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
Practice exercise (made-up values, not clinical guidance). A vial contains ampicillin 1000 mg as a powder. The practice label says to add 3.5 mL of sterile water; the powder adds 0.5 mL to the volume. What is the concentration C in mg/mL after reconstitution?
1000 mg3.5 mL+0.5 mL
C = mg/mL
2.Pharmacy calculationsHard
Practice exercise (made-up values, not clinical guidance). You have 40 g of 20% zinc oxide ointment. How many grams m of plain ointment base (0%) must you add to make a 10% ointment? Round to the nearest whole gram.
40 g · 20%0%10%
m = g
3.Dosage calculationsMedium
A patient weighs 60 kg. The prescribed dose is 10 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?
60 kg10 mg/kg/day2× per day
D = mg
4.Dosage calculationsHard
The prescription is 0.62 mg. The ampoule contains 2000 micrograms per mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
0.62 mg2000 mcg/mL
V = mL
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 80 mL/min. What infusion rate R in mg/h gives a steady-state level of 25 mg/L?
CL = 80 mL/minCss = 25 mg/L
R = mg/h
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A patient receives vancomycin IV every 12 h; the vancomycin clearance is 6 L/h. Each dose is 1000 mg of vancomycin. Find the average steady-state level Css,avg.
CL = 6 L/hτ = 12 hS = 1F = 1D = 1000 mg
Css,avg = mg/L
3Solutions
1.Pharmacy calculations
Answer: C = 250 mg/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.
Final volume
3.5 + 0.5 = 4 mL
Concentration
C = 1000/4 = 250 mg/mL
Answer
C = 250 mg/mL
2.Pharmacy calculations
Answer: m = 40 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.
Alligation parts
20%: 10 − 0 = 10 parts
0%: 20 − 10 = 10 parts
Scale to the amount you have
m = 40·10/10 = 40 g
Answer
m = 40 g
Check: 40 g + 40 g = 80 g of 10% ointment.
3.Dosage calculations
Answer: D = 300 mg
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.
Total per day
10·60 = 600 mg
Per dose
D = 600/2 = 300 mg
Answer
D = 300 mg
4.Dosage calculations
Answer: V = 0.31 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
0.62 mg = 620 mcg
Volume
V = 620/2000 = 0.31 mL
Answer
V = 0.31 mL
5.Clinical pharmacokinetics
Answer: R = 120 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
80·60/1000 = 4.8 L/h
Infusion rate
R = 4.8·25 = 120 mg/h
Answer
R = 120 mg/h
6.Clinical pharmacokinetics
Answer: Css,avg = 13.89 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.