Pharmacy Calculations: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Pharmacy calculations

Percentage strength
% w/v = g per 100 mL
Amount in a solution
g = % × mL / 100
Ratio strength
1:X = 1 g in X mL; % = 100 / X
Reconstitution
final volume = diluent + powder volume
Concentration
mg/mL = drug in vial / final volume
Alligation
parts of H = T − L, parts of L = H − T
Water or base
0%

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

Clinical pharmacokinetics

Rate constant and half-life
k = ln 2/t½ = 0.693/t½
First-order decay
C = C₀·e−kt = C₀·(1/2)t/t½
Two levels
k = ln(C₁/C₂)/Δt
Volume and clearance
Vd = dose/C₀, CL = k·Vd
Loading dose
LD = Vd·C/(S·F)
Maintenance rate
R = CL·Css/(S·F)
Average steady state
Css,avg = S·F·D/(CL·τ)
Steady state
1 − (1/2)ⁿ after n half-lives; ≈ 97% after 5
Infusion
C = (R/CL)(1 − e−kt)
Interval and dose from peak and trough
τ = ln(Cpeak/Ctrough)/k, D = Vd·(Cpeak − Ctrough)
Cockcroft–Gault
CrCl = (140 − age) × kg/(72 × SCr mg/dL), × 0.85 for women
Renal adjustment
dose × CrCl/normal; Dettli Q = 1 − fe·(1 − CrCl/normal)

Method

  1. Convert the half-life to a rate constant: k = 0.693/t½.
  2. Turn per-kg values into totals: Vd (L) = L/kg × weight, CL (L/h) = L/kg/h × weight.
  3. Pick the relation: C = C₀·e−kt, LD = Vd·C/(S·F), maintenance rate = CL·Css/(S·F), τ = ln(Cpeak/Ctrough)/k.
  4. For kidney function, estimate CrCl with Cockcroft–Gault first, then scale the dose or the interval.
  5. Check the result: levels fall by half every half-life, and steady state takes about five half-lives.

2Practice problems

1.Pharmacy calculationsMedium
00.10.20.30.40.50.60.70.80.911 mL

A solution has a ratio strength of 1:1000. You need 0.15 mg. Draw up the volume in the 1 mL syringe: what volume V is that?

1:10000.15 mg
V = mL
2.Pharmacy calculationsHard
20%150 g+0%base? g15%zinc oxide

Practice exercise (made-up values, not clinical guidance). You have 150 g of 20% zinc oxide ointment. How many grams m of plain ointment base (0%) must you add to make a 15% ointment? Round to the nearest whole gram.

150 g · 20%0%15%
m = g
3.Dosage calculationsMedium
70 kg2 mg/kg/day4× per dayD = ? mg

A patient weighs 70 kg. The prescribed dose is 2 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

70 kg2 mg/kg/day4× per day
D = mg
4.Dosage calculationsHard
100 mg/5 mLV = ? mL

A child weighing 20 kg is prescribed 15 mg/kg per dose of an oral suspension that contains 100 mg in 5 mL. What volume V do you give?

20 kg15 mg/kg100 mg/5 mL
V = mL
5.Clinical pharmacokineticsMedium
Vd = 0.7 L/kgC = 15 mg/LLD = ? mg96 kg · S = 0.92 · F = 1

Practice exercise (made-up values, not clinical guidance). A 96 kg patient is to be loaded intravenously with phenytoin sodium to reach a phenytoin level of 15 mg/L. The volume of distribution is 0.7 L/kg and the salt factor is S = 0.92. Find the loading dose LD of phenytoin sodium in mg.

96 kgVd = 0.7 L/kgC = 15 mg/LS = 0.92
LD = mg
6.Clinical pharmacokineticsHard
VCss,avg​ = 12 mg/LD = ? mg · q12hCL = 0.04 L/kg/h73 kg · S = 0.8 · F = 1

Practice exercise (made-up values, not clinical guidance). A 73 kg patient takes oral aminophylline (S = 0.8, F = 1) every 12 h. The theophylline clearance is 0.04 L/kg/h. What dose D in mg gives an average steady-state level of 12 mg/L?

CL = 0.04 L/kg/hτ = 12 hS = 0.8F = 173 kgCss,avg = 12 mg/L
D = mg

3Solutions

1.Pharmacy calculations

Answer: V = 0.15 mL

Strength to volume: turn the strength into mg per mL first. A w/v percentage is grams per 100 mL, so x% = 10x mg/mL. A ratio strength 1:n is 1 g in n mL. After reconstitution the concentration is the powder's dose over the final volume (diluent + powder volume). Then volume = dose/concentration.

Strength in mg/mL

1000 mg/1000 mL = 1 mg/mL

Volume

V = 0.15/1 = 0.15 mL

Answer

V = 0.15 mL
2.Pharmacy calculations

Answer: m = 50 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.

Alligation parts

20%: 15 − 0 = 15 parts
0%: 20 − 15 = 5 parts

Scale to the amount you have

m = 150·5/15 = 50 g

Answer

m = 50 g

Check: 150 g + 50 g = 200 g of 15% ointment.

3.Dosage calculations

Answer: D = 35 mg

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.

Total per day

2·70 = 140 mg

Per dose

D = 140/4 = 35 mg

Answer

D = 35 mg
4.Dosage calculations

Answer: V = 15 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.

Dose from weight

15·20 = 300 mg

Volume

V = (300/100)·5 = 15 mL

Answer

V = 15 mL
5.Clinical pharmacokinetics

Answer: LD = 1096 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.

Volume of distribution

Vd = 0.7·96 = 67.2 L

Amount of active drug needed

Vd·C = 67.2·15 = 1008 mg

Loading dose

LD = 1008/(0.92·1) = 1096 mg

Answer

LD = 1096 mg

In practice the dose is rounded to a convenient amount.

6.Clinical pharmacokinetics

Answer: D = 525.6 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.

Clearance

CL = 0.04·73 = 2.92 L/h

Dose

D = Css,avg·CL·τ/(S·F) = 12·2.92·12/(0.8·1) = 525.6 mg

Answer

D = 525.6 mg

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