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 1:10 000. 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
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
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
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
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
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.