Pharmacy Calculations: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Pharmacy calculations

Percentage strength
% w/v = g per 100 mL
Amount in a solution
g = % × mL / 100
Ratio strength
1:X = 1 g in X mL; % = 100 / X
Reconstitution
final volume = diluent + powder volume
Concentration
mg/mL = drug in vial / final volume
Alligation
parts of H = T − L, parts of L = H − T
Water or base
0%

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

Clinical pharmacokinetics

Rate constant and half-life
k = ln 2/t½ = 0.693/t½
First-order decay
C = C₀·e−kt = C₀·(1/2)t/t½
Two levels
k = ln(C₁/C₂)/Δt
Volume and clearance
Vd = dose/C₀, CL = k·Vd
Loading dose
LD = Vd·C/(S·F)
Maintenance rate
R = CL·Css/(S·F)
Average steady state
Css,avg = S·F·D/(CL·τ)
Steady state
1 − (1/2)ⁿ after n half-lives; ≈ 97% after 5
Infusion
C = (R/CL)(1 − e−kt)
Interval and dose from peak and trough
τ = ln(Cpeak/Ctrough)/k, D = Vd·(Cpeak − Ctrough)
Cockcroft–Gault
CrCl = (140 − age) × kg/(72 × SCr mg/dL), × 0.85 for women
Renal adjustment
dose × CrCl/normal; Dettli Q = 1 − fe·(1 − CrCl/normal)

Method

  1. Convert the half-life to a rate constant: k = 0.693/t½.
  2. Turn per-kg values into totals: Vd (L) = L/kg × weight, CL (L/h) = L/kg/h × weight.
  3. Pick the relation: C = C₀·e−kt, LD = Vd·C/(S·F), maintenance rate = CL·Css/(S·F), τ = ln(Cpeak/Ctrough)/k.
  4. For kidney function, estimate CrCl with Cockcroft–Gault first, then scale the dose or the interval.
  5. Check the result: levels fall by half every half-life, and steady state takes about five half-lives.

2Practice problems

1.Pharmacy calculationsMedium
00.10.20.30.40.50.60.70.80.911 mL

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
2.5%60 g+0.5%hydrocortisone? g1%hydrocortisone

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
024681010 mL

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
20%stockwater = ? mL

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
110t (h)C (mg/L)C₀ = 6 mg/Lt½ = 3 hC₀/2

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
VCss,avg​ = ?300 mg · q8hCL = 0.035 L/kg/h92 kg · S = 1 · F = 1

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.

Clearance

CL = 0.035·92 = 3.22 L/h

Average steady-state level

Css,avg = S·F·D/(CL·τ) = 1·1·300/(3.22·8) = 11.65 mg/L

Answer

Css,avg = 11.65 mg/L

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