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 ceftriaxone 2000 mg as a powder. The practice label says to add 19.2 mL of sterile water; the powder adds 0.8 mL to the volume. What is the concentration C in mg/mL after reconstitution?
2000 mg19.2 mL+0.8 mL
C = mg/mL
2.Pharmacy calculationsHard
A vial holds 1000 mg of powder. You add 4.6 mL of diluent, and the powder adds 0.4 mL of volume. The prescription is 520 mg. Draw up the dose: what volume V do you give?
1000 mg4.6 mL + 0.4 mL520 mg
V = mL
3.Dosage calculationsMedium
A patient weighs 30 kg. The prescribed dose is 15 mg/kg per day, given in 2 equal doses. How many milligrams D are given per dose?
30 kg15 mg/kg/day2× per day
D = mg
4.Dosage calculationsHard
The prescription is 4250 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
4250 units5000 units/mL
V = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). After an IV dose of tobramycin, the level is 6 mg/L at 2 h and 2.6 mg/L at 5 h. Assume first-order elimination. Find the elimination rate constant k.
C1 = 6 mg/L (2 h)C2 = 2.6 mg/L (5 h)
k = h⁻¹
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A 90 kg patient takes oral aminophylline (S = 0.8, F = 1) every 8 h. The theophylline clearance is 0.035 L/kg/h. What dose D in mg gives an average steady-state level of 10 mg/L?
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
19.2 + 0.8 = 20 mL
Concentration
C = 2000/20 = 100 mg/mL
Answer
C = 100 mg/mL
2.Pharmacy calculations
Answer: V = 2.6 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
4.6 + 0.4 = 5 mL
C = 1000/5 = 200 mg/mL
Volume
V = 520/200 = 2.6 mL
Answer
V = 2.6 mL
3.Dosage calculations
Answer: D = 225 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
15·30 = 450 mg
Per dose
D = 450/2 = 225 mg
Answer
D = 225 mg
4.Dosage calculations
Answer: V = 0.85 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.
Volume
V = 4250/5000 = 0.85 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.85 mL
5.Clinical pharmacokinetics
Answer: k = 0.2787 h⁻¹
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
Answer
k = 0.2787 h⁻¹
6.Clinical pharmacokinetics
Answer: D = 315 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.
Clearance
CL = 0.035·90 = 3.15 L/h
Dose
D = Css,avg·CL·τ/(S·F) = 10·3.15·8/(0.8·1) = 315 mg