Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Practice exercise (made-up values, not clinical guidance). A vial contains ampicillin 500 mg as a powder. The practice label says to add 1.8 mL of sterile water; the powder adds 0.2 mL to the volume. The prescribed dose is 300 mg. What volume V do you draw up? Round to one decimal place.
A vial holds 500 mg of powder. You add 9.8 mL of diluent, and the powder adds 0.2 mL of volume. The prescription is 130 mg. Draw up the dose: what volume V do you give?
A patient weighing 65 kg has a body surface area of 1.6 m². The prescription is 375 mg/m². Find the dose D in mg.
An infusion contains 40000 units of a drug in 1000 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?
Practice exercise (made-up values, not clinical guidance). An 81 kg patient is to be loaded intravenously with aminophylline to reach a theophylline level of 12 mg/L. The volume of distribution is 0.5 L/kg and the salt factor is S = 0.8. Find the loading dose LD of aminophylline in mg.
Practice exercise (made-up values, not clinical guidance). A theophylline infusion runs at 37.5 mg/h with no loading dose. The patient's clearance is 2.5 L/h and the half-life is 9 h. What is the level C after 19 h?
Answer: V = 1.2 mL
Reconstitution: the powder takes up space, so the final volume is the diluent plus the powder volume. Concentration = drug in the vial/final volume, and the volume to give = dose/concentration. On a multi-strength label, use the concentration that belongs to the amount of diluent you actually added. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
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: D = 600 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).
Answer: R = 20 mL/h
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: LD = 607.5 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.
In practice the dose is rounded to a convenient amount.
Answer: C = 11.53 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.
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