Calculation of doses..

General consideration
Objectives
Upon successful completion of this chapter, the student
will be able to:
1. Differentiate between the various kinds of doses.
2. Describe the primary routes of drug/dose,
administration and, for each, the dosage forms utilized.
3. Perform calculations of doses involving household
measures.
4. Perform calculations pertaining to the quantity of a dose,
the dosage regimen, and the supply of medication
required for the prescribed period.
Dose definition
Dose of the drug:
The quantitative amount administered or taken by a
patient for the intended medicinal effect.
Expression of the Dose:
Single dose:
• The amount taken at one time
Daily dose; or a Total dose:
• The amount taken during the course of therapy.
• May be subdivided and taken in divided doses.
Divided doses:
Two or more times per day depending on the
characteristics of the drug and the illness.
The schedule of dosing (e.g., four times per day for
10 days) is referred to as the Dosage regimen.
Quantitatively, Drug doses vary greatly among drug
substances:
a) Some drugs have small doses.
b) Other drugs have relatively large doses.
Factors that affect the dose of a drug:
1) Biochemical and pharmacologic activity of a drug,
2) Physical and chemical properties of a drug
3) The dosage form used
4) The route of administration
5) Patient factors.
The dose of a drug for a particular patient:
Determined by:
1. The patient’s age
2. Weight
3. Body surface area
4. General physical health
5. Liver and kidney function (for drug metabolism and
elimination)
6. The severity of the illness being treated.
DOSE CALCULATIONS CAPSULE

Doses
Given two factors in the following equation, by
rearrangement, the third may be calculated:
Number of doses =
In using the equation:
The total quantity and The size of dose
Must be in the Same unit of measure.
Pharmacokinetic dosing:
Takes into account a patient’s ability to metabolize
and eliminate drugs from the body
Due to impaired liver or renal function
Often necessitates a Reduction in dosage.
The usual adult dose of a drug
• Is the amount of a drug that ordinarily produces the
medicinal effect intended in the adult patient.
The usual pediatric dose
• Is the amount of a drug that ordinarily produces the
medicinal effect intended in the infant or child
patient.
The ‘‘usual’’ adult and pediatric
doses of a drug:
Importance of the above:
Serve as a guide to physicians.
Who may select to prescribe that dose initially
Or vary it depending on the assessed
requirements of the particular patient.
The usual dosage range for a drug
Indicates the quantitative range or amounts of the
drug that may be prescribed within the guidelines of
usual medical practice.
The dose response of
individuals
Varies from individual to individual
May require dosage adjustment in a given patient.
For certain conditions, e.g. cancer patients.
Drug dosing is highly specialized and individualized
Most commonly dosed on the basis of the
patient’s body surface area.
The dose response of
individuals
Frequently, combinations of drugs are used.
The doses of each drug adjusted according to the
patient’s response.
Many anticancer drugs are administered cyclically
Usually for 21 to 28 days, with a rest period
between dosing cycles to allow recovery from the
toxic effects of the drugs.
The Median Effective dose of a drug
Is the amount that produces the desired intensity of effect
in 50% of the individuals tested
The Median toxic dose of a drug:
Is the amount that produces toxic effects in 50% of the
individuals tested.
Drugs intended to produce
systemic effects
 Must be absorbed or placed directly into the blood circulation
 Must be distributed in adequate concentrations to the body’s cellular
sites of action.
 For certain drugs,
A correlation exists between
a. drug dosage.
b. the drug’s blood serum concentration after administration
c. the presentation and degree of drug effects.
 An average blood serum concentration of a drug can be
measured.
 The Minimum Effective Concentration(MEC).
The minimum concentration expected to produce the drug’s
desired effects in a patient.
 The Minimum Toxic Concentration (MTC) of the drug.
The base level of blood serum concentration that produces dose-
related toxic effects
Appropriate drug dosage:
• Result in blood serum drug concentrations above MEC and
below MTC period of time that drug effects are desired.
The priming or loading dose:
Is a larger-than-usual initial dose given for certain drugs to achieve
the desired blood drug level.
To achieve the desired drug blood level rapidly, the loading dose
may be administered as an injection or oral liquid.
Maintenance doses:
A dose similar in amount to usual doses, administered according
to the dosage regimen to sustain the desired drug blood levels or
drug effects.
Maintenance doses may be administered in other forms, such as
tablets or capsules.
Prophylactic dose:
This is a dose administered to protect the patient
from contracting a specific disease.
Biological or immunological products
Examples are vaccines
Therapeutic doses:
 Doses administered to counter a disease after exposure or
contraction.
Compounding:
The fabrication of a pharmaceutical product from individual
ingredients, carefully weighed, measured, and mixed.
Fabrication is on a smaller scale
Many community and hospital pharmacists fill prescriptions and
medication orders requiring compounding.
Compounding:
Pharmaceutical products may be prepared to contain one or more
therapeutic agents.
 Products containing more than one therapeutic agent are termed
combination products
The primary responsibilities of the
pharmacist
Check doses specified in prescriptions based on a
knowledge of the:
1) Usual doses
2) Usual dose ranges, and
3) Dosage regimens of the medicines prescribed.
The primary responsibilities of the
pharmacist
If an unusual dose is noted
a) The pharmacist is ethically bound to consult the
physician
b) To make sure that the dose as written or
interpreted is the dose intended.
c) It is suitable for the patient and condition being
treated.
Routes of Drug/Dose
Administration and Dosage Forms:
Doses of drugs are administered by a variety of:
Dosage forms and Routes of administration
Dosage forms
a) contain pharmaceutical ingredients
b) provide the physical features
c) stability requirements
d) characteristics desired for optimal therapeutic effects
Dose Measurement
Institutional setting:
Doses are measured and administered by:
Professional and Paraprofessional personnel.
Measuring devices used:
a) Calibrated cups for oral liquids
b) Syringes and intravenous sets for parenteral
medication.
Home setting:
The adult patient or a child’s parent generally
measures and administers medication.
Liquid dosage is usually measured by:
Teaspoonful and Tablespoonful.
Teaspoon and Tablespoon
In calculating doses:
Pharmacists and physicians accept a capacity of:
a) 5 mL for the teaspoonful.
b) 15 mL for the tablespoonful.
Factors that influence the actual volume held by a
household spoon:
a) Viscosity of the given liquid
b) Surface tension of a given liquid
c) The technique of the person measuring the liquid
The Drop as a Unit of Measure
The drop (abbreviated gtt) is used as a measure for
small volumes of liquid medications.
Does not represent a definite quantity, because drops
of different liquids vary greatly.
To standardize the drop as a unit of volume, dropper
is constricted at the delivery end to a round opening
with an external diameter of about 3 mm.
Each of drop of water weighs between 45 and 55 mg
The official dropper is calibrated to deliver
approximately 20 drops of water per milliliter.
i.e., 1 mL of water = 1 gram or 1000 mg ÷50mg = drop
20 drops
Practice exercise
If a pharmacist counted 40 drops of a medication in filling a graduate
cylinder to the 2.5-mL mark, how many drops per milliliter did the
dropper deliver?
A physician asks a pharmacist to calculate the dose of a cough syrup
so that it may be safely administered dropwise to a child. The cough
syrup contains the active ingredient dextromethorphan HBr, 30
mg/15 mL, in a 120-mL bottle.
• Based on the child’s weight and literature references, the pharmacist
determines the dose of dextromethorphan HBr to be 1.5 mg for the
child. The medicine dropper to be dispensed with the medication is
calibrated by the pharmacist and shown to deliver 20 drops of the
cough syrup per 1 mL. Calculate the dose, in drops, for the child.
General Dose Calculations
A pharmacist often needs to calculate:
a) The size of a dose
b) The number of doses
c) The total quantity of medication to dispense
General Dose Calculations
For these calculations the following equation is
useful with the terms rearranged depending on the
answer required.
In using the equation:
• The units of weight or volume must be the same for
the total quantity and size of the dose.
General Dose Calculations
For these calculations the following equation is
useful with the terms rearranged depending on the
answer required.

Number of doses =
Example Calculations of the Number
of Doses
1. If the dose of a drug is 200 mg, how many doses are
contained in 10 g?
2. If 1 tablespoon is prescribed as the dose,
approximately how many doses will be contained in
1 pint of the medicine?
3. If the dose of a drug is 50 g, how many doses are
contained in 0.020 g?
Example Calculations of the Size
of a Dose

Size of dose =

The size of the dose is expressed in whatever

denomination is chosen for measuring the given total
quantity.
Practice examples:
1) How many teaspoonfuls would be prescribed in each
dose of an elixir if 180 mL contained 18 doses?
2) How many drops would be prescribed in each dose
of a liquid medicine if 15 mL contained 60 doses?
The dispensing dropper calibrates 32 drops/mL.
Example
Calculations of the Total
Quantity of Product
Total quantity = Number of doses x Size of dose
It is convenient first:
to convert the given dose to the denomination in
which the total quantity is to be expressed.
Practice examples
1. How many milliliters of a liquid medicine would
provide a patient with 2 tablespoonfuls twice a day
for 8 days?
2. How many milliliters of a mixture would provide a
patient with a teaspoonful dose to be taken three
times a day for 16 days?
3. How many grams of a drug will be needed to
prepare 72 dosage forms if each is to contain 30 mg?
Practice examples
a) It takes approximately 4 g of ointment to cover an adult
patient’s leg. If a physician prescribes an ointment for a
patient with total leg eczema to be applied twice a day for
1 week, which of the following product sizes should be
dispensed: 15 g, 30 g, or 60 g?
b) If 0.050 g of a substance is used in preparing 125 tablets,
how many micrograms are represented in each tablet?
c) If a preparation contains 5 g of a drug in 500 mL, how many
grams are contained in each tablespoonful dose?
How many milligrams each of hydrocodone bitartrate
and guaifenesin will be contained in each dose of the
following prescription?
a. Hydrocodone Bitartrate 0.12 g
b. Guaifenesin 2.4 g
c. Cherry Syrup ad 120 mL
d. Sig. Teaspoonful for cough.
1 teaspoonful = 5 mL
i. How many grams of a drug substance are required to make
120 mL of a solution each teaspoonful of which contains 3
mg of the drug substance?
ii. A physician ordered 500-mg capsules of tetracycline to be
taken twice a day for 10 days. How many total grams of
tetracycline would be prescribed?
Fixed-Dose Combination
Products
A number of prescription and nonprescription products
contain two or more therapeutic agents in fixed-dose
combinations.
 Advantage of combination products:
Two or more needed drugs may be taken in a single dose:
• Which may be more convenient,
• Enhance compliance, and be
• Less expensive for the patient than taking the same drugs
individually.
Disadvantage
The relative inflexibility in dosing compared with individual drug
dosing.
PRACTICE PROBLEMS
• 1. How many capsules, each containing 150-mcg dose of a drug may
be prepared p.m.) from 0.12 g of the drug?