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
024681010 mL

A solution has a ratio strength of 1:10 000. You need 0.66 mg. Draw up the volume in the 10 mL syringe: what volume V is that?

1:10 0000.66 mg
V = mL
2.Pharmacy calculationsHard
90%ethanol+0%water? mL45%250 mL

Practice exercise (made-up values, not clinical guidance). You must prepare 250 mL of 45% ethanol from a 90% stock and purified water. How many mL V of water do you need? Round to the nearest whole mL.

90%0%45%250 mL
V = mL
3.Dosage calculationsMedium
12 kg20 mg/kgD = ? mg

A patient weighs 12 kg and is prescribed 20 mg/kg as a single dose. Find the dose D in mg.

12 kg20 mg/kg
D = mg
4.Dosage calculationsHard
100 mg/1 mLV = ? mL

A patient weighs 112.2 lb. The prescription is 0.5 mg/kg as a single dose, and the stock contains 100 mg in 1 mL. Using 1 kg = 2.2 lb, what volume V do you give? Round to two decimal places.

112.2 lb0.5 mg/kg100 mg/1 mL1 kg = 2.2 lb
V = mL
5.Clinical pharmacokineticsMedium
VCss​ = 15 mg/LR = ? mg/hCL = 0.045 L/kg/h61 kg

Practice exercise (made-up values, not clinical guidance). A 61 kg patient receives a theophylline infusion. The clearance is 0.045 L/kg/h. What infusion rate R in mg/h gives a steady-state level of 15 mg/L?

61 kgCL = 0.045 L/kg/hCss = 15 mg/L
R = mg/h
6.Clinical pharmacokineticsHard
Vd = 0.25 L/kg1 → 8 mg/LD = ? mg87 kg

Practice exercise (made-up values, not clinical guidance). An 87 kg patient on regular gentamicin doses is at steady state. The target is a peak of 8 mg/L and a trough of 1 mg/L, and the volume of distribution is 0.25 L/kg. Assuming rapid IV doses, what dose D raises the level from the trough to the peak?

87 kgVd = 0.25 L/kgCpeak = 8 mg/LCtrough = 1 mg/L
D = mg

3Solutions

1.Pharmacy calculations

Answer: V = 6.6 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.

Strength in mg/mL

1000 mg/10 000 mL = 0.1 mg/mL

Volume

V = 0.66/0.1 = 6.6 mL

Answer

V = 6.6 mL
2.Pharmacy calculations

Answer: V = 125 mL

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

90%: 45 − 0 = 45 parts
0%: 90 − 45 = 45 parts
total: 90 parts

Water

V = 250·45/90 = 125 mL

Answer

V = 125 mL

Check: 125 mL of 90% contains 112.5 mL of drug, which is 45% of 250 mL. This assumes the volumes simply add up; in practice ethanol is made up to volume.

3.Dosage calculations

Answer: D = 240 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

20·12 = 240 mg

Answer

D = 240 mg
4.Dosage calculations

Answer: V = 0.26 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.

Weight in kg

112.2/2.2 = 51 kg

Dose

0.5·51 = 25.5 mg

Volume

V = (25.5/100)·1 = 0.255 ≈ 0.26 mL

Answer

V = 0.26 mL
5.Clinical pharmacokinetics

Answer: R = 41.18 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 = 0.045·61 = 2.745 L/h

Infusion rate

R = 2.745·15 = 41.18 mg/h

Answer

R = 41.18 mg/h
6.Clinical pharmacokinetics

Answer: D = 152.3 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.

Volume of distribution

Vd = 0.25·87 = 21.75 L

Dose

D = 21.75·(8 − 1) = 152.3 mg

Answer

D = 152.3 mg

In practice the dose is rounded to a convenient amount.

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