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 0.85 mg. Draw up the volume in the 1 mL syringe: what volume V is that?
1:10000.85 mg
V = mL
2.Pharmacy calculationsHard
Practice exercise (made-up values, not clinical guidance). You must prepare 250 mL of 3% hydrogen peroxide from a 30% stock and purified water. How many mL V of water do you need? Round to the nearest whole mL.
30%0%3%250 mL
V = mL
3.Dosage calculationsMedium
How many milligrams of drug m are in 20 mL of a 1% (w/v) solution?
1% w/v20 mL
m = mg
4.Dosage calculationsHard
The prescription is 790 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?
790 units1000 units/mL
V = mL
5.Clinical pharmacokineticsMedium
Practice exercise (made-up values, not clinical guidance). A patient has a lidocaine clearance of 700 mL/min. What infusion rate R in mg/min keeps the steady-state level at 2.5 mg/L?
CL = 700 mL/minCss = 2.5 mg/L
R = mg/min
6.Clinical pharmacokineticsHard
Practice exercise (made-up values, not clinical guidance). A theophylline infusion runs at 25 mg/h with no loading dose. The patient's clearance is 2.5 L/h and the half-life is 8 h. What is the level C after 15 h?
R = 25 mg/hCL = 2.5 L/ht½ = 8 ht = 15 h
C = mg/L
3Solutions
1.Pharmacy calculations
Answer: V = 0.85 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 = 0.85/1 = 0.85 mL
Answer
V = 0.85 mL
2.Pharmacy calculations
Answer: V = 225 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
30%: 3 − 0 = 3 parts
0%: 30 − 3 = 27 parts
total: 30 parts
Water
V = 250·27/30 = 225 mL
Answer
V = 225 mL
Check: 25 mL of 30% contains 7.5 g of drug, which is 3% of 250 mL.
3.Dosage calculations
Answer: m = 200 mg
Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.
Concentration
1% = 1 g/100 mL = 10 mg/mL
Mass of drug
m = 10·20 = 200 mg
Answer
m = 200 mg
4.Dosage calculations
Answer: V = 0.79 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 = 790/1000 = 0.79 mL
On the syringe
On this 1 mL syringe every small line is 0.01 mL.
Answer
V = 0.79 mL
5.Clinical pharmacokinetics
Answer: R = 1.75 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
700 mL/min = 0.7 L/min
Infusion rate
R = 0.7·2.5 = 1.75 mg/min
Answer
R = 1.75 mg/min
6.Clinical pharmacokinetics
Answer: C = 7.274 mg/L
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.