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IP 121 Lecture
2nd semester, AY 2012-2013
Department of Industrial Pharmacy
College of Pharmacy
UP Manila
A Dose of Definitions
Dose
Quantitative amount administered or taken by
a patient for an intended medical effect
-
Single dose
Daily dose
Total dose
Divided doses
A Dose of Definitions
Usual Adult Dose
the amount that ordinarily produces the
medicinal effect intended in adults
Usual Pediatric Dose
amount that ordinarily produces the medicinal
effect intended in infants or children
A Dose of Definitions
Prophylactic Dose
Given to protect the patient from
acquiring/contracting a specific disease
Therapeutic Dose
Given to counter an existing condition, sign,
symptom, or disease once contracted
Maintenance Dose
Based from a usual dose, given according to
dosage regimen to sustain drug levels or effects
throughout the course of therapy
Dosing
Calculating the amount of a medicinal substance
or preparation to be administered to a patient to
obtain the desired therapeutic effect
Dosage Problem
Calculations:
Miscellaneous
Total amt.
Size of dose
Example:
1.8 g of fluconazole was used in compounding a 60mL
suspension. If one dose is one teaspoonful, how
many mg are contained in one dose?
1.8 g
x
60 mL 5 mL
x = 0.15 g = 150 mg
Dose Titration
The process of gradually adjusting the dose
of a medication (based on recommended
dose range and frequency) until optimal
results are observed
- Helps the body adapt to certain medications
- Often reduces side effects
- Adjustment can be increasing or decreasing
Desensitization
Process starting a patient with very small
doses and then rapidly increasing the dose
for the patient to develop tolerance to the
immune response caused by the drug
When patient is already immune to the drug for
which there is no optimal alternative
Tapering
Sample problem
A patient brings in a prescription for a prednisone taper
as follows:
prednisone 30 mg po tonight
20 mg po BID tomorrow and day 3
10 mg po BID days 4 and 5
10 mg po qd days 6 and 7
5 mg po qd days 8 and 9
then off
Drug Dosage
Adjustments
Based on Age
Based on Body Weight
Based on Surface Area
Infants: Birth to
12 months
Toddlers: 1-3 years
Preschoolers:
3-5 years
School age aka
late childhood:
6-12 years
Adolescence: 13-17 years
Youngs Rule
For children from 1-12 years
Age
Child dose
Adult dose
Age 12
Cowlings Rule
Age (years) 1
Child dose
Adult dose
24
Age (months)
Infant dose
Adult dose
150
Clarks Rule
Based on weight
Weight (lb)
Childdose
Adult dose
150
*150 conveniently based on 154 lb, which is the average
weight of an adult
BSA W
0.425
0.725
0.007184
2. Mosteller formula
W H
BSA
3600
Where W = weight (expressed in kg)
W H
BSA
3131
BSA is still in m2
West nomogram
Allows calculation of
BSA for children of
normal height and
weight using weight
alone
Child's BSA (m )
Childdose
adult dose
2
1.73 m
1.73 m2 average adult BSA
If dose per sqm. Is given:
Child dose = child BSA x dose per sqm.
BSA
74 50
1.087m2
3131
1kg 0.425
BSA (74 lb
)
(127cm) 0.725 0.007184
2.2lb
BSA 1.073 m2
Intravenous
Admixtures and
Rate of Flow of
Intravenous Fluids
Intravenous Fluids
Sterile preparations intended for parenteral
administration into a vein
Functions
Fluid volume replenishment
Such as in severe vomiting and diarrhea
Electrolyte imbalances
Administration of nutrients
As a means of administering medication
Rapid delivery of a large dose of medication when
needed
Delivery of small amounts of medication over
controlled and pre-determined periods of time
IV Infusion
Continuous infusions are LVPs with or without
drugs and are run into a vein uninterrupted for
a specified time duration
IV Push (IVP)
A relatively large dose of medication
administered into a vein in a short period or in
one immediate shot (usually less than 1
minute)
rapid injection in an emergency or critical care
situation
Also called IV stat or IV bolus
Intended to quickly control heart rate, blood
pressure, cardiac output, respiration, or other
life threatening conditions
Depends on precise calculations of dose and
rate of administration
Intravenous Admixtures
Preparation involves the addition of one or
more drugs (with or without additives) to LVPs
e.g. NaCl Injection, Dextrose Injection,
Lactated Ringers Injection, etc.
Additives include electrolytes, antibiotics,
vitamins, trace minerals
- As SVPs packaged in ampoules, vials, piggybacks
or sterile solids requiring constitution
1 kg
154 lb
70kg
2.2 lb
0.25mg
70 kg
17.5 mg
kg
x mL
10 mL
17.5 mg 50 mg
x = 3.5mL
1 kg 0.25mg 10 mL
154 lb
3.5 mL
2.2 lb
1 kg
50 mg
1000mL 10 drops
1 hr
20.833 21drops/min
8 hr
mL
60 min
500 mL
x mL
5 mg
0.25mg
mL 18 drops
1 hr
25
7.5 drops/min
hr
mL
60 min
x = 25 mL;
therefore, 25 mL/hr
1 hr
x hr
25 mL 500 mL
500 mL
= 20 hours
25 mL/hr
150 mL
60 drops
9000drops
mL
Standard set:
15 drops
150 mL
2250drops
mL
1s
1 min
1 hr
9000drops
1 drop 60 s 60 min
= 2.5 hours
1s
1 min
1 hr
2250drops
1 drop 60 s 60 min
= 0.63 hours ~ 38 mins