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 cefazolin 1000 mg as a powder. The practice label says to add 4.5 mL of sterile water; the powder adds 0.5 mL to the volume. What is the concentration C in mg/mL after reconstitution?
1000 mg4.5 mL+0.5 mL
C = mg/mL
2.Pharmacy calculationsHard
Practice exercise (made-up values, not clinical guidance). You have 30 g of 5% coal tar ointment. How many grams m of 1% coal tar ointment must you add to make a 2% ointment? Round to the nearest whole gram.
30 g · 5%1%2%
m = g
3.Dosage calculationsMedium
A child weighing 6 kg is prescribed 15 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?
6 kg15 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
The prescription is 2560 micrograms. The ampoule contains 4 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
2560 mcg4 mg/mL
V = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). A patient has a lidocaine clearance of 750 mL/min. What infusion rate R in mg/min keeps the steady-state level at 2.5 mg/L?
CL = 750 mL/minCss = 2.5 mg/L
R = mg/min
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. What dose D in mg gives an average steady-state level of 20 mg/L?
CL = 6 L/hτ = 12 hS = 1F = 1Css,avg = 20 mg/L
D = mg
3Solutions
1.Pharmacy calculations
Answer: C = 200 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
4.5 + 0.5 = 5 mL
Concentration
C = 1000/5 = 200 mg/mL
Answer
C = 200 mg/mL
2.Pharmacy calculations
Answer: m = 90 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
5%: 2 − 1 = 1 parts
1%: 5 − 2 = 3 parts
Scale to the amount you have
m = 30·3/1 = 90 g
Answer
m = 90 g
Check: 30 g + 90 g = 120 g of 2% ointment.
3.Dosage calculations
Answer: V = 3.6 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 = 15·6 = 90 mg
Volume
V = 90/25 = 3.6 mL
On the syringe
On this 10 mL syringe every small line is 0.2 mL.
Answer
V = 3.6 mL
4.Dosage calculations
Answer: V = 0.64 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
4 mg/mL = 4000 mcg/mL
Volume
V = 2560/4000 = 0.64 mL
Answer
V = 0.64 mL
5.Clinical pharmacokinetics
Answer: R = 1.875 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.
Clearance in L/min
750 mL/min = 0.75 L/min
Infusion rate
R = 0.75·2.5 = 1.875 mg/min
Answer
R = 1.875 mg/min
6.Clinical pharmacokinetics
Answer: D = 1440 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.