Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
A solution has a ratio strength of 1:10 000. You need 0.48 mg. Draw up the volume in the 10 mL syringe: what volume V is that?
Practice exercise (made-up values, not clinical guidance). You must prepare 500 mL of 5% sodium chloride by mixing 23% and 3% sodium chloride. How many mL V of the 23% solution do you need? Round to the nearest whole mL.
A patient weighs 80 kg. The prescribed dose is 7.5 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?
The prescription is 2960 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
Practice exercise (made-up values, not clinical guidance). A patient receives an IV bolus of 110 mg of gentamicin. The level back-extrapolated to time zero is 7 mg/L and the half-life is 2 h. Find the clearance CL in L/h.
Practice exercise (made-up values, not clinical guidance). An 82 kg patient on regular tobramycin doses is at steady state. The target is a peak of 7 mg/L and a trough of 0.5 mg/L, and the volume of distribution is 0.3 L/kg. Assuming rapid IV doses, what dose D raises the level from the trough to the peak?
Answer: V = 4.8 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.
Answer: V = 50 mL
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: 50 mL of 23% + 450 mL of 3% = 500 mL.
Answer: D = 150 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.
Answer: V = 0.74 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: CL = 5.446 L/h
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: D = 159.9 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.
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