Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
What should the nurse teach a patient about taking levothyroxine?
A patient has received a sodium nitroprusside infusion for several days. He becomes confused and develops a metabolic acidosis. What should be suspected?
A patient weighing 31 kg has a body surface area of 1.11 m². The prescription is 50 mg/m². Find the dose D in mg.
A patient weighs 136.4 lb. The prescription is 15 mg/kg as a single dose, and the stock contains 100 mg in 1 mL. Using 1 kg = 2.2 lb, what volume V do you give?
Practice exercise (made-up values, not clinical guidance). A 92 kg patient is to be loaded with digoxin tablets to reach a level of 1 mcg/L. The volume of distribution is 7 L/kg and the tablets have a bioavailability F = 0.7. Find the total oral loading dose LD in mcg.
Practice exercise (made-up values, not clinical guidance). A 41-year-old man weighs 68 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 gentamicin dose is 120 mg every 8 h for a creatinine clearance of 100 mL/min. Keeping the interval, the dose is reduced in proportion to the creatinine clearance. Find the adjusted dose D. Round to the nearest whole number.
Answer: B · Take it on an empty stomach, 30–60 minutes before breakfast
Levothyroxine is best absorbed on an empty stomach, and calcium, iron and antacids should be taken some hours apart. It is taken every day, usually for life.
Answer: B · Cyanide toxicity from nitroprusside breakdown
Nitroprusside releases cyanide, which is normally converted to thiocyanate. With high doses, long infusions or poor organ function, cyanide and thiocyanate can accumulate; the infusion is also protected from light.
Answer: D = 55.5 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 = 9.3 mL
Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.
Answer: LD = 920 mcg
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 = 43 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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