OBJECTIVES

To emphasize the importance of calculations

To review important calculation concepts related to

Joy A. Awoniyi, PharmD.

PGY1 Pharmacy Practice Resident
Miami VA Healthcare System

Patient Parameters
Measurements
Concentrations
Electrolyte Solutions
Clinical Laboratory Tests
IV infusions flow rates
Parenteral Nutrition

To practice using the reviewed calculation concepts

For The FAMU COPPS Class of 2013

To review important pharmacokinetic concepts

1

WHY SHOULD YOU CARE?

PATIENT
PARAMETERS

Youcantescapeit
YouneedittopasstheNAPLEX
Itcanbeappliedtoanypharmacy
relatedspecialty

ImportantCalculationConcepts

Itmaysaveyourpatientsmoney
Itmaysaveyourpatientslife(and
yourlicense)

BSAANDIBW

BODYMASSINDEX(BMI)

BodySurfaceArea(BSA),m2

Measureofbodyfattohelpcategorizepatientsandassessriskof
morbidityforcertaindiseases

BSA=Weight(kg)0.425 xHeight(cm)0.725 x0.007184

BSA=

BMI=weight(kg) [height(m)2]

cm kg
3600

BMI

IdealBodyWeight,kg
Males:50+(2.3xinchesgreater60)
Females:45.5+(2.3xinchesgreaterthan60)

Classification

<18.5

Underweight

18.5 to<25

Normal

25to <30

Overweight

>30

Obese
5

CREATININECLEARANCE(CRCL)
Formulausedtoestimaterenalfunction
Notusefulwhenrenalfunctionisfluctuatingrapidly

MEASUREMENTS

Usedinthedosingofseveralmedications
Tamiflu,Antibiotics,Lowmolecularweightheparins

140 Age IBW

72 SCr
Multiplyby0.85iffemale

CrCl(mL/min)

Interpretation

60 to90

Mildrenalimpairment

30to<60

ModerateRenalimpairment

15to <30

SevereRenalimpairment

<15

Kidneyfailure

ImportantCalculationConcepts

THE BASICS OF
MEASUREMENT

EXAMPLE
Acoughsyrupcontains10mgofdextromethorphanper5mL.
Yourpharmacyhas6bottlesleftinstock.Eachbottlecontains
120mLofthesyrup.Howmanygramsofthedrugareinone
bottle?

Irrelevantinformationisoftengiven
Fundamentalinformationisoftenleftout
Howmanygramsareinakilogram?
Howmanymillilitersareinafluidounce?

Whatinformationisirrelevant?

Starteachproblembyassessingwhatyou
knowandwhatyouwanttoknow

Whatfundamentalinformationdoyouneedtoknowtocomplete
thisproblem?

Doublecheck!

Whatdoyouknow?
Whatdoyouwanttoknow?

EXAMPLE

SPECIFICGRAVITY

Acoughsyrupcontains10mgofdextromethorphan per5mL.
Yourpharmacyhas6bottlesleftinstock.Eachbottlecontains
120mLofthesyrup.Howmanygramsofthedrugareinone
bottle?

Definition

Aratiooftheweightofany
substanceinrelationtothe
weightofanequalvolumeof
water
Waterisusedbecause1gof
waterisequalto1mL

10mg/5
mL

120mL/
1bottle

1
gram/10
00mg

0.24grams/
1bottle

10

Equations

Grams=mLxSG
mL=Grams SG
SG=Grams mL
Donotconfusewithdensityor
concentration

IfSG>1thesubstanceisheavier
thanwater
IfSG<1thesubstanceislighter

11

EXAMPLE

EXAMPLE
Thereis10gramsofglycerinina500mLsolution.300mLof
glycerinweighs165grams.Whatisthespecificgravityof
glycerin?

Thereis10gramsofglycerinina500mL
solution.300mLofglycerinweighs165grams.
Whatisthespecificgravityofglycerin?
SpecificGravity=grams/mL
10g/500mL?
165g/300mL?
ThinkofSGasaconversionfactor
10gramsofglycerindoesnotEQUAL500mLofglycerin
165gramsofGlycerinEQUALS300mLofglycerin

165
grams

300mL

0.55

12

EXAMPLE

13

DOUBLE CHECK
DOESTHEANSWERMAKESENSE?

Whatistheweight,ingramsofa2fluidouncesofaliquidwith
aspecificgravityof1.118?

IftheSGis1.118,thesubstanceis
Heavierthanwater?
Lighterthanwater?

Grams=mLxSG

2fluidouncesofwater(60mL)=60grams

2fl oz

30mL/
1fl oz

1.118

Theansweris67.08gramswhichis>60
grams

67.08
grams

Anyanswerbelow60wouldbeWRONG

14

15

PERCENTAGEPREPARATIONS
Weightinvolume

CONCENTRATIONS

Amountofgramsin100mLofsolution

Volumeinvolume
AmountofmLin100mLofsolution

ImportantCalculationConcepts

Weightinweight
Amountofgramsin100gramsofsubstance

16

17

EXAMPLE
WEIGHT IN VOLUME

ALLIGATION

Howmanygramsofdextrosearerequiredtoprepare4000mL
ofa5%solution?
5%Dextrosebydefinitionmeans5gramsin100mL

5
grams/
100mL

4000mL

Alligation isamethodofsolving
problemsthatinvolvesthemixingof
solutionsorsubstanceswithdifferent
percentagestrengths
Alligationalternateisamethodto
calculatethenumberofpartsoftwoor
morecomponentsofdifferentstrengths
mixedtoprepareadesiredstrength.

200grams

18

EXAMPLE
ALLIGATION

19

EXAMPLE
ALLIGATIONALTERNATE

Whatisthepercentageofzincoxideinanointmentprepared
bymixing200gramsofa10%ointment,50gramsofa20%
ointment,and100gramsofa5%ointment

Apharmacistneedstoprepare50mLof3%hydrogen
peroxidesolution.Hehas30%and1.5%solutionsinstock.
HowmanymLofeachshouldheuse?
A C=Y

0.10 x

200g

= 20grams

0.20 x

50g

= 10grams

0.05 x

100g
350 g

= 5grams
35grams

Percent
Available

Percent
Desired

Proportions
required
X

C
B

35grams 350grams=0.10x100%=10%

C B=X
XandYare
proportions ofAand
B(respectively)
neededfortheentire
preparation

20

EXAMPLE
ALLIGATIONALTERNATE

EXAMPLE
ALLIGATIONALTERNATE

Apharmacistneedstoprepare50mLof3%hydrogen
peroxidesolution.Hehas30%and1.5%solutionsinstock.
HowmanymLofeachshouldheuse?
Percent
Available

Percent
Desired

30%

Proportions
required
1.5

Apharmacistneedstoprepare50mLof3%hydrogen
peroxidesolution.Hehas30%and1.5%solutionsinstock.
HowmanymLofeachshouldheuse?
Weneed1.5ofall28.5partstocontain30%Hydrogenperoxide
1.5/28.5=x/50mL

1.5partsof30%

X=2.63mLof30%
Weneed27partsofall28.5partstocontain3%Hydrogenperoxide

27partsof1.5%

27/28.5=x/50mL

3%

X=47.37mLof1.5%

TotalParts:28.5
1.5%

21

27

22

23

MILLIEQUIVALENTS
Unitofmeasurerelatedtothetotalnumberofionic
chargesinasolution
Measuresthechemicalactivityofanelectrolyte
relativeto1mgofhydrogen

ELECTROLYTE
SOLUTIONS

1mEqrepresentsthemilligramsequaltoitsequivalent
weight,takingintoaccountthevalency

ImportantCalculationConcepts

mEq

mg valence
Molecular.Weight

mg

mEq Molecular.Weight
Valence

24

MILLIEQUIVALENTS

25

EXAMPLE
Whatistheconcentration,inmilligramspermilliliter,ofa
solutioncontaining2mEqofNaClpermL?

Ion

Abbr.

Valence

Atomic
Weight

Milliequivalent
weight

Aluminum

Al3+

27

Magnesium

Mg2+

24

12

MolecularweightofSodiumchloride=58.5

Sodium

Na+

23

23

Valency=1(Na+,Cl+)

Bicarbonate

HCO32

60

???

MolecularweightofSodium=23

MolecularweightofChloride=35.5

mg

30

mEq Molecular.Weight
Valence

2mEq 58.3
1

2mEq 58.5
1

26

27

MOLARITY

OSMOLARITY

Millimoles
1mol =molecularweightingrams,therefore
mmol=molecularweightinmilligrams

mOsmoles representthenumberofparticlesinasolution
whenthesubstancedissociates
NaCl=2mOsmol
CaCl2 =3mOsmol
Anhydrousdextrose=1mOsmol

Molarity isthenumberofmmols inasolution

Howmanymilligramswould3mmolofmonobasicsodium
phosphate(MW=138)weigh?

3mmol

138mg/1
mmol

Osmolality isthemilliosmolesofsoluteinasolution

mOsmol mg

414mg
28

1mmol
Molecular.Weight(mg)
29

CALCIUMALBUMIN
Almost50%ofcalciumisboundtoplasmaproteins

CLINICAL
LABORATORYTESTS

Iflevelsofproteinsarelow,thentheserumcalcium
maybeinaccurate
Ifalbuminislow,calciumwillappeartobelow,
whenitlevelsareactuallywithinnormallimits
CorrectlevelswhenAlbuminislessthan4g/dL

ImportantCalculationConcepts

CorrectedCa2+ =Ca2++0.8[4 albumin(g/dL)]

30

31

SODIUMGLUCOSE
Inpatientswithhyperglycemia,glucosedoesnot
enterthecell,causingashiftoffluidfrom
intracellulartoextracellular
Theshiftoffluiddilutestheconcentrationofsodium
intheextracellularfluid
Thistypeofhyponatremia(translational)doesnot
needtobetreated,insteadcontrolofglucoselevelsis
indicated

INFUSIONFLOW
RATES
ImportantCalculationConcepts

CorrectedNa+=Na+ +0.016(SerumGlucose 100)

32

33

EXAMPLE
Aphysicianorders2litersofD5Wtobeadministeredover8
hours.TheIVadministrationsetinyourpharmacydelivers10
drops/mL.Howmanydropsperminuteshouldthepatientbe
settoreceive?

TOTALPARENTERAL
NUTRITION
ImportantCalculationConcepts

2Liters/
8hours

1000mL/
1Liter

1hour/60
min

10drops/
1mL

42drops/
min

34

35

TOTALPARENTERAL
NUTRUTION

TPNHIGHLIGHTS
FluidRequirements:
Generally30 40mL/kg/day
Calculated:1500mL+20mL(kgover20)

Providesapatientwithall
nutritionalrequirements
Composition:
Fluids
Carbohydrates(Dextrose)
Protein(Aminoacids)
Fats
Vitamins,minerals,trace
elements
Electrolytes

ProteinRequirements
Ambulatory:0.8 1g/kg/day
Hospitalized:1.2 2g/kg/day
NonProteinRequirements(TotalEnergyExpenditure)
Male: 66.47+13.75(kg)+5.0(cm) 6.76(yrs)
Female: 655.1+9.6(kg)+1.85(cm) 4.68(yrs)
Multiplyby1.2ifconfinedtoabed,and1.3ifoutofbed
36

37

TPNHIGHLIGHTS
Component

Units

EachTPN
componentprovides
Dextrose
adefinedamountof
calories
COMMITTHESETO AminoAcids
MEMORY!!

3.4kcalper
gram
4kcalpergram

Lipids

9kcalpergram

10%lipid
emulsion
20%lipid
emulsion

1.1 kcalpermL

PHARMACOKINETIC
S
ImportantCalculationConcepts

2kcal permL
38

PHARMACOKINETCS

FIRSTORDERKINETICS
Theamountofdruggivenisproportionaltothechangein
concentration
Thechangeindrugconcentrationwithrespecttotimewill
createarateconstant(k)

Pharmacokineticsdescribeswhathappenstoadrugor
substanceinsideofthebody

Absorption
Metabolism

39

Distribution

dC
dt

C=C0ekt

Excretion
40

41

HALFLIFE

EXAMPLE
Apatientisreceivinganantibioticforthetreatmentofa
respiratoryinfection.Theinitialconcentrationofthedrugwas
17.9mg/L.Thedrughasaneliminationhalflifeof2hours.How
muchofthedrugispresentafter8hours?

Thehalflife(t1/2)isthetimerequiredforthe
concentrationofthedrugtodecreasebyonehalf
t1/2 =0.693/k(kistherateconstant)

C=C0ekt SOLVEFORC

Apatientisreceivinganantibioticforthetreatmentofa
respiratoryinfection.Theinitialconcentrationofthedrugwas
17.9mg/L.Thedrughasaneliminationhalflifeof2hours.How
muchofthedrugispresentafter8hours?
42

THANKYOU!
JoyA.Awoniyi
Emailyourquestions,commentsorconcernsto
Joy.awoniyi@va.gov

44

t1/2 =0.693/k(kistherateconstant)
2h=0.693/k
k=0.347h1
C=17.90e0.347(8) =1.11mg/L
43