Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
How should oral potassium chloride tablets be taken?
Why is glibenclamide (glyburide) generally avoided in older adults?
A patient weighing 25 kg has a body surface area of 1.05 m². The prescription is 175 mg/m². Find the dose D in mg.
The prescription is 2.08 mg. The ampoule contains 4000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
Practice exercise (made-up values, not clinical guidance). An 86 kg patient is to be loaded intravenously with aminophylline to reach a theophylline level of 12 mg/L. The volume of distribution is 0.5 L/kg and the salt factor is S = 0.8. Find the loading dose LD of aminophylline in mg.
Practice exercise (made-up values, not clinical guidance). An 88-year-old man weighs 82 kg and has a serum creatinine of 2.6 mg/dL (230 µmol/L). Estimate the creatinine clearance with Cockcroft–Gault: CrCl (mL/min) = (140 − age) × weight (kg)/(72 × SCr in mg/dL), × 0.85 for women. The usual atenolol dose is 100 mg for a creatinine clearance of 100 mL/min, and a fraction fe = 0.9 of the drug is excreted unchanged by the kidneys. Using the Dettli dose fraction Q = 1 − fe·(1 − CrCl/normal CrCl), find the adjusted dose D. Round to the nearest whole number.
Answer: A · With food and plenty of water, swallowed whole if slow-release
Oral potassium can cause nausea and, if a tablet lodges, ulceration of the oesophagus or gut. Taking it with food and plenty of water and staying upright reduces this; levels are monitored.
Answer: A · It is long-acting and can cause prolonged, severe hypoglycaemia
Glibenclamide has a long action and active metabolites that accumulate when kidney function declines. Older adults are at high risk of prolonged hypoglycaemia, so shorter-acting agents or other drug classes are preferred.
Answer: D = 183.8 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Answer: V = 0.52 mL
Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.
Answer: LD = 645 mg
Clearance and volume: at steady state the dosing rate equals the elimination rate, so the maintenance rate = CL × Css. A loading dose is LD = Vd × C/(S × F), with S the salt factor (fraction of active drug in the salt) and F the bioavailability (1 for IV). From two levels, k = ln(C₁/C₂)/Δt; for an IV bolus Vd = dose/C₀ and CL = k × Vd. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
In practice the dose is rounded to a convenient amount.
Answer: D = 31 mg
Designing a regimen: with rapid IV doses the level falls from peak to trough during the interval, so τ = ln(Cpeak/Ctrough)/k and the dose that restores the peak is Vd × (Cpeak − Ctrough). The average steady-state level is Css,avg = S·F·dose/(CL·τ). An infusion rises as C = (R/CL)(1 − e−kt). For a drug cleared by the kidneys, the dose is scaled with the creatinine clearance. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
In practice the dose is rounded to a convenient amount and checked against the product information.
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