Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Practice exercise (made-up values, not clinical guidance). A vial of penicillin G contains 5 000 000 units. Its practice label gives three strengths (see the table). You add 8.2 mL of diluent. The prescribed dose is 1 500 000 units. What volume V do you draw up? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). You have 120 g of 5% coal tar ointment. How many grams m of 1% coal tar ointment must you add to make a 3% ointment? Round to the nearest whole gram.
A child weighing 6 kg is prescribed 10 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?
A child weighing 20 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?
Practice exercise (made-up values, not clinical guidance). A patient has a lidocaine clearance of 650 mL/min. What infusion rate R in mg/min keeps the steady-state level at 2.5 mg/L?
Practice exercise (made-up values, not clinical guidance). A 55 kg patient takes oral aminophylline (S = 0.8, F = 1) every 12 h. The theophylline clearance is 0.05 L/kg/h. Each dose is 500 mg of aminophylline. Find the average steady-state level Css,avg.
Answer: V = 3 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.
Answer: m = 120 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.
Check: 120 g + 120 g = 240 g of 3% ointment.
Answer: V = 1.2 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.
On this 10 mL syringe every small line is 0.2 mL.
Answer: V = 5 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.
Answer: R = 1.625 mg/min
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.
Answer: Css,avg = 12.12 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.
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