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 1000 mg of powder. You add 3.5 mL of diluent, and the powder adds 0.5 mL of volume. The prescription is 325 mg. Draw up the dose: what volume V do you give?
1000 mg3.5 mL + 0.5 mL325 mg
V = mL
3.Dosage calculationsMedium
A dose of 15 mg is needed from a 0.5% (w/v) solution. What volume V contains this dose?
15 mg0.5% w/v
V = mL
4.Dosage calculationsHard
A patient is 170 cm tall and weighs 53 kg. The prescription is 50 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.
170 cm53 kg50 mg/m²
D = mg
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). Vancomycin is given as a continuous infusion to a patient whose vancomycin clearance is 65 mL/min. What infusion rate R in mg/h gives a steady-state level of 20 mg/L?
CL = 65 mL/minCss = 20 mg/L
R = mg/h
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A patient's tobramycin half-life is 2 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.
t½ = 2 hCpeak = 10 mg/LCtrough = 0.5 mg/L
τ = h
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 = 1.3 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
3.5 + 0.5 = 4 mL
C = 1000/4 = 250 mg/mL
Volume
V = 325/250 = 1.3 mL
Answer
V = 1.3 mL
3.Dosage calculations
Answer: V = 3 mL
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Concentration
0.5% = 5 mg/mL
Volume
V = 15/5 = 3 mL
Answer
V = 3 mL
4.Dosage calculations
Answer: D = 79.1 mg
Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).
Body surface area
BSA = √(170·53/3600) = √2.503 = 1.582 m²
Dose
D = 50·1.582 = 79.1 mg
Answer
D = 79.1 mg
5.Clinical pharmacokinetics
Answer: R = 78 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.
Clearance in L/h
65·60/1000 = 3.9 L/h
Infusion rate
R = 3.9·20 = 78 mg/h
Answer
R = 78 mg/h
6.Clinical pharmacokinetics
Answer: τ = 8.6 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.
Rate constant
k = 0.693/2 = 0.3466 h⁻¹
Dosing interval
τ = ln(10/0.5)/0.3466 = 2.996/0.3466 = 8.644 ≈ 8.6 h
Answer
τ = 8.6 h
In practice the interval is rounded to a convenient value such as 8, 12, 24 or 36 h, and the levels are checked again.