Pick the relation: C = C₀·e−kt, LD = Vd·C/(S·F), maintenance rate = CL·Css/(S·F), τ = ln(Cpeak/Ctrough)/k.
For kidney function, estimate CrCl with Cockcroft–Gault first, then scale the dose or the interval.
Check the result: levels fall by half every half-life, and steady state takes about five half-lives.
2Practice problems
1.Pharmacy calculationsMedium
A solution has a ratio strength of 1:10 000. You need 0.6 mg. Draw up the volume in the 10 mL syringe: what volume V is that?
1:10 0000.6 mg
V = mL
2.Pharmacy calculationsHard
A vial holds 2000 mg of powder. You add 1.9 mL of diluent, and the powder adds 0.6 mL of volume. The prescription is 1280 mg. Draw up the dose: what volume V do you give?
2000 mg1.9 mL + 0.6 mL1280 mg
V = mL
3.Dosage calculationsMedium
A patient weighs 30 kg. The prescribed dose is 30 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?
30 kg30 mg/kg/day2× per day
D = mg
4.Dosage calculationsHard
A child weighing 28 kg is prescribed 12.5 mg/kg per dose of an oral suspension that contains 250 mg in 5 mL. What volume V do you give?
28 kg12.5 mg/kg250 mg/5 mL
V = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). A 63 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.
63 kgVd = 0.7 L/kgC = 15 mg/LS = 0.92
LD = mg
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A theophylline infusion runs at 30 mg/h with no loading dose. The patient's clearance is 2.5 L/h and the half-life is 6 h. What is the level C after 5 h?
R = 30 mg/hCL = 2.5 L/ht½ = 6 ht = 5 h
C = mg/L
3Solutions
1.Pharmacy calculations
Answer: V = 6 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/10 000 mL = 0.1 mg/mL
Volume
V = 0.6/0.1 = 6 mL
Answer
V = 6 mL
2.Pharmacy calculations
Answer: V = 1.6 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.
Final volume and concentration
1.9 + 0.6 = 2.5 mL
C = 2000/2.5 = 800 mg/mL
Volume
V = 1280/800 = 1.6 mL
Answer
V = 1.6 mL
3.Dosage calculations
Answer: D = 450 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
30·30 = 900 mg
Per dose
D = 900/2 = 450 mg
Answer
D = 450 mg
4.Dosage calculations
Answer: V = 7 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
12.5·28 = 350 mg
Volume
V = (350/250)·5 = 7 mL
Answer
V = 7 mL
5.Clinical pharmacokinetics
Answer: LD = 719 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 = 0.7·63 = 44.1 L
Amount of active drug needed
Vd·C = 44.1·15 = 661.5 mg
Loading dose
LD = 661.5/(0.92·1) = 719 mg
Answer
LD = 719 mg
In practice the dose is rounded to a convenient amount.
6.Clinical pharmacokinetics
Answer: C = 5.265 mg/L
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.