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
A solution has a ratio strength of 1:1000. You need 0.45 mg. Draw up the volume in the 1 mL syringe: what volume V is that?
1:10000.45 mg
V = mL
2.Pharmacy calculationsHard
A vial holds 250 mg of powder. You add 9.4 mL of diluent, and the powder adds 0.6 mL of volume. The prescription is 117.5 mg. Draw up the dose: what volume V do you give?
250 mg9.4 mL + 0.6 mL117.5 mg
V = mL
3.Dosage calculationsMedium
A patient weighs 30 kg and is prescribed 10 mg/kg as a single dose. Find the dose D in mg.
30 kg10 mg/kg
D = mg
4.Dosage calculationsHard
The prescription is 2800 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
2800 units10000 units/mL
V = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). A 95 kg patient receives a theophylline infusion. The clearance is 0.05 L/kg/h. What infusion rate R in mg/h gives a steady-state level of 15 mg/L?
95 kgCL = 0.05 L/kg/hCss = 15 mg/L
R = mg/h
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A vancomycin infusion is started without a loading dose. The half-life in this patient is 6 h. How long t does it take to reach 75% of the steady-state level?
t½ = 6 h75% Css
t = h
3Solutions
1.Pharmacy calculations
Answer: V = 0.45 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 = 0.45/1 = 0.45 mL
Answer
V = 0.45 mL
2.Pharmacy calculations
Answer: V = 4.7 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
9.4 + 0.6 = 10 mL
C = 250/10 = 25 mg/mL
Volume
V = 117.5/25 = 4.7 mL
Answer
V = 4.7 mL
3.Dosage calculations
Answer: D = 300 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.
Dose
10·30 = 300 mg
Answer
D = 300 mg
4.Dosage calculations
Answer: V = 0.28 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 = 2800/10000 = 0.28 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.28 mL
5.Clinical pharmacokinetics
Answer: R = 71.25 mg/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.
Clearance
CL = 0.05·95 = 4.75 L/h
Infusion rate
R = 4.75·15 = 71.25 mg/h
Answer
R = 71.25 mg/h
6.Clinical pharmacokinetics
Answer: t = 12 h
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.