Pharmaceutical Calculations

Nani Kartinah, M.Sc, Apt

Lecturer in Pharmacy
Lambung Mangkurat University
Why calculations?
 At least 1.5 million Americans are injured
annually as a result of medication errors
 10-fold dosing errors are common
 Peppermint Water PJ 1 Feb 2003 Vol 270
Pg 172

 “If you have no confidence in maths, or

are just no good at it, you can kill a
patient”
[Dr C Hall, Nursing Standard, 2004]
Pre-registration examination
 Calculations must be passed
 OPEN BOOK paper
 20 questions
 Currently 80% pass mark
 Potentially 100%

 No room for errors – patients can be

killed!
Pharmaceutical Calculation
Exercise 1

Nani Kartinah, S.Farm, M.Sc, Apt

Pharmacy, Lambung Mangkurat University
Case 1
You’ve been handed a prescription
from your assistant which asks for
200mL of Chalk Mixture, Paediatric
BP. The formula is listed as follows
 Ingredient Qty
Chalk 20 gram
Tragacanth Powder 2 gram
Conc. Cinnamon Water 4 mL
Syrup 100 mL
Double Strength Chloroform Water 500 mL
Aquadest 1000 mL
Case 2
Calculate the quantities required to
produce 600mL of Aromatic
Magnesium Carbonate Mixture BP
using the formula:
 Ingredient Qty
Magnesium Carbonate 300 mg
Sodium Bicarbonate 500 mg
Aromatic Cardamom Tincture 0.3 mL
Double Strength Chloroform Water 5 mL
Aquadest 10 mL
Case 3
Find the quantities of ingredients
needed to produce 50g of product
using the following formula:

Calamin 2
Yellow Soft Paraffin 38
Case 4
Using the following formula, calculate
the amount of ingredients required to
make 75g.

Sulfur – 6%
Salicylic Acid – 4%
White Soft Paraffin to 100%
Case 5
How many tablets should a
pharmacist prescribe if the patient
requires 4 tablets of drug A twice
daily for 6 days?
Case 6
 An angry patient enters your pharmacy
demanding his cough medication. The doctor
prescribed him a dosage regimen of 15mL
four times a day for 7 days. Calculate the
quantity of doses this patient will take as well
as the total quantity of cough medication to be
dispensed?
Case 7
 Despondent patient Y is prescribed 9mg of
Drug X twice-daily for 5 days. In addition, this
same patient is prescribed 7mg once-daily of
the same drug for the next subsequent 2
days. However, Drug X is only available in
2mg and 5mg tablets. Bearing this in mind,
how many tablets of each strength should be
prescribed to the patient?
Case 8
Adrenaline is available as an injection
containing 100 micrograms/mL. However,
the patient requires an intramuscular
injection of 0.5mg. How many millilitres of
injection are needed to supply this
required dose?
Case 9
The recommended dose of fluconazole
for mucosal candidiasis in children is
3mg/kg daily. Your job is to calculate the
dose of fluconazole for a child aged 3
years old. In addition, suggest an
appropriate formulation.
Case 10
 Drug X has a dose of 15mg/kg daily in two
divided doses. Try to calculate the dose for a
6 month old child and the volume of paediatric
injection to be provided. The available
formulation of Drug X is 50mg/mL.

 The idea body weight of a 6 month old child is 7.6kg

Case 11
 What oral dose of methotrexate would be
suitable for a 5 year old child who weighs
18kg? The oral dose of methotrexate is
15mg/m2 weekly.

 The body surface area happens to be 0.74m2 for a 5 year

old child weighing 18kg.
Case 12
 Formulation X contains 9.25mg of Vitamin A
(as retinyl acetate) and 400 IU of
ergocalciferol while Formulation Y contains
2,240 IU of Vitamin A and 10 micrograms of
Vitamin D. Which product contains the most
vitamins?

 For Vitamin A
1 IU = 0.344 micrograms.
Pharmaceutical Calculation
Exercise 2

Nani Kartinah, S.Farm, M.Sc, Apt

Pharmacy, Lambung Mangkurat University
Question format
 False / true answer
 Determine which variable you are going to
prove or disprove
Question 1
 1.25 g of potassium permanganate is
required to produce 1 L of a solution such
that 10 mls of this solution diluted to 250
mls gives a 0.01% solution suitable for
wound cleansing.
 0.01% = 0.01 g in 100ml = 0.025 g in 250 ml

 0.025 g in 250 ml comes from 10 ml so there is 0.025 g in the 10
ml
Question 2
 If 300 mls of a 15% solution is added to
200 mls of a 45% solution the resulting
mixture is a 27% solution.
 Solution 1

 Solution 2

 Final amount A = 45 + 90 = 135 g

 Final volume = 300 + 200 = 500 ml
Question 3
 The formula for Ammonia and Ipecacuanha Mixture BP is:
 Ammonium bicarbonate 200 mg
 Liquorice liquid extract 0.5 ml
 Ipecacuanha tincture 0.3 ml
 Concentrated camphor water 0.1 ml
 Concentrated anise water 0.05 ml
 Double-strength chloroform water 5 ml
 Water to 10 ml

 You have been asked to prepare 12 bottles each containing 60 ml
of the mixture. You only have concentrated chloroform water to
use. It is appropriate to use 18 ml concentrated chloroform water
to fulfil the order.

Question 3
 To make 12 bottles x 60 ml = 720 ml
 Need 5 ml DS chloroform water in 10 ml, so will need 360
ml DS chloroform water for 720 ml

 SS 1:40
 DS 1:20
 Conc 1:1

 Concentrated chloroform water is therefore 20 x stronger
than DS, so need to divide amount by 20

 360 ml / 20 = 18 ml concentrated chloroform water
required.
Question 4
 A prescription reads:
 Prednisolone tablets, 30 mg daily for 7 days, then
reduce by 5 mg every three days to a
maintenance dose of 5 mg daily. To be reviewed
at outpatient clinic on 5th April.
 The prescription is dispensed on 12th March It
would be appropriate to dispense 91 x 5 mg
prednisolone tablets to last from the first dose on
dispensing day to the last dose on the day of the
clinic appointment.
Question 4
 30 mg = 6 x 5 mg tablets, etc.

 6 x 7 days = 42 tablets
 5 x 3 days = 15 tablets
 4 x 3 days = 12 tablets
 3 x 3 days = 9 tablets
 2 x 3 days = 6 tablets
 = 19 days treatment
 12 March – 5 April = 20 days in March and 5 days in April =
25 days in total
 1 x 6 days = 6 tablets
 Total = 42+15+12+9+6+6 = 90 tablets
 FALSE
Question 5
 30 g of Diprosalic® ointment contains 0.9
g salicylic acid and 0.15 g betamethasone
diproprionate.

 Diprosalic® ointment contains 3% salicylic acid
and 0.05% betamethasone (BNF pg 1025)
 3% = 3 g in 100 g = 0.9 g in 30 g
 0.05% = 0.05 g in 100 g = 0.015 g in 30 g


 FALSE
Question 6
 A 3 month baby weighing 5.2kg has been
prescribed 0.78 mls of Augmentin-Duo®
twice daily. It is appropriate for you to
contact the prescriber as this is an
underdose?

 BNF for children

 Augmentin-Duo® 0.15 ml / kg twice daily
 = 0.15 x 5.2 = 0.78 mls twice daily

 FALSE
Question 7
 A patient has an Atrovent® inhaler and
his directions are 20 -40 mcg three to four
times a day. He is going on holiday for six
weeks and it is appropriate for you to
advise the patient that he should take two
inhalers on holiday with him.
 Atrovent® inhaler 20 mcg has 200 doses (BNF pg 218)
 If patient needs maximum dose = 2 puffs four times a day
= 8 puffs a day
 8 x 42 days = 336 doses
 Two inhalers required
 TRUE
Question 8
 You have been asked to prepare 300 mls
of Magnesium Trisilicate Mixture BP. You
will be required to use 12 g of light
magnesium carbonate.

 BNF Magnesium Trisilicate Mixture BP contains
5% light magnesium carbonate (BNF pg 61)

 5% = 5 g in 100 mls = 15 g in 300 mls

 FALSE
 Question 9
 A patient is receiving Nutriflex Lipid plus®
2500 ml infusion. The prescriber wishes to
increase the potassium content of the bag to
80 mmol. It would be appropriate for you to
suggest that 10 mls of Potassium Chloride
Concentrate is added to the bag.
 Nutriflex Lipid plus® 2500 ml contains 28 mmol K+ per litre =
70 mmol K+ (BNF pg 875)
 Need to add 10 mmol K+
 Potassium chloride concentrate contains 20 mmol K+ per 10 ml
 (BNF pg 863) Add 5 mls Potassium chloride concentrate
 FALSE
Question 10
 A pharmacist adds 59 mls water to an
antibiotic powder to produce 100 ml of a
125 mg / 5 ml solution. The displacement
volume of the antibiotic powder is 9 mls
per 125 mg antibiotic.
 A 125 x x = 100 x 125 = 2500 mg
 Vol 5 100 5

 Amount water displaced = 100 – 59 = 41 mls
 DV 41 y y = 125 x 41 = 2.05 mls per 125 mg antibiotic
 A 2500 125 2500

 FALSE
Question 11
 9.17g base is required to produce 10 x 1 g
suppositories each containing 125 mg
paracetamol given that the displacement
value of paracetamol is 1.5.
 10 suppositories will need 10 x 125 mg = 1250 mg or 1.25 g
paracetamol
 10 x 1 g base = 10 g base
 Displacement value = weight of drug that displaces 1 g base
 Displacement amount:
 Paracetamol 1.5 1.25 x=1 x 1.25 = 0.833 g base
 Base 1 x 1.5
 Therefore amount of base required = (10 x 1) – 0.833 = 9.17 g
base
 TRUE
Question 12
 Lithium carbonate (RMM 74 g) is a prescription-only
medicine, but if it is in preparations intended for internal use
with a maximum dose of 5 mg (calculated as base) and a
maximum daily dose of 15 mg (calculated as base) the
preparation is a P medicine. A tablet containing 20 mg of
lithium carbonate to be taken three times a day can be sold
over the counter. Lithium base has a RMM of 14 g.

 Base 14 x x = 20 x 14 = 3.78 mg – less than 5 mg
 Salt 74 20 74 so single tablet okay

 One tablet 3 times a day = 3 x 3.78 mg = 11.35 mg so daily
dose okay
 TRUE
Question 13
 A syringe driver contain 5 mls of injection
Y and has a length of 60 mm. Injection Y
is a strength of 5 mg/ml. If a patient
needs to receive 3 mg of drug Y per hour,
the syringe driver should be set at a rate
of 7.2 mm / hr.
 Injection Y is 5 mg / ml = 25 mg within 5 mls syringe
driver
 Inj 25 3 x = 3 x 5 = 0.6 mls
 Vol 5 x 25
 Mm 60 y y = 60 x 0.6 = 7.2 mm / hr
 Ml 5 0.6 5
 TRUE
Question 14
 A patient is given an intravenous dose of gentamicin and his
one-hour peak serum concentration is found to be 13.5
mg/litre. Given that 10 hours later his serum concentration is
1.6875 mcg/mL the elimination half-life of gentamicin in this
patient is 2.5 hours. (You can assume that the distribution is
complete and the elimination is described by a 1st order
process)

 Peak = 13.5 mg/L = 13500 mcg/L = 13.5 mcg/mL

 13.5------6.75-----3.375------1.6875-----0.84375 mcg/mL

 t0 t2.5 t5 t7.5 t10 hrs

 FALSE
 Question 15
 A consultant wishes to prescribe rifabutin for an
immunocompromised patient for the prophylaxis of
Mycobacterium avium infection. The patient is 37
years old, weighs 56 kg and is 1.68 m tall. On his
medical notes you notice that the serum creatinine is
0.13 micromol / ml. It is appropriate for you to
recommend 300 mg once daily for prophylactic
treatment.

 Body surface area (m2) = √ [ {wt (kg) x ht (cm)} / 3600]

 Creatinine clearance mL/min = constant x (140-age) x ideal wt (kg)

 serum creatinine (micromole/L)
Question 15
 Constant = 1.04 (for women); 1.23 (men)
 creatinine = 0.13 micromole/mL = 130 micromole/L
 wt = 56 kg
 creatine clearance = 1.23 x (140-37) x 56 =54.57 mL/min
 130
 Body SA = √ [ {wt (kg) x ht (cm)} / 3600]
 = √ [ {56 x 168} / 3600]
 = 1.62 m2

 Creatinine clearance = 54.57 mL/min for 1.62 m2
 = 58.27 mL/min/1.73 m2
 BNF (pg 507)
 If creatinine clearance is less than 30 mL/min/1.73 should half
normal dose so this dose is fine for this patient

 TRUE
Exercise 2
Exercise 2 Answers
1 6 11

2 7 12

3 8 13

4 9 14

5 10 15