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 0.67 mg. Draw up the volume in the 1 mL syringe: what volume V is that?
1:10000.67 mg
V = mL
2.Pharmacy calculationsHard
Practice exercise (made-up values, not clinical guidance). You have 60 g of 2.5% hydrocortisone ointment. How many grams m of 0.5% hydrocortisone ointment must you add to make a 1% ointment? Round to the nearest whole gram.
60 g · 2.5%0.5%1%
m = g
3.Dosage calculationsMedium
A child weighing 16 kg is prescribed 4 mg/kg of a drug. The stock solution contains 10 mg/mL. Draw up the dose: what volume V do you give?
16 kg4 mg/kg10 mg/mL
V = mL
4.Dosage calculationsHard
You must prepare 250 mL of a 0.5% (w/v) solution from a 20% (w/v) stock solution. How much water W must be added to the stock?
C₁ = 20%C₂ = 0.5%V₂ = 250 mL
W = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). A patient receives an IV bolus of 110 mg of gentamicin. The level back-extrapolated to time zero is 6 mg/L and the half-life is 3 h. Find the clearance CL in L/h.
D = 110 mgC₀ = 6 mg/Lt½ = 3 h
CL = L/h
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A 92 kg patient takes oral theophylline (F = 1) every 8 h. The clearance is 0.035 L/kg/h. Each dose is 300 mg of theophylline. Find the average steady-state level Css,avg.
CL = 0.035 L/kg/hτ = 8 hS = 1F = 192 kgD = 300 mg
Css,avg = mg/L
3Solutions
1.Pharmacy calculations
Answer: V = 0.67 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 = 0.67/1 = 0.67 mL
Answer
V = 0.67 mL
2.Pharmacy calculations
Answer: m = 180 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
2.5%: 1 − 0.5 = 0.5 parts
0.5%: 2.5 − 1 = 1.5 parts
Scale to the amount you have
m = 60·1.5/0.5 = 180 g
Answer
m = 180 g
Check: 60 g + 180 g = 240 g of 1% ointment.
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 = 4·16 = 64 mg
Volume
V = 64/10 = 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: W = 243.8 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.
Volume of stock
V₁ = 0.5·250/20 = 6.25 mL
Water to add
W = 250 − 6.25 = 243.8 mL
Answer
W = 243.8 mL
5.Clinical pharmacokinetics
Answer: CL = 4.236 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 = 110/6 = 18.33 L
Rate constant
k = 0.693/3 = 0.231 h⁻¹
Clearance
CL = 0.231·18.33 = 4.236 L/h
Answer
CL = 4.236 L/h
6.Clinical pharmacokinetics
Answer: Css,avg = 11.65 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.