Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Practice exercise (made-up values, not clinical guidance). A vial of penicillin G contains 5 000 000 units. Its practice label gives three strengths (see the table). You add 18.2 mL of diluent. The prescribed dose is 400 000 units. What volume V do you draw up? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). You have 60 g of 5% coal tar ointment. How many grams m of 1% coal tar ointment must you add to make a 3% ointment? Round to the nearest whole gram.
A vial contains 500 mg of powder. The label says: add 4.6 mL of water for injection to give a total volume of 5 mL. The prescription is 80 mg. What volume V of the reconstituted solution do you give?
A child weighing 14 kg is prescribed 20 mg/kg per dose of an oral suspension that contains 250 mg in 5 mL. What volume V do you give?
Practice exercise (made-up values, not clinical guidance). A patient receives an IV bolus of 170 mg of gentamicin. The level back-extrapolated to time zero is 7 mg/L and the half-life is 3 h. Find the volume of distribution Vd.
Practice exercise (made-up values, not clinical guidance). A patient's tobramycin half-life is 3.5 h. The target is a peak of 10 mg/L and a trough of 0.5 mg/L. Assuming rapid IV doses and first-order elimination, what dosing interval τ lets the level fall from the peak to the trough? Round to one decimal place.
Answer: V = 1.6 mL
Reconstitution: the powder takes up space, so the final volume is the diluent plus the powder volume. Concentration = drug in the vial/final volume, and the volume to give = dose/concentration. On a multi-strength label, use the concentration that belongs to the amount of diluent you actually added. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: m = 60 g
Alligation: to mix a higher strength H and a lower strength L into a target strength T, take (T − L) parts of H and (H − T) parts of L. The parts are crossed: each stock gets the distance from the target to the other stock. Water or a plain base counts as 0%. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Check: 60 g + 60 g = 120 g of 3% ointment.
Answer: V = 0.8 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: V = 5.6 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: Vd = 24.29 L
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.
Answer: τ = 15.1 h
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 interval is rounded to a convenient value such as 8, 12, 24 or 36 h, and the levels are checked again.
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