Calculations practice

To practice calculations, I chose a range of questions covering dilutions, doses and pharmacokinetics from
MCQs in pharmaceutical calculations.
Donnelly RF, Barry J. MCQs in Pharmaceutical Calculations. Pharmaceutical Press; 2009.

1. A liquid medicine is supplied in a concentration of 20mg/5mL. A patient requires 40mg orally three
times daily for 5 days, then 20 mg three times daily for 5 days, then 20mg twice daily for 5 days and
then 20mg once daily for 5 days. Which of the following is the volume of liquid medicine that you
will need to dispense?

A. 600mL
B. 200mL
C. 300mL
D. 60mL
E. 30mL

Each 5mL of liquid contains 20mg of drug. How many mL contains 4mg?
5/5 = 1mL.
40mg TDS for 5 days would be 10mL X 3 X 5 = 150mL
20mg TDS for 5 days would be 5mL X 3 X 5 = 75mL
20mg BD for 5 days would be 5mL X 2 X 5 = 50mL
20mg OD for 5 days would be 5mL X 1 X 5 = 25mL
In total = 300mL

2. 1 in 10 000 solution of potassium permanganate contains which of the following concentrations?

A. 50.0mg potassium permanganate in 500mL solution

B. 1.0mg potassium permanganate in 100mL solution
C. 5.0mg potassium permanganate in 500mL solution
D. 1.0mg potassium permanganate in 1000mL solution
E. 3.0mg potassium permanganate in 300mL solution

1g in 10 000mL solution
Percentage strength is 0.01%
0.01g in 100mL
500mL should contain 0.05g = 50mg therefore answer is A

3. Which one of the following volumes of an adrenaline 1 in 1000 solution would be given by
intramuscular injection to a 2-year old child for treatment of anaphylaxis if the dose were 120mcg
stat?
A. 12.00mL
B. 120.00mL
C. 0.12mL
D. 24.0mL
E. 0.24mL
1 in 1000 = 1g in 1000mL
1000 000 mcg in 1000mL
1/1000 X 120 mcg = 0.12 mL
 4. Which of the following amounts of copper sulphate is required to make 400mL of an aqueous stock
solution, such that, when the stock solution is diluted 50 times with water, a final solution of 0.1%
w/v copper sulphate is produced?

A. 0.2g
B. 20.0g
C. 0.4g
D. 40.0g
E. 50.0g

Multiple 0.1% w/v by 50 to give concentration of stock solution = 5% w/v. This equals 5g in 100mL. We
started with 400mL of stock solution so 5.0 X 4 = 20.0 g of copper sulfate.

5. Potassium permanganate solution 1 in 8000 is prepared from a stock of 10 times this strength. How
much potassium permanganate will be needed to make sufficient stock solution if a patient uses
200mL of the diluted solution each day for 20 days?

A. 100mg
B. 125mg
C. 250mg
D. 400mg
E. 500mg

200 X 20 = 4000mL used in 20 days. The volume of the stock solution required would be 400mL as the
dilution factor is 10. The stock solution has a strength of 1 in 800 so there is 1 g potassium permanganate
in 800mL. In 400mL there would be 0.5 gram = 500mg.

6. What volume of phenytoin suspension 30mg/5mL is required to be added to a suitable diluent to

obtain 150mL phenytoin suspension 20mg/5mL

A. 75mL
B. 100mL
C. 120mL
D. 125mL
E. 130mL

600mg is in 150mL of suspension. A 30mg/5mL suspension contains 600mg in 100mL. 100mL should be
added to the diuent.

7. You are presented with a prescription for allopurinol tablets 100mg at a dose of 300mg each day for
14 days reducing to 200mg for a further 7 days. How many packs of 28 tablets should you supply?

A. Two
B. Three
C. One
D. Four
E. One and a half
Three tablets OD for 14 days = 42 tablets. Two tablets OD for 7 days = 14 days. 14 and 42 = 56
Two packs of 28 tablets are needed.
 8. In your pharmacy you have a stock solution of drug F with a concentration of 25%w/v. Drug F is
used as a mouthwash at a concentration of 0.25% w/v. You are requested to supply 50mL of a
solution of intermediate strength, such that the patient will dilute this solution 1 in 20 to get the
correct concentration immediately before use. Which of the following should be the concentration
of the intermediate solution?

A. 5% w/v
B. 10% w/v
C. 2.5% w/v
D. 0.5% w/v
E. 15% w/v

The concentration of the intermediate solution is 5% because it is diluted 20 times to produce the
concentration of 0.25%.

9. An ointment contains 1% w/w/ calamine. Which of the following is the amount of calamine powder
that should be added to 200g of the ointment to produce a 4% w/w calamine ointment?

A. 0.625g
B. 6.250g
C. 62.50
D. 5.0g
E. 50.0g

The initial amount of drug is 2g and the initial amount of cream is 200g.
(2 + x)/(200 + x) X 100 = 4% w/w
200 + 100x = 800 + 4x
Solve for x
X = 6.25g

10. Fertiliser residues are sometimes found in drinking water in rural areas. For compound Z, the safe
limit for drinking water is 9ppm Analytical results of the amount of compound Z in the drinking
water of various villages are given below. Which ONE of the following villages has drinking water
that is safe to drink?

A. Toome: 24.6micrograms/mL
B. Blackhill: 0.3mg/L
C. Drumhowan: 0.009% w/v
D. Magheracloone: 0.041% w/v
E. Annagassan: 1 in 100 000

0.3mg/L
0.3mg/1000mL so there is 0.3g in 1000 000mL or 0.3 ppm

11. You mix together 50g of 0.5% w/w hydrocortisone cream and 25g of 2% w/w sulphur cream (the
creams are compatible). What is the final concentration of each of the two drugs?

A. 0.5% w/w hydrocortisone cream and 2.0% w/w sulphur

B. 0.25% w/w hydrocortisone cream and 1.00% w/w sulphur
C. 0.33% w/w hydrocortisone cream and 0.67% w/w sulphur
 D. 0.67% w/w hydrocortisone cream and 0.33% w/w sulphur
E. 0.33% w/w hydrocortisone cream and 0.33% w/w sulphur

The final weight of the cream would be 50 + 25 = 75g

0.5% w/w = 0.5 g in 100g = 0.25 g in 50g - hydrocortisone
2% w/w = 2g in 100g = 0.5g in 25g - sulfur
0.25g in 75g = 0.33g in 100g = 0.33% w/w

Sulfur - 0.5g in 75g = 0.67g in 100g = 0.67% w/w

12. A patient is prescribed a reducing oral dose of prednisolone as follows:

Day 1: 10mg
Day 2: 8mg
Day 3: 6mg
Day 4: 4mg
Day 5: 3mg
Day 6: 2mg
Day 7: 1mg

Prednisolone is supplied as 5mg and 1mg tablets. Prednisolone tablets cannot be split. Therefore, the
patient needs to take a number of whole tablets. How many of each tablet strength would it be most
appropriate to supply?

A. Four 5mg tablets and fourteen 1mg tablets

B. Fourteen 5mg tablets and four 1mg tablets
C. Five 5mg tablets and fifteen 1mg tablets
D. Fifteen 5mg tablets and five 1mg tablets
E. One 5mg tablet and twenty 1mg tablets

Day 1 - 10mg - 2 X 5 tablets

Day 2 - 8mg - 1 X 5mg and 1 X 3mg
Day 3 - 6mg - 1 X 5mg and 1 X 1mg
Day 4 - 4mg - 4 X 1 mg
Day 5 - 3mg = 3 X 1mg
Day 6 - 2mg = 2 X 1mg
Day 7 - 1mg = 1 X 1mg
4 X 5mg tablets and 14 X 1 mg tablet.

13. You are requested to supply 35g of a cream containing 20% w/w methylaminolevulinate for use in a
photodynamic therapy clinical trial. You have Cetomacrogol Cream, BP in your hospital pharmacy
department and can use this as the cream base. What is the formula for your
methylaminolevulinate cream?

A. 10g methylaminolevulinate and 25g Cetomacrogol Cream, BP

B. 30g methylaminolevulinate and 5g Cetomacrogol Cream, BP
C. 5g methylaminolevulinate and 30g Cetomacrogol Cream, BP
D. 7g methylaminolevulinate and 28g Cetomacrogol Cream, BP
E. 28g methylaminolevulinate and 7g Cetomacrogol Cream, BP

35/100 X 20 = 7g of methylaminoevulinate
The rest of the cream is the cream base so 35 - 7 = 28g

14. You have in your pharmacy a cream containing 0.5% w/w hydrocortisone. You have been requested
to use this cream as a base and to add in sufficient calamine such that the final concentration of
calamine in the new cream will be 10.0% w/w. What is the concentration of hydrocortisone in the
new cream?

A. 0.3% w/w
B. 0.45% w/w
C. 0.5% w/w
D. 0.05% w/w
E. 0.045% w/w

The new cream has 10.0% w/w calamine. The 0.5% hydrocortisone cream makes up 90% of the new cream.
The hydrocortisone has been diluted by a factor of 0.9. 0.5 X 0.9 = 0.45% w/w

15. A stock solution of drug G is available at 10% w/v. You need to dilute this with Syrup, BP in order to
supply a patient with a solution containing 5mg/ML of drug G. Assuming no volume displacement
effects, what is your formula for the preparation of 100mL of the final solution?

A. 10mL stock solution and 90mL Syrup, BP

B. 80mL stock solution and 20mL Syrup, BP
C. 20mL stock solution and 80mL Syrup, BP
D. 95mL stock solution and 5mL Syrup, BP
E. 5mL stock solution and 95mL Syrup, BP

The stock solution contains 10g in 100mL = 10 000mg in 100mL

The patient requires a solution with a concentration of 5mg/mL so a 1 in 20 dilution is made. 5mL of the
stock solution is diluted in 100mL and 95mL syrup.

16. A patient is on a continuous intravenous drip of drug B. He needs to be dosed at a rate of 25mg/h.
The drip is set to administer 10 drops of fluid/h, with 4 drops equally 1mL in volume. Which of the
following is the concentration of drug B in the intravenous fluid?

A. 1mg/mL
B. 10mg/mL
C. 5mg/mL
D. 2.5mg/mL
E. 25mg/mL

10 drops/h and 4 drops is in 1 mL. In one hour, 2.5mL is delivered. The patient needs 25mg/hour there is
25mg in 2.5mL or 10mg in 1 mL

17. A patient requires an intravenous infusion of 0.9% w/v sodium chloride. In your hospital pharmacy
department you have Water for Injections, BP and 4.5% w/v sodium chloride solution, BP. Assuming
no volume displacement effects, which of the following volumes of 4.5% w/v sodium chloride
solution, BP need to be added aseptically to an expandable PVC infusion bag containing 100mL
Water for Injections, BP to produce the requisite sodium chloride concentration?

A. 25mL
 B. 50mL
C. 100mL
D. 125mL
E. 150mL

The volume of 4.5% w/v sodium chloride solution added - y

The amount of sodium chloride in y mL of 4.5% sodium chloride is 0.045y
0.045y (100 + y) X 100 = 0.9
4.5y(100+y) = 0.9
3.6y = 90
Y = 25mL

18. A patient needs to use a 1 in 2500 chlorhexidine gluconate solution for wound washing. In your
pharmacy you have a stock solution of 20% w/v chlorhexidine gluconate. Using this solution you
need to prepare an intermediate solution such that the patient will then dilute this 20-fold to
obtain a solution of the requisite concentration. Which of the following is the correct strength of
the intermediate solution?

A. 0.5% w/w
B. 0.2% w/w
C. 1.0% w/w
D. 0.4% w/w
E. 0.8% w/w

1 in 2500
Intermediate solution = (final concentration) X dilution factor = 1 in 2500 X 20
1 = 125 which means 1 g in 125mL = 0.8g in 100mL

19. According to an official formula for potassium citrate mixture, 300mL double-strength chloroform
water is required 1L mixture. A 2L bottle of mixture is required. If the double-strength chloroform
water is prepared from concentrated chloroform water, which of the following is the correct
volume of concentrate required? (Double-strength water is 2 parts concentrate to 38 parts water).

A. 10mL
B. 20mL
C. 3mL
D. 30mL
E. 15mL

Two litres require 600mL of double strength chloroform water. Double strength = 1/20
600 X 1/20 = 30mL

DOSING:

1. Mr B has been started on Cellcept suspension (mycophenolate mofetil 1g/5mL when reconstituted
with water) after a heart transplantation. He is taking the medicine at a dose of 1.5 twice daily. How
many complete days of compliant therapy will each 175mL bottle of reconstituted Cellcept
suspension provide him?

A. 11 days
 B. 12 days
C. 17 days
D. 23 days
E. 58 days

1.5 BD = 3g
The strength of the suspension is 1g/5mL so the patient will use 15mL daily. Each bottle contains 175/15 =
11.66.. days - 11 complete days-worth

2. A patient weighing 70kg is prescribed drug C to be given intravenously at a dose of 4mg/kg per hour
Drug C is available as a 10mg/2mL intravenous solution. Which of the following is a suitable flow
rate for administering drug C to this patient?

A. 1mL/min
B. 2mL/min
C. 14mL/hr
D. 28mL/hr
E. 56mL/hr

4mg/kg/h for 70kg patient is 4 X 70mg/h = 280mg/h.

10mg/2mL is the strength of drug C
280 X 2/10 so the rate is 56mL/hour

3. Drug D has been prescribed for a 5-month old baby with a body surface area of 0.4m 2. Drug D
should be given as a daily dose of 200 micrograms/m 2 in two divided doses. Drug D is available as
an oral liquid with a concentration of 0.1mg/mL. Which of the following is an appropriate single
dose for this baby?

A. 0.4mL
B. 0.8mL
C. 4mL
D. 8mL
E. 80mL

200 mcg/m2 daily in two doses so single dose is 100 mcg/m2. 100 X 0.4 = 40 micrograms = 0.04mg
Drug D concentration is 0.1mg/mL so 0.04/0.1mL = 0.4mL

4. A ward register requires an IV infusion of 3L physiological (normal) saline to be administered over a

2 and a half hour period. The IV giving set being used has a flow rate of 10 drops/mL. Which of the
following is a suitable drop rate?

A. 20 drops/min
B. 25 drops/min
C. 200 drops/min
D. 200 drops/hr
E. 250 drops/min
3000mL is given over 2 and a half hours.
150 minutes = 3000mL
10 drops in 1 mL so the rate is (3000 X 10mL/150 minutes) = 200 drops/min

5. A patient is to be administered 300mg fosphenytoin sodium by intravenous infusion. This drug is

available as a 10mL vial of fosphenytoin sodium at a concentration of 75mg/mL (Pro-Epantuin),
 which is to be diluted to 25mg/mL strength using glucose 5% before it can be administered to a
patient. How much fosphenytoin sodium and 5% glucose need to be used to administer the correct
dose to this patient?

A. 4mL Pro-Epantuin made up to 12mL with 5% glucose

B. 4mL Pro-Epantuin and 12mL 5% glucose
C. 10mL Pro-Epantuin made up to 12mL with 5% glucose
D. 5mL Pro-Epantuin and 4mL of 5% glucose
E. 1mL Pro-Epantuin made up to 4mL with 5% glucose

Each vial contains 750mg as its concentration is 75mg/mL.

300mg is in 4mL of 75mg/mL.
This needs to be diluted to 25mg/mL = 1 in 3 dilution.
4mL is in 12 mL

6. A junior house officer (JHO) asks for your advice about setting up an intravenous infusion of
dopexamine hydrochloride for a male patient, weighing 80kg, on the cardiac ward. The JHO wishes
to administer the drug at a dose of 500ng/kg/min. The drug is formulated as a strong 10mg/mL
sterile solution, but needs to be diluted to a concentration of 400 micrograms/mL with 5% glucose
before intravenous administration can occur. Which of the following is an appropriate
administration flow rate for you to advise the JHO?

A. 0.1mL/min
B. 1.25mL/min
C. 4mL/min
D. 8mL/min
E. 0.1 L/min

The dose is 500mg/kg per minute so the patient needs 50 X 80ng/min = 40 000ng/min = 40 mcg/min
400 mcg/mL so 40 micrograms is in 0.1mL.
The IV rate is 0.1mL/min

7. A woman weighing 70kg has been prescribed danaparoid sodium for thromboembolic disease
following the standard directions for patient with a history of heparin-induced thrombocytopenia.
This standard dose is 2500 units (1250 units if body weight <55kg, 3750 units if > 90kg) by IV
injection followed by an IV infusion of 400 units/hr for 2 hours, then 300 units/h for 2 hours, then
200 units/h for 5 days. Danaparoid sodium is available as a 1250 units/mL injection distributed in
0.6mL ampoules. What volume of drug will be administered to this woman over this complete
course of therapy?

A. 13.392mL
B. 21.32mL
C. 22.32mL
D. 23.32mL
E. 37.2mL

As patient weighs 70kg, a standard dose is prescribed.

2500 units
400 units/hour X 2 hours = 800 units
300 units/hour X 2 hours = 600 units
200 units/hour X 5 days = 200 X 24 X 5 = 24000 units
Total is 2500 + 800 + 600 + 24000 units = 27900
Danaparoid is available as 1250 units/mL so use 27900/1250mL = 22.32mL

8. A 70kg adult patient is being treated for iron poisoning. He is administered desferrioxamine.
Mesylate initially at a dose of 12mg/kg per h to be reduced by 25% after 6 hours. How much
desferrioxamine mesylate will this patient have received after 12 hours of therapy?

A. 0.0882g
B. 0.882g
C. 63g
D. 6300mg
E. 8820mg

After 6 hours, 12 X 6 X 70= 5040mg

6-12 hours, dose is reduced by 25% so 0.75 X 12mg/kg per hour - 0.75 X 12 X 6 X 70 = 3780mg
5040 + 3780 = 8820mg

9. Following a medication review a patient currently being prescribed opioid analgesia is to have his
analgesia changed. Previously the patient was taking 5.2mg hydromorphone hydrochloride every 4
hours and now is to be prescribed oxycodone hydrochloride oxycodone hydrochloride. Given that
1.3mg hydromorphone hydrochloride is approximately equivalent to 5mg oxycodone hydrochloride
orally, and the patient takes the drug fully compliantly throughout the 24 hours of a day, which of
the following dosage regimens is a suitable alternative for this patient?

A. 5mg oxycodone hydrochloride capsules every 4 hours

B. 20mg oxycodone hydrochloride capsules every 6 hours
C. 15mL oxycodone hydrochloride 5mg/5mL liquid every 6 hours
D. 3mL oxycodone hydrochloride 10mg/mL concentrate every 6 hours
E. 20mg oxycodone hydrochloride MR (modified-release) tablets every 12 hours

5.2mg hydromorphone hydrochloride/4 hours = 5.2 X 6 doses in 24 hours = 31.2mg

1.3mg hydromorphone hydrochloride = 5mg oxycodone hydrochloride
31.25mg hydrmorphone hydrochloride = 120mg oxycodone hydrochloride
5mg X 6 doses = 30mg NOT A
20mg X 4 doses = 80mg NOT B
15mL X 5mg/5mL X 4 doses = 60mg NOT C
3mL X 10mg/mL X 4 doses = 120mg ANSWER IS D
20mg X 2 doses = 40mg NOT E

10. A 6-year old is to be prescribed topiramate as monotherapy for partial seizures. This child weighs
20kg and her consultant has decided to prescribe her drug according to a regimen of 0.5mg/kg at
night for 1 week, then increase in steps of 500 micrograms/kg at 1-week intervals, with the drug
given twice daily. Her therapy is started on 1st August. Assuming that she tolerates her medication
and the prescribed regimen is effective, what dose will she be receiving on 15 th August?

A. One 15mg topiramate sprinkle capsule twice daily

B. One 15mg topiramate sprinkle capsule three times a day
C. One 25mg topiramate tablet daily
D. One 25mg topiramate sprinkle capsule twice daily
E. One 50mg topiramate tablet once daily
th
1-7 August - 0.5mg/kg at night
8-14th August - 0.5mg/kg BD
15-21st August - 0.5mg/kg + 1mg/kg BD
On 15th August, she is taking 1.5mg/kg in two divided doses.
1.5 X 20/2 = 15mg twice daily

11. The recommended dose for pericyazine for children aged between 1 and 12 years is initially 500
micrograms daily for 10kg child, increased by 1mg for each additional 5kg to maximum total daily
dose of 10mg. Which of the following initial doses is within these guidelines?

A. 0.25mL periciazine 10mg/5mL syrup daily for a 10 month old weighing 10kg
B. 0.5mL periciazine 10mg/5mL syrup daily for a 14 month weighing 10kg
C. 1.75mL periciazine 10mg/5mL syrup daily for a 10 year old weighing 25kg
D. 2.5mL periciazine 10mg/5mL syrup daily for a 12 year old weighing 35kg
E. 7mL periciazine 10mg/5mL syrup daily for a 12 year old weighing 45kg

500 micrograms + (25 - 10/5) = 3.5mg, 1.75mL of 10mg/5mL = 3.5mg

12. A patient is administered potassium chloride as a slow infusion over 150 min at a rate of 0.1mmol
potassium/kg per h. If 15 mmol potassium is delivered during the infusion what weight is the
patient?
A. 50kg
B. 55k
C. 60kg
D. 65kg
E. 75kg

0.1mmol/kg per hour

150 minutes = 2.5 hours
The patient weighs x kg
0.1 X x X 2.5 = 15
0.25x = 15
X = 60kg

13. A 3-year old has been prescribed ganciclovir (as the sodium salt) as maintenance therapy at a dose
of 6mg/kg daily on 5 days/week until she has adequate recovery of immunity after a
transplantation. She weighs 12kg and has normal renal function. For administration as an
intravenous infusion the gangciclovir (as the sodium salt) powder is reconstituted with water for
injections (500mg/10mL), then diluted to a concentration of 5mg/mL with 0.9% sodium chloride,
and the infusion then given over 1 hour. What flow rate is appropriate for this patient and how
much gangciclovir (as the sodium salt) will she have been administered after 1 week?

A. 0.24mL/min and 360mg

B. 7.2mL/min and 504g
C. 18mL/min and 360mg
D. 30mL/min and 360mg
E. 30mL/min and 360mg
F. 30mL/min and 504mg

6mg/kg daily for 12 kg patients - 72mg daily

72mg/hour = 72/60 minutes = 1.2mg/min
Strength of 5mg/mL = 1mg in 1/5mL = 0.2mL so 1.2mg is in 1.2 X 0.2mL.min
0.24mL/min
 14. A syringe driver contains 15mL diamorphine hydrochloride 4mg/mL solution. The length of the
syringe driver is 60mm. What rate should the syringe driver be set at, so that the patient receives
5mg/h of diamorphine hydrochloride?

A. 3mm/h
B. 4mm/h
C. 5mm/h
D. 6mm/h
E. 7mm/h

4m/mL 15 mL contains 60mg

Syringe driver has a length of 60mm so it delivers 60mg over 60mm.
1mg/mm
5mg/hour - 5mm/hours

15. A 2-month old baby needs to be given fluconazole for a candidal infection. The standard dose of
fluconazole for this indication is 3mg/kg one the first day, then 3mg/kg (max 100mg) daily for 7
days. However, if the child has renal impairment, the following advice needs to be heeded: usual
initial dose, then halve subsequent dose if creatinine clearance < 50mL/min/1.73m 2. How much
fluconazole will a 4.5kg (0.28m2) baby have been administered after this course of therapy if the
creatinine clearance is 5mL/min?

A. 48.75mg
B. 54mg
C. 60.75mg
D. 94.5mg
E. 108mg
50mL/min per 1.73m2
The child has a clearance of 5mL.min which is per 0.28m 2 because this is the surface area of the child.
5mL/min per 0.28m2 which is 5/0.28 X 1.73mL/min per m2 = 30/89mL/min per 1.73m2.
Initial dose is 3mg/kg on day 1 then 1.5mg/kg daily for 7 days
4.5kg patient (3 X 4.5) + (1.5 X 4.5 X 7) = 60.75mg

16. A patient is being given an infusion of 0.95% sodium chloride. Which of the following is the
concentration of the infusion that she is receiving? (atomic number of sodium: 23; atomic number
of chlorine: 35.5)

A. Approximately 100mmol/L
B. Approximately 134mmol/L
C. Approximately 154mmol/L
D. Approximately 160mmol/L
E. Approximately 271mmol/L

1 mole of NaCl = 23 + 35.5 = 58.5g

0.9% strength means 0.9 g NaCl in 100mL of solution which equals 9g in 1000mL
58.5mg in 1 mol
1g = 1/58.5mol
9g = 9/58.5mol = 0.1538 mol = 154 mmol
Pharmacokinetics:
 1. Drug M with a half-life of 45 minutes displays first-order kinetics, which means that the rate of
change of drug concentration in the body by any process is directly proportional to the drug
concentration remaining. Which of the following is the elimination rate constant (k el) of drug M
given that kel = 0.693/t1/2

A. 1.54 min-1
B. 0.0154 h-1
C. 0.0154 min-1
D. 0.0145 min-1
E. 0.0145 h-1

0.693/45 minutes = 0.0154/min

2. A 54 year old male patient with a body weight of 65kg requires an oral loading dose of digoxin. You
know that the volume of distribution (VD) per kg body weight is 6L, the salt factor (S) = 1 and the
bioavailability (F) is 0.7. What dose should be used to achieve a target plasma concentration (C p) of
1.25 micrograms/L?

Loading dose = Vd X Cp/S X F

A. 500 micrograms
B. 600 micrograms
C. 700 micrograms
D. 800 micrograms
E. 900 micrograms

6 litres X 65 X 1.25 micrograms/litre divided by 1 X 0.7 = 696.43 micrograms which is closest to 700
micrograms.

3. A patient is given an intravenous dose of drug H and her peak serum level is found to be 12
micrograms/L; 12 hours later her serum concentration is 0.75mg/L. What is the elimination half-life
of drug H in this patient? (You may assume that the distribution is complete and that the
elimination is described by a first-order process).

A. 2h
B. 3h
C. 4h
D. 5h
E. 6h

Her peak serum level is 12 micrograms/L

After 12 hours, it reached 0.75 mg/L which is equal to 0.75micrograms/mL
12  6  3  1.5  0.75
4 half lives. There are four half-lives in 12 hours so each half-life is 3 hours.

4. Phenytoin has a narrow therapeutic index and hence small changes in drug absorption may result in
a marked change in plasma concentration. Individual maintenance doses should be calculated for
patients to maintain patient safety. The following equation can be used for this purpose:
Maintenance dose (mg) = (Vmax X serum concentration)/S X F X (Km [mg/L] + serum concentration [mg/L])

Isobel, a 63kg woman newly diagnosed with epilepsy, requires a serum concentration of 18mg/L for
optimum response. Isobel is to be prescribed phenytoin as capsules; the maximum metabolic capacity
Vmax is 7mg/kg per day and the plasma concentration at which the rate of metabolism is half the
maximum is 4mg/L. Which dose is a suitable maintenance dose for Isobel, given that the bioavailability (F)
of phenytoin capsules is 1 and the salt factor (S) is 0.92?

A. 300mg
B. 350mg
C. 400mg
D. 450mg
E. 500mg

Maintenance dose = (7 X 63 X 18)/(0.92 X 1 X (4 + 18)) = 392.19mg

This is closest to 400 mg.

5. Cathal, who is 54 years old, has mild renal impairment and weighs 63kg. Before his doctor is willing
to recommend a dose of venlafaxine for his depression, he wants to calculate his creatinine
clearance. What is the best estimate of Cathal’s creatinine clearance given the equation below and
that his serum creatinine is 175 micromoles/L?

Creatinine clearance (mL/min) = 1.23 X (140 - age) X weight (kg)/serum creatinine (micromoles/L)

A. 29.22 mL/min
B. 30.96 mL/min
C. 32.64 mL/min
D. 34.10 mL/min
E. 38.08 mL/min

1.23 X (140 - 54) X 63/175 = 38.0808..mL/min = 38.08 mL/min

6. Diane, aged 84 years, is to be given an intravenous loading dose of digoxin. Upon administration to
hospital Diane’s weight was recorded in her notes as 59kg. The JHO on the ward asks for your
advice about a suitable loading dose for Diane, to achieve a serum concentration of 0.002mg/L.
Which of the following is a suitable loading dose for you to recommend to the JHO?
You have access to the following information:
Loading dose = {VD [L] X Cp)/(S X F)
Volume of distribution (VD) = 7.3L/kg
Target concentration (Cp) = 0.002mg/L
Bioavailability (F) = 1
Salt factor (S) = 1

A. 0.08614 mcg
B. 0.8164 mcg
C. 8.614 mcg
D. 86.14 mcg
E. 861.4mcg
Loading dose (mg) = (7.3 X 59 X 0.002)/1 X 1
0.8614 mg X 1000 = 861.4 mcg
 7. Mrs Fletcher is admitted to accident and emergency with fast atrial fibrillation and requires digoxin
therapy. She is 75kg in weight. What oral loading dose would you recommend to the prescribing
doctor who contacts you about this patient explaining he is aiming to achieve a serum
concentration of 1.5 micrograms/L? Your hospital policy on the prescribing of digoxin recommends
that you assume the volume of distribution to be 7L/kg, the salt factor to be 1 and the
bioavailability of digoxin tablets to be 0.7 and of digoxin elixir to be 0.77. The loading dose can be
given in divided doses over 24 hours or as a single dose. Loading dose = {V D [L] X Cp)/(S X F)

A. 3 X 250 microgram digoxin tablets over 24 h in divided doses

B. 2 X 250 microgram digoxin tablet and 1 X 125 microgram tablet over 24 h in divided doses
C. 4 X 250 microgram digoxin tablet and 1 X 125 microgram tablet over 24 h in divided doses
D. 15 mL digoxin elixir 50 micrograms/L as a single dose
E. 35mL digoxin elixir 50 micrograms/L over 24 h as divided doses 6 h apart

Loading dose for tablets:

(7 X 75 X 1.5)/0.7 = 1125 micrograms
Loading dose for elixir:
(7 X 75 X 1.5/0.77 = 1022.73 micrograms

A: 3 X 250 = 750 micrograms in 24 hours

B: 3 X 250 micrograms + 125 micrograms = 625 micrograms in 24 hours
C: 4 X 250 micrograms + 125 micrograms = 1125 micrograms in 24 hours
D: 15mL of digoxin 50 micrograms/mL elixir = 750 micrograms (elixir)
E: 35mL of digoxin 50 micrograms/mL elixir = 1750 micrograms (elixir)

8. An 81-kg patient requires oral theophylline for his chronic asthma. Which of the following dosage
regimens of a 12-hourly modified-release theophylline preparation would provide a steady-state
plasma concentration (Css) between 10 and 20mg/L, assuming that oral bioavailbility (F) is 1, the salt
factor (S) is 1, his clearance (Cl) is 36.67 mL/min and the volume of distribution (V D) is 0.5L/kg?
Maintenance dose = (Css X Cl X dosage interval)/(F X S)

A. 60mg every 12 hours

B. 125 mg every 12 hours
C. 175mg every 12 hours
D. 250 mg every 12 hours
E. 350 mg every 12 hours

Clearance = 36.67 mL/min, make units the same as concentration

36.67 X 60 = 2200 mL/h = 2.2L/h
Maintenance dose for 10mg/L = (10mg/L X 2.2L/h X 12h)/(1 X 1)
Maintenance dose = 10 X 2.2. X 12 = 264 mg every 12 hours
Maintenance dose for 20mg/L concentration = 20 X 2.2 X 12 = 528mg every 12 hours

The range should be 264 - 528mg every 12 hours

The answer within this range is 350mg.

9. An 8-year old child is having his Lanoxin formulation changed from elixir to tablets due to a
manufacturing problem with the elixir. The child is currently taking a dose of 1.3mL of 50
micrograms/mL elixir twice daily. Given that the bioavailability of the tablets is 63% and the elixir is
 75%, which of the following is a suitable alternative dosage regimen? Digoxin can be given as a once
or twice daily dose for children between the ages of 5 and 10 years.

A. 125 micrograms Lanoxin tablet twice daily

B. 62.5 microgram Lanoxin-PG tablet twice daily
C. 1 X 125 microgram Lanoxin and ½ X 62.5 microgram Lanoxin-PG tablet daily
D. 250 microgram Lanoxin tablet daily
E. 1 and a half 125 microgram Lanoxin tablets daily

The first step is to find out how much digoxin the patient is receiving from the elixir. 1.3mL BD X 50
micrograms/mL = 50 X 1.3 X 2 = 130 micrograms daily.
75% of this dose gets into systemic circulation (i.e. is bioavailable) = 0.75 X 130 micrograms = 97.5
micrograms.
What dose of Lanoxin tablets are needed to supply 97.5 micrograms.

The bioavailability of Lanoxin tablets is 63%

The mass of Lanoxin tablets is denoted by x
0.63x = the amount of digoxin bioavailable from the tablets.
We want 97.5 micrograms
0.63x = 97.5
x = 154.75 micrograms
A daily dose of 154.75 micrograms is needed from Lanoxin tablets. FROM THE BNF, lanoxin is available as:
 Lanoxin PG 62.5 microgram tablets
 Lanoxin 125 mcg tablets
 Lanoxin 250 mcg tablets

Half of 62.5 = 31.25 micrograms

125 + 31.25 = 156.25 which is closest to 154.75 micrograms therefore the answer is C

10. For this question, one or more of the responses are correct. Decide which of the responses is (are)
correct. Then choose

A. If 1, 2 and 3 are correct

B. If 1 and 2 only are correct
C. If 2 and 3 only are correct
D. If 1 only is correct
E. If 3 only is correct

A 53-year old woman with epilepsy, weighing 56kg has been taking 150 mg phenytoin capsules daily to
control her condition. Plasma concentration of phenytoin should be in the range 10-20 mg/L for optimum
response from the drug. However, during a recent outpatient review, it was discovered that her plasma
concentration was only 6mg/L.

1) Given that the bioavailability (F) of phenytoin capsules is 1, the salt factor (S) is 0.92 and the plasma
concentration at which the rate of metabolism is half the maximum (K m) is 4mg/L, the maximum
metabolic capacity (Vmax) in this patient would be 7mg/kg per day. Maintenance dose (mg/day) =
Vmax X serum concentration/{(S X F X (Km [mg/L] + serum concentration [mg/L]}
2) To achieve a serum concentration of 12mg/L for this patient, her daily dose should be adjusted to
250mg/day
3) To achieve a serum concentration of 15mg/L for this patient, it would be appropriate to adjust her
phenytoin daily dose to 200mg
WORKING OUT
1) Maintenance dose (mg/day) = Vmax X serum concentration/{(S X F X (Km [mg/L] + serum
concentration [mg/L]}

150 = (Vmax X 6)/{0.92 X 1 X (4 + 6)}

150 (0.92 X 10)/6 = Vmax
Vmax = 230mg/day
Patient weighs 56 kg so 230/56 = 4.107 mg/kg per day

2) Maintenance dose (mg/day) = Vmax X serum concentration/{(S X F X (Km [mg/L] + serum

concentration [mg/L]}

= 230 mg/day X 12/{0.92 X 1 X (4 + 12)}

2760/14.72 = 187.5mg
This is the maintenance dose per day

3) Maintenance dose (mg/day) = Vmax X serum concentration/{(S X F X (Km [mg/L] + serum

concentration [mg/L]}

= 230 mg/day X 15mg/L/{0.92 X 1 X (4 + 15)}

3450/17.48mg = 197.37mg ~ 200mg

Therefore the only correct answer is 3