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 1:1000. You need 0.61 mg. Draw up the volume in the 1 mL syringe: what volume V is that?
1:10000.61 mg
V = mL
2.Pharmacy calculationsHard
Practice exercise (made-up values, not clinical guidance). You must prepare 200 mL of 13% 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.
23%3%13%200 mL
V = mL
3.Dosage calculationsMedium
A child weighing 16 kg is prescribed 10 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
16 kg10 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
An infusion contains 50000 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?
50000 units/1000 mL800 units/h
R = mL/h
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). After an IV dose of tobramycin, the level is 6 mg/L at 1 h and 2.6 mg/L at 4 h. Assume first-order elimination. Find the half-life t½.
C1 = 6 mg/L (1 h)C2 = 2.6 mg/L (4 h)
t½ = h
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A 73 kg patient on regular gentamicin doses is at steady state. The target is a peak of 10 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?
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/1000 mL = 1 mg/mL
Volume
V = 0.61/1 = 0.61 mL
Answer
V = 0.61 mL
2.Pharmacy calculations
Answer: V = 100 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.
Alligation parts
23%: 13 − 3 = 10 parts
3%: 23 − 13 = 10 parts
total: 20 parts
Share the volume
V = 200·10/20 = 100 mL
Answer
V = 100 mL
Check: 100 mL of 23% + 100 mL of 3% = 200 mL.
3.Dosage calculations
Answer: V = 6.4 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.
Dose from body weight
D = 10·16 = 160 mg
Volume
V = 160/25 = 6.4 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 6.4 mL
4.Dosage calculations
Answer: R = 16 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.
Concentration
50000/1000 = 50 units/mL
Pump rate
R = 800/50 = 16 mL/h
Answer
R = 16 mL/h
5.Clinical pharmacokinetics
Answer: t½ = 2.487 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.
Elimination rate constant
k = ln(6/2.6)/3 = 0.8362/3 = 0.2787 h⁻¹
Half-life
t½ = 0.693/0.2787 = 2.487 h
Answer
t½ = 2.487 h
6.Clinical pharmacokinetics
Answer: D = 208 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.
Volume of distribution
Vd = 0.3·73 = 21.9 L
Dose
D = 21.9·(10 − 0.5) = 208 mg
Answer
D = 208 mg
In practice the dose is rounded to a convenient amount.