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 0.73 mg. Draw up the volume in the 1 mL syringe: what volume V is that?
1:10000.73 mg
V = mL
2.Pharmacy calculationsHard
A vial holds 250 mg of powder. You add 9.6 mL of diluent, and the powder adds 0.4 mL of volume. The prescription is 100 mg. Draw up the dose: what volume V do you give?
250 mg9.6 mL + 0.4 mL100 mg
V = mL
3.Dosage calculationsMedium
A vial contains 1 g of powder. The label says: add 9.6 mL of water for injection to give a total volume of 10 mL. The prescription is 300 mg. What volume V of the reconstituted solution do you give?
1 g+ 9.6 mL → 10 mL300 mg
V = mL
4.Dosage calculationsHard
The prescription is 0.68 mg. The ampoule contains 2000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
0.68 mg2000 mcg/mL
V = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). A patient receives an IV bolus of 180 mg of tobramycin. The level back-extrapolated to time zero is 6 mg/L and the half-life is 2.5 h. Find the clearance CL in L/h.
D = 180 mgC₀ = 6 mg/Lt½ = 2.5 h
CL = L/h
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A 94 kg patient takes oral theophylline (F = 1) every 8 h. The clearance is 0.035 L/kg/h. Each dose is 450 mg of theophylline. Find the average steady-state level Css,avg.
CL = 0.035 L/kg/hτ = 8 hS = 1F = 194 kgD = 450 mg
Css,avg = mg/L
3Solutions
1.Pharmacy calculations
Answer: V = 0.73 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/1000 mL = 1 mg/mL
Volume
V = 0.73/1 = 0.73 mL
Answer
V = 0.73 mL
2.Pharmacy calculations
Answer: V = 4 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
9.6 + 0.4 = 10 mL
C = 250/10 = 25 mg/mL
Volume
V = 100/25 = 4 mL
Answer
V = 4 mL
3.Dosage calculations
Answer: V = 3 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.
Concentration after mixing
1000 mg/10 mL = 100 mg/mL
Volume
V = 300/100 = 3 mL
Answer
V = 3 mL
4.Dosage calculations
Answer: V = 0.34 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.
Same units
0.68 mg = 680 mcg
Volume
V = 680/2000 = 0.34 mL
Answer
V = 0.34 mL
5.Clinical pharmacokinetics
Answer: CL = 8.318 L/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.
Volume of distribution
Vd = 180/6 = 30 L
Rate constant
k = 0.693/2.5 = 0.2773 h⁻¹
Clearance
CL = 0.2773·30 = 8.318 L/h
Answer
CL = 8.318 L/h
6.Clinical pharmacokinetics
Answer: Css,avg = 17.1 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.