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
cefazolin 1 gAdd 4.5 mL sterile water.Powder volume: 0.5 mL.? mg/mL

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
5%30 g+1%coal tar? g2%coal tar

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
024681010 mL

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
00.10.20.30.40.50.60.70.80.911 mL

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
VCss​ = 2.5 mg/LR = ? mg/minCL = 750 mL/min

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
VCss,avg​ = 20 mg/LD = ? mg · q12hCL = 6 L/hS = 1 · F = 1

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.

Dose

D = Css,avg·CL·τ/(S·F) = 20·6·12/(1·1) = 1440 mg

Answer

D = 1440 mg

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