Calculation of Doses

UNIT II :
CALCULATION OF
MEDICATION
DOSES
WHAT IS A DOSE?
The dose of a drug is the quantitative amount
administered or taken by a patient for the intended
medicinal effect. The dose may be expressed as a single
dose, the amount taken at one time; a daily dose; or a total
dose, the amount taken during the course of therapy. A daily
dose may be subdivided and taken in 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.
The dose of a drug for a particular patient may be
determined in part on the basis of the patient’s age,
weight, body surface area, general physical health, liver
and kidney function (for drug metabolism and
elimination), and the severity of the illness being
treated.
DEFINITION OF TERMS
1. Usual adult dose of a drug is the amount that ordinarily produces
the medicinal effect intended in the adult patient.
2. Usual pediatric dose is the amount of drug that ordinarily produces
the medicinal effect intended for the infant or child patient.
3. 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.
4. Median effective dose of a drug is the amount that produces the
desired intensity of effect in 50% of the individuals tested.
5. Median toxic dose of a drug is the amount that produces toxic
effects in 50% of the individuals tested.
6. Minimum effective concentration (MEC) is the minimum
concentration determined that can be expected to produce the
drug’s desired effects in a patient.
7. Minimum toxic concentration (MTC) is the base level of blood
serum concentration that produces dose-related toxic effects.
Routes of administration
Doses of drugs are administered by a variety of dosage
forms and routes of administration. Aside from the drug itself,
dosage forms contain pharmaceutical ingredients, which
provide the physical features, stability requirements, and
aesthetic characteristics desired for optimal therapeutic
effects. Included in the array of pharmaceutical ingredients
are solvents, vehicles, preservatives, stabilizers, solubilizers,
binders, fillers, disintegrants, flavorants, colorants, and others
Dose Measurement
In the institutional setting, doses are measured and administered
by professional and paraprofessional personnel. A variety of measuring
devices may be used, including calibrated cups for oral liquids and
syringes and intravenous sets for parenteral medication.
General Dose Calculations
A pharmacist often needs to calculate the size of a dose, the
number of doses, or the total quantity of medication to dispense. 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.
EXAMPLES:
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. How many teaspoonfuls would be prescribed in each dose of an elixir if
180 mL contained 18 doses?
4. How many milliliters of a liquid medicine would provide a patient with 2
tablespoonfuls twice a day for 8 days?
PEDIATRIC PATIENTS
Pediatrics is the branch of medicine that deals with disease in
children from birth through adolescence. Because of the range in age
and bodily development in this patient population, the inclusive groups
are defined further as follows:
NEONATES - (newborn), from birth to 1 month
INFANT – 1 month to 1 year
EARLY CHILDHOOD – 1 year through 5 years
LATE CHILDHOOD – 6 years through 12 years
ADOLESCENCE – 13 years through 17 years of age
GERIATRIC PATIENTS
Although the term elderly is subject to varying definitions with
regard to chronologic age, it is clear that the functional capacities of
most organ systems decline throughout adulthood, and important
changes in drug response occur with advancing age. Geriatric medicine
or geriatrics is the field that encompasses the management of illness in
the elderly.
Pharmacotherapy—that is, the use of pharmacologically active
substances in the treatment of disease and illness—is of much greater
use in the elderly compared with other age groups.
Special Considerations in Dose Determination
for Elderly Patients
Dose determinations for elderly patients frequently require consideration of some
or all of the following:
• Therapy is often initiated with a lower-than-usual adult dose.
• Dose adjustment may be required based on the therapeutic response.
• The patient’s physical condition may determine the drug dose and the route of
administration employed.
• The dose may be determined, in part, on the patient’s weight, body surface area,
health and disease status, and pharmacokinetic factors.
• Concomitant drug therapy may affect drug/dose effectiveness.
• A drug’s dose may produce undesired adverse effects and may affect patient
compliance.
• Complex dosage regimens of multiple drug therapy may affect patient
compliance.
Drug Dosage Based on Age
EXAMPLE:
An over-the-counter cough remedy contains 120 mg of
dextromethorphan in a 60-mL bottle of product. The label states the
dose as 11 ⁄ 2 teaspoonfuls for a child 6 years of age. How many
milligrams of dextromethorphan are contained in the child’s dose?
Drug Dosage Based on Body Weight
The doses of the majority of drugs based on body weight are conveniently expressed in terms of
mg/kg, since the doses of most drugs are administered in milligram amounts. However, this is not
always the case. Depending on the drug, dosage form, and/or route of administration, the doses of
some drugs are expressed in other units of measure, such as micrograms or milliliters per pound or
kilogram of body weight.
EXAMPLE:
The usual initial dose of chlorambucil is 150 mcg/kg of body
weight. How many milligrams should be administered to a person
weighing 154 lb.?
Drug Dosage Based on Body Surface Area
The body surface area (BSA) method of calculating drug doses is

widely used for two types of patient groups: cancer patients receiving
chemotherapy and pediatric patients, with the general exception of
neonates, who are usually dosed on a weight basis with consideration of age
and a variety of biochemical, physiologic, functional, pathologic, and
immunologic factors.
EXAMPLE:
If the adult dose of a drug is 100 mg, calculate the approximate
dose for a child with a BSA of 0.83 m2.
Drug Dosage Based on Body Surface Area
If the BSA of the patient is not given, this formula may be used to get
the patient’s BSA:
Special Dosing Considerations in Cancer
Chemotherapy
The term chemotherapy applies to the treatment of
disease with chemical drugs or chemotherapeutic agents.
Chemotherapy is primarily associated with the treatment of
cancer patients and is considered the mainstay of such
treatment in that it is effective in widespread or metastatic
cancer, whereas treatments such as surgery and radiation
therapy are limited to specific body sites.
Dosage Calculations Based on Creatinine
Clearance
The two major mechanisms by which drugs are
eliminated from the body are through hepatic (liver)
metabolism and renal (kidney) excretion. When renal
excretion is the major route, a loss of kidney function will
dramatically affect the rate at which the drug is cleared from
the body. Polar drugs are eliminated predominantly by renal
excretion and are generally affected by decreased kidney
function
The ideal body weight (IBW) provides an excellent
estimation of the distribution volume, particularly for some
polar drugs that are not well distributed in adipose (fat) tissue.
These calculations have been used clinically with the
aminoglycoside antibiotics and with digoxin to determine
doses and to predict blood levels. The IBW may be calculated
readily through the use of the following formulas based on the
patient’s height and sex.
• Calculate the ideal body weight for a male patient weighing 164 lb. and
measuring 5 ft. 8 in. in height.
• Calculate the ideal body weight for a female patient weighing 60 kg and
measuring 160 cm in height.
CREATNINE CLEARANCE
The filtration rate of the kidney can be estimated by a number of
methods. One of the most useful, however, is the estimation of the
creatinine clearance rate (CrCl) through the use of the following empiric
formulas based on the patient’s age, weight, and serum creatinine value.
Creatine, which is a break-down product of muscle metabolism, is generally
produced at a constant rate and in quantities that depend on the muscle
mass of the patient. Because creatinine is eliminated from the body
essentially through renal filtration, reduced kidney performance results in a
reduced creatinine clearance rate. The normal adult value of serum
creatinine is 0.7 to 1.5 mg/dL. The creatinine clearance rate represents the
volume of blood plasma that is cleared of creatinine by kidney filtration per
minute. It is expressed in milliliters per minute.
Determine the creatinine clearance rate for an 80-year-old male
patient weighing 70 kg and having a serum creatinine of 2 mg/dL. Use both
the Jelliffe and Cockcroft-Gault equations.
Adjusting Creatinine Clearance for Body
Surface Area
It is sometimes desirable to adjust the calculated creatinine
clearance for body surface area to account for this possible variable in
determining drug dosage. This adjustment is accomplished through the
use of a nomogram of body surface area (BSA), and the following
formula:

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UNIT II :

The body surface area (BSA) method of calculating drug doses is

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