PHCL LEC 111

Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

CALCULATION OF DOSES: GENERAL ● Median Effective Dose

CONSIDERATIONS - The amount of drug that produces the desired
TERMINOLOGIES intensity of effect in 50% of the individuals
● Dose tested.
- The dose of the drug is the quantitative amount - Abbreviated as ED50 (effective dose 50%)
administered or taken by a patient for intended ● Minimum Effective Concentration (MEC)
medicinal effect. - Refers to the average blood serum
● Single Dose concentration of a drug that represents the
- Amount taken at one time. minimum concentration that can be expected to
● Daily Dose produce the drug’s desired effects in a patient.
- may be subdivided and taken in divided doses, - Minimum concentration that can expect to
two or more times per day depending on the release therapeutic effects.
characteristics of the drug and the illness. ● Minimum Toxic Concentration (MTC)
● Usual Dose - The base level of blood serum concentration
- amount of drug that ordinarily produces the that produces dose-related toxic effects
medicinal effect intended in adults. - Detrimental (causes harm)/ toxic effect produced
by the drug.
- Standard drug intended
- Is reduced when the patients is pediatrics or has
kidney failure
- Kidney - excretes (filters out the blood)
- Liver - metabolize
● Usual pediatric dose
- Amount of drug used for infants or children.
● 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.

- Toxic/toxins (waste) is released through urination

(mostly the metabolites)
❖ Y AXIS - drug concentration
● Usual initial dose Priming or Loading dose ❖ X AXIS - time (in hours)
- Amount required to achieve the desired blood ❖ Once reach MEC, it has the therapeutic effect
drug level already.
- In order for the drug to effect, it should/need to ❖ If it reaches MTC, the drug is releasing detrimental
reach the bloodstream. effect (toxicity)
● Larger than the usual/initial dose. ❖ Safe concentration is 40-90 (between MEC and
● Maintenance Dose below MTC)
- Similar with the usual dose ❖ Termination of Action - it is the end of the
therapeutic effect
❖ Duration of Action - it is between the onset of
action (lag time) to the line before it reaches lower
than the MEC (termination of action.

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

➢ Transdermal - patch
○ Ex. leg nicotine patch DETERMINING THE SIZE OF THE DOSE
➢ Intranasal - nostrils
DETERMINING THE DOSE OF THE DRUG
Dosage Regimen
- The schedule of dosing (e.g. four times per day
for 10 days).
- Numbers of doses in a specified amount of
medicine.

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

DETERMINING THE SIZE OF THE DOSE - blood thinner; anti coagulant

- NSAID
- 81 mg is use to lower risk of
having heart attack
○ low-dose oral contraceptive and
low-dose postmenopausal hormone
therapy.
○ Elderly are most commonly
immunocompromise.
● HIGH DOSE THERAPY
- Commonly for cancer patients
- Chemoteraphy
- Biopsy - the type of tumor (benign/malignant)
can be seen here; test used for living patients
- Autopsy - to know the cause of death; test used
for dead patients
○ Example: commonly associated with the
chemotherapeutic treatment of cancer,
in which there is an attempt, through
increased dose intensity, to kill tumor
cells.
■ Benign - non cancerous
■ Malignant - cancerous
○ Use of progestin in the treatment of
endometriosis and the high-dose
influenza vaccination of the elderly.

LOW DOSE AND HIGH DOSE THERAPIES

-The administration of doses that are much
smaller or much larger than the usual dose of a
drug.
● LOW DOSE THERAPY
- Decrease dose than the usual
concentration/dose
○ Example: the use of aspirin in 81-mg
amounts (rather than the usual dose of ● Progesterone - natural hormone
325 mg) to lower the risk of heart attack ● Progestin - a synthetic female hormone
and clot-related stroke (minimize the - These hormones are used for female geriatric
dosage use for the maintenance of the postmenopausal
elderly/geriatic/immunocompromised
patients) - As the women ages, the estrogen level
decreases
■ Aspirin - Hot flushes

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

- Night sweats
- Irregular to complete stop of
menstruation
- Vaginal dryness
- Endometriosis and endometrial/endometrion
tissue that grew outside the uterus/uterine wall
FIXED-DOSE COMBINATION PRODUCTS
● A variety of prescription and nonprescription
products are available containing two or more
therapeutic agents.
● An advantage of combination products is that
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.
● A disadvantage is the relative inflexibility in
dosing compared with individual drug dosing.

❖ Losartan, Telmisartan, Valzartan - ARBS

(angiotensin receptor blockers) an
anti-hypeternsive drug
❖ Hydrochlorothiazone (HCTZ) - diuretic
(Thiazide) it increases the urine output
➢ Increase of urine output is also the
increase of blood volume that lowers the
blood pressure.

● Ethinyl estradiol - estrogen

● Levonorgestrel - progestin
● Inert - placebo pills
○ No active ingredient, it only helps and
encourages the patient to take the
remaining days of the contraceptive pill.
CALCULATION BASED ON SPECIAL DOSING PCOS
REGIMEN - Polycystic ovary syndrome
● Certain drugs have unique dosing regimens. - High level of Androgen = increase excessive
○ Example: chemotherapeutic and oral hair growth
contraceptives - Acne due to hormonal imbalances

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

Oral Contraceptive Pills (OCP)

- To prevent the ovulation/fertilization
- Used in PCOS, to manage the manifestation
such as the hair growth, high level of androgen
etc.
- Also there is OCP that is used for the
enhancement of body parts.

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

CALCULATION OF DOSES: PATIENT PARAMETERS GERIATRIC PATIENTS:

● Also known as elderly.
PEDIATRIC PATIENTS: (adjective) ● Medical care for older adults, an age group that
Pediatrics (noun) - is the branch of medicine that deals is not easy to define precisely.
with disease in children from birth through adolescence. ● No specific age range
● As the age increases, the function of the kidney
decreases (the capability that filters out the
GROUPS:
toxins in the blood)
● Neonate/Newborn - birth to 1 month
● Infant - 1 month to 1 year ○ Dialysis - weekly or monthly treatment
● Early childhood - 1 year to 5 years that is machine operated and the one
● Late childhood - 6 years to 12 years that filters the blood.
● Adolescence - 13 years to 17 years
SPECIAL CONSIDERATIONS IN DOSE
FACTORS OF PROPER DOSING IN PEDIATRIC DETERMINATIONS FOR ELDERLY PATIENTS
PATIENTS ● Therapy is often initiated with a lower-than-usual
1. Age adult dose.
2. Weight ● Dose adjustment may be required based on the
3. Overall health status therapeutic response.
a. Biological functions ● The patient’s physical condition may determine
i. Respiration the drug dose and the route of administration used.
ii. Circulation ● The dose may be determined, in part, on the
iii. Metabolism (liver- metabolic agents) patient’s weight, body surface area, health and
iv. Elimination (kidney; filter outs the disease status, and pharmacokinetic factors.
blood through urination and ● Concomitant drug therapy may affect drug/dose
defecation) effectiveness.
● A drug’s dose may produce undesired adverse
SPECIAL CONSIDERATIONS IN DOSE effects and may affect patient adherence.
DETERMINATIONS FOR PEDIATRIC PATIENTS ● Complex dosage regimens of multiple drug therapy
● Doses should be based on accepted clinical studies may affect patient adherence.
as reported in the literature.
● Doses should be age appropriate and generally DRUG DOSAGE
based on body weight or body surface area. Based on Age
● Pediatric patients should be weighed as closely as • Young’s Rule
possible to the time of admittance to a healthcare
facility and that weight recorded in kilograms.
● As available, pediatric formulations rather than those
intended for adults should be administered.
● All calculations of dose should be double-checked
by a second health professional.
● All caregivers should be properly advised with
regard to dosage, dose administration, and
important clinical signs to observe.
● Calibrated oral syringes should be used to measure
and administer oral liquids.

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

• Cowling’s Rule Based on Weight

• Clark’s Rule

Based on Body Weight

• Fried’s Rule

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PHCL LEC 111
Alvarez, Andrea P.
1Y-1ST SEM (MIDTERMS)

Based on Body Surface Area (BSA)

- 1.73 m2 (constant average BSA for adults)