rental car. Gas cost only $1.25 per liter. Technician Josh is so excited that gas is so cheap. What would the cost of gas be in 473 ml gallons? 8 pint 1 liter $1.25
-------1 pint x ----------1 gal x ----------

x --------1 liter

$4.73 gal
1000 ml

Round to the nearest Thousand

1) 14,389 _________ 2) 29,610 _________ 3) 3,492 _________

Round to the nearest Thousand

1) 14,389 2) 29,610 3) 3,492 14,000 30,000 3,000

Round to the nearest tenth

1) 0.89 _________ 2) 2.673 _________ 3) 2.57 _________

Round to the nearest tenth

1) 0.89 0.9 2) 2.673 2.7 3) 2.57 2.6

What is the flow rate in ml/hr if 1 liter Starbucks Coffee with 100% french roast is given over 12 hours???

83.3 ml/hr
(1 liter = 1000 ml) 1000 ml/12 hours = 83.3ml/hr

Try and solve this problem ;o)

The Recommended dose of meperidine (demerol) is 6mg/kg/24hrs for pain. It is given in divided doses of every 4 to 6 hours. How many milliliters (ml) of demerol injection (50 mg/ml) should be administered to a 33 pound child as a single dose every 6 hours?

1. The first step is to calculate the daily dose for a 33 pound child 6 mg___ = ____x mg 1 Kg (2.2 pounds) 33 pounds *By inserting the conversion unit 2.2 pounds for 1kg in the ratio there is no need to do a separate calculation of the number of kilograms in 33 pounds. X = 90 mg of demerol per day (24 hours)

2. The next step is to calculate the number of milliliters of demerol injection (50 mg/ml) needed for the total daily dose 50mg = 90mg 1 ml x ml

50x = 90 X = 1.8 ml every 24 hours

3. The final step is to calculate the number of milliliters to be given every 6 hours 1.8 ml = x ml 24 hrs 6 hrs 24x = 10.8 X = 0.45

ml

**So therefore the amount of demerol (50mg/ml) to be administered is 0.45 ml every 6 hours **

Any Questions?

Any Questions?