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 0.26 mg. Draw up the volume in the 10 mL syringe: what volume V is that?
Practice exercise (made-up values, not clinical guidance). You have 50 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 1 g of powder. The label says: add 4.2 mL of water for injection to give a total volume of 5 mL. The prescription is 480 mg. What volume V of the reconstituted solution do you give?
A patient weighs 28.6 lb. The prescription is 5 mg/kg as a single dose, and the stock contains 10 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 99 kg patient is to receive an aminophylline infusion (salt factor S = 0.8: 80% of aminophylline is theophylline). The theophylline clearance is 0.05 L/kg/h. What aminophylline infusion rate R in mg/h gives a steady-state theophylline level of 10 mg/L?
Practice exercise (made-up values, not clinical guidance). A patient's tobramycin half-life is 3.5 h. The target is a peak of 7 mg/L and a trough of 1 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 = 2.6 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.
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.
Check: 50 g + 50 g = 100 g of 3% ointment.
Answer: V = 2.4 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 = 6.5 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: R = 61.88 mg/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: τ = 9.8 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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