Q1 Mrs A has been taking regular daily doses of 250 micrograms of digoxin tablets for the treatment of atrial fibrillation. She is now NIL by MOUTH and the doctor wants you to recommend an equivalent daily IV dose of digoxin. What volume of digoxin injection will need to be given to achieve an equivalent dose? [The bioavailability of digoxin tablets = 70%; the bioavailability of digoxin injection = 100%]
A. 0.6mL B. 0.7mL C. 0.8mL D. 0.9mL E. 1mL
ANSWER: Easier than it looks Multiply the amount of drug in tablet by the bioavailability of a tablet 250mcg x 0.7 = 175mcg of available drug Divide the amount of available drug by the strength of the injection in the BNF (250mcg/mL) 175 250 = 0.7mL You should be able to see the pattern in the numbers and not have to complete the second calculation.
Q2 How much concentrated chloroform water is contained in 450mL sodium chloride mouthwash BP? ( formula states that sodium chloride mouthwash contains 50ml double strength chloroform water per 100ml of mouthwash A. 8.75mL B. 9.50mL C. 10.125mL D. 11.25mL E. 12.0mL
Step 1: Calculate the total amount of double strength chloroform water in the product. From above know there is 50mL double strength chloroform water contained in 100mL 50mL X 4.5 = 225mL DS chloroform water in mouthwash Step 2: Calculate the total volume of concentrate If there is 225mL of DS divide this by 20 to find the amount of concentrate (DS is 1 part concentrate in 20 parts) 225mL 20 = 11.25mL Therefore answer is D
Q3 A 65-year old man weighing 80kg is administered dopexamine 500nanograms/kg/minute. The doctor wants the dose to be increased in 500nanogram increments at 15 minute intervals until a dose of 4 micrograms/kg/minute is reached. How much dopexamine in total will this patient receive in 4 hours?
A. 60mg B. 90mg C. 126mg D. 168mg E. 216mg
Step 1: Create a table so that you can calculate each increment 0 - 15 mins 500 x 80 = 40000ng x 15 = 600mcg 15 30 mins 1000 x 80 = 80000ng x 15 = 1200mcg 30 45 mins 1500 x 80 = 120mcg x 15 = 1800mcg 45 60 mins 2000 x 80 = 160mcg x 15 = 2400mcg 60 75 mins 2500 x 80 = 200mcg x 15 = 3000mcg 75 90 mins 3000 x 80 = 240mcg x 15 = 3600mcg 90 105 mins 3500 x 80 = 280mcg x 15 = 4200mcg 105 -120 mins 4000 x 80 = 320mcg x 15 = 4800mcg 2hrs 4 hrs 4000 x 80 = 320mcg x 120 = 38400mcg Total dopexamine administered (add totals) = 60000mcg = 60mg
Q4 You are asked to prepare an extemporaneous eye drop preparation for a prescription. What volume of the product would you need to supply if the patient has to use 2 drops six times a day in both eyes for 14 days? You can assume that there are 20 drops per mL and an overage of 20% is required
A. 20 21ml B. 21 22ml C. 22 23ml D. 23 24ml E. 24 25ml
Step 1: Calculate the total number of doses to be used 2 doses x 2 eyes x 6 times daily x 14 days = 336 doses Step 2: Calculate the total volume needed 336 doses x 0.05mL per dose = 16.8mL Step 3: Calculate a 20% overage 16.8ml x 1.2 = 20.16mL
Or 16.8 x 0.2 = 3.36 3.36 + 16.8 = 20.16mL
Q5 Theophylline has been administered intravenously to a patient. The drug has a half - life of 8 hours. The patient is assessed immediately after administration, where the plasma level of the drug is found to be 168mcg/ml. What would the plasma concentration be after 36 hours?
A. 21.625mcg/mL B. 13.125mcg/mL C. 7.875mcg/mL D. 5.275mcg/mL E. 1.375mcg/mL
Step 1: Calculate the number of half lives that will elapse 36 hours 8hours/half life = 4.5 half lives
Step 2: Divide the plasma concentration by 2 to find the desired concentration range Starting plasma conc. 168mcg/mL 1HL (8HR) 84mcg/mL 2 2HL (16HR) 42mcg/mL 2 3HL (24HR) 21mcg/mL 2 4HL (32HR) 10.5mcg/mL 2 5HL (40HR) 5.25mcg/mL STOP HERE The desired plasma conc. is between 10.5 and 5.25mcg/mL
Step 3: We know the desired plasma conc. is between 10.5 and 5.25mcg/mL we also know that the desired concentration will be found at 4.5 half lives. Therefore the plasma concentration will be of the difference between the concentration at 4 and 5 half lives The difference between 4 and 5 half lives = 5.25mcg/mL Find of this value 0.5 x 5.25mcg/ml = 2.625mcg/mL Therefore the plasma conc at 30 hours will be 10.5 2.625 = 7.875mcg/mL
Q6 A doctor has prescribed the following for a patient: Sodium valproate liquid: 100mg OD 7/7, then 200mg OD 7/7, then 200mg bd 21/7. Carbamazepine liquid: 100mg OD 7/7 then 200mg OD 7/7, then 300mg OD 21/7 Which of the following is the correct supply?
A. 262.5ml sodium valproate liquid; 340ml carbamazepine liquid B. 340ml sodium valproate liquid; 340ml carbamazepine liquid C. 275ml carbamazepine liquid; 420ml sodium valproate liquid D. 420ml carbamazepine liquid; 262.5ml sodium valproate liquid E. 275ml sodium valproate liquid; 320ml carbamazepine liquid
Step 1: find the strength of each liquid from the BNF Sodium valproate 200mg/5mL Carbamazepine 100mg/5mL
Step 2: convert each dose into a volume and add together (carbamazepine is easier) Carbamazepine 100mg/5mL therefore dose 5mL OD 7/7 + 10mL OD 7/7 + 15mL OD for 21/7 = 35mL + 70mL + 315mL = 420mL therefore answer must be D.
Sodium Valproate 200mg/5mL 2.5mL OD 7/7 + 5mL OD 7/7 + 5mL BD 21/7 = 262.5mL
Q7 What weight of a drug Z, containing 10% w/w moisture, should be added when preparing a 40L batch of an aqueous solution formulation with a final concentration of 4% w/v anhydrous drug Z?
A. 580g B. 1060g C. 1778g D. 2202g E. 2520g
Dont fall into the trap! DO NOT complete using C1V1 Step 1: Calculate the total anhydrous drug needed 4% of 40L = 40000 100 x 4 = 1600g Step 2: Calculate the total amount of drug with moisture needed 1600g = anhydrous drug 90% of drug with moisture Step 3: Calculate the total weight of drug including moisture 1600mg drug 90 x 100 = 1777.77 Therefore the closest answer is C 1778g
Q8 A patient receives diamorphine infusion over 24 hours. They currently receive a dose of 150mg over a 24 hour period using a syringe pump that is calibrated to 48mm / 24 hours (some syringe pumps are calibrated in mm/hr). After 8 hours it is decided to increase the rate of infusion to 72mm/ 24 hours. How much diamorphine will the patient receive in 24 hours?
A. 180mg B. 185mg C. 190mg D. 195mg E. 200mg
Step 1: Calculate the amount administered in the first 8 hours 150mg 3 (24h 3 = 8hr) = 50mg in 8 hours Step 2: Calculate the relationship between 48 and 72mm If you cant spot the relationship divide 72 by 48 = 1.5 Step 3: Convert to dose rate in mg/24hr 48 -72 = x 1.5 increase 150mg x 1.5 = 225mg/24 hours Step 4: calculate amount administered in remaining 16 hours 16 hours is 2/3 of 24 hours therefore 2/3 x 225 = 150mg (or divide by 3 and multiply by 2 if not good at fractions) Total amount supplied = 50mg + 150mg = 200mg
Q9 Which of the following is/are the approximate equivalent dose to recommend for a patient controlled on 12mg Hydromorphone given orally per 24 hours? 1. Fentanyl 25 patch 2. 20mg of diamorphine given by subcutaneous infusion over 24 hours 3. 30mg of morphine sulphate given by subcutaneous infusion over 24 hours
Step 1: Use the tables on page 21 and 24 of the BNF 2mg hydromorphone = 10mg morphine (orally) 12 mg hydromorphone = 60mg morphine (orally)
Step 2: compare with tables in BNF 60mg morphine fentanyl 25 patch so 1 is true 60mg morphine 20mg subcutaneous infusion diamorphine 60mg morphine 30mg subcutaneous infusion morphine Therefore the answer is A (1,2 and 3)
Q10 A 12-year-old child is prescribed a cytotoxic medicine at a dose of 200 mg/m2. Given that the child weighs 57.6 kg and is 1.6 m tall, which one of the following is the correct dose? Body surface area (m2) = (weight (kg) x Height (cm)) 3600 A. 240 mg B. 320 mg C. 400 mg D. 480 mg E. 560 mg
Step 1: complete the equation in brackets first 57.6kg x 160cm = 9216 9216 3600 = 2.56
Step 2: calculate the square root of 2.56 Hopefully you will spot a pattern. (the answer has to be between 1 and 2 and has to be an even number) If not: remove the decimal and try multiplying numbers together e.g square root of 256 is 16 (16 x 16 = 256)
Step 3: Calculate the amount of drug contained in 1 dose BSA calculated from above = 1.6 1.6 x 200 = 320mg Therefore the answer is B
End of Session Review In response to the review consider the following and formulate an action plan. Which calculations are you particularly good/poor at? Are issues with understanding or basic technique affecting your speed of completion? Are you getting incorrect answers because of calculation errors or lack of understanding? What are you going to do to make a change to your performance?