Professional Documents
Culture Documents
ones you used to work the problem . For exam ple, a problem that gives an answer of 100 m g m ay
be expressed as 0.1 gram . Sim ilarly, 0.5 m g could be expressed as 500 m cg or 0.0005 gram s.
Use the inform ation provided for questions 1 through 3. You receive an order for 500 m g of
am inophylline in norm al saline in a total volume of 250 m l. The patient weighs 132 pounds. The
am inophylline is to be adm inistered at a dose of 0.3 m g per kg per hour. Aminophylline Injection is
supplied in vials with 25 mg per ml. The IV set you will use delivers 60 drops per m l.
1. How m any m illigram s of theophylline will the patient receive each hour?
2. How m any hours will the 250 m l last if adm inistered at the correct dose?
3. W hat will be the flow rate, in drops per minute, to administer the dose ordered?
4. A dose of 120 m g of gentam icin is administered IV. After 10 m inutes, a blood sam ple is assayed for
gentamicin content. The result is 8 mcg per m l. W hat is the volume of distribution for gentamicin?
Reserpine Liquid
0.1 m g per m l
Disp:
60 m l
Sig:
0.01 m g per kg per dose
one dose twice a day
Questions 9 and 10. You need to prepare 30 gram s of 0.25% triam cinolone in Cold Cream.
Triam cinolone is available in a suspension of 40 mg per m l that has a specific gravity of 1.0.
9. How m any ml of the triam cinolone solution will be needed?
10. How m any grams of the Cold Cream will be needed?
1000 ml
10 %
60 mEq
13. After all of the ingredients are m ixed, what will be the
flow rate in milliliters per hour?
Page 1 of 27
m illigrams
gram s
milliliters
fluid ounces
m illiliters
19. Digoxin Injection is supplied in am pules of 500 m cg per 2 m l. W hat quantity, in m L, m ust a nurse
administer to provide a dose of 0.2 mg?
20. Gentamicin Injection is supplied in a concentration of 80 m g per 2 m l vial. How m any m illiliters are
needed to give a single dose of 4 mg per kg to a patient weighing 165 pounds?
21. You have Sodium Phenobarbital Injection, 13% . How m any m l will be needed to obtain 2 grains?
22. Concentrated Acetic Acid is supplied at a concentration of 90% weight/weight and has a specific
gravity of 1.11. W hat volum e is needed to obtain enough acetic acid to prepare 60 m ls of Acetic Acid
Solution, 5% (e.g., vinegar)?
23. How many milligram s of codeine will be needed to com pound the
prescription?
24. W hat will be the total final weight, in grains, of ingredients for one
capsule?
25. A patient is to prepare one liter of a 1:5000 potassium perm anganate (KM nO 4) solution as a foot
soak. You have a stock solution of KMnO 4, 5% . How m any m illiliters of the stock solution m ust be
used to prepare one liter of the foot soak?
Inform ation For Problem s 26 and 27. Your patient is receiving lithium carbonate (Li 2CO 3) capsules but
needs to change to a liquid form (lithium citrate; Li3C 6H 5O 7). Molecular w eights: lithium = 7, carbon =
12, hydrogen = 1, oxygen = 16
26. If the patients dose of lithium carbonate was 300 mg three tim es a day, how many m illimoles of
lithium did the patient receive in a day?
27. Lithium citrate syrup is available as 300 mg of lithium citrate per 5 ml of syrup. How many
m illiliters of syrup will be required per day to provide the dose calculated in No. 26?
Page 2 of 27
29. You receive an order for 30 grams of 0.1 percent hydrocortisone cream for use on an infant. You
have available 1 percent hydrocortisone cream and cold cream that can be m ixed with the
hydrocortisone. How many gram s of the cold cream will be needed to fill the order?
30. A physician orders one liter of 3% sodium chloride injection for a sodium depleted patient. You have
0.9% sodium chloride injection in one liter bags and sodium chloride injection, 23.4% , in 50 m l
vials. How many milliliters of the 23.4% NaCl solution will you ADD TO the one liter bag of 0.9%
NaCl to prepare the 3% sodium chloride injection? Molecular weights sodium = 23, chlorine = 35.5
31. In question num ber 30, you calculated the num ber of m l of 23.4% NaCl to m ake the 3% NaCl
solution. How many milliequivalents of sodium chloride did you add to the bag?
Molecular weights sodium = 23, chlorine = 35.5
32. After you finished m ixing the 3% sodium chloride, how m any m illiosm oles of sodium chloride, per
liter, are in the final product? Molecular weights sodium = 23, chlorine = 35.5
33. You are out of Robitussin-AC, a cough syrup that contains 10 mg of codeine per 5 ml. You can make
Robitussin-AC by adding codeine injection to Robitussin. If the codeine injection has 60 mg per ml,
how m any milliliters of the injection will you ADD TO a four fluid ounce bottle of Robitussin to
produce the sam e am ount of codeine as in Robitussin-AC?
Tetracycline HCl
NaCl to isotonicity
2 per cent
qs 30 m l
For questions 34 and 35, use the RX in the box to the left.
34. You have tetracycline HCl powder and sodium chloride
crystals. How m uch sodium chloride will you need to add to
m ake the final 30 m l volum e isotonic? E value for
tetracycline HCl = 0.12
Hyoscine HBr
Oxycodone
Acetam inophen
0.3 m g
7.5 m g
300.0 m g
DTD:
caps no. XX
Sig:
39. A balance has a sensitivity of 5 milligram s. W hat is the least am ount you can weigh on this balance
if you need to work with an accurary of 2% ?
Page 3 of 27
Morphine Sulfate
7.5 m g
Acetam inophen
325 m g
DTD: XX caps
Sig: one cap q 4 hrs prn pain
42. A drug product costs $62.20 an avoirdupois ounce. W hat will be the cost of the 60 m g of drug you
need for a prescription?
43. A patient is to receive IV theophylline 24 m g every hour. If am inophylline is 80% theophylline, how
m uch aminophylline must the pharm acist use to prepare a 24 hr supply?
44. Am inophylline Injection is supplied as 25 m g per m l. W hat volum e of Am inophylline Injection will
the pharm acist need to obtain the dose in Num ber 43 above?
45. A drug product has 0.05% active drug. If the dose is one-half () teaspoonful four tim es a day for
ten days. How many milligram s will be consum ed in total?
46. You have a stock drug solution that contains 10% active drug. W hat volum e of this stock solution
will you use to prepare 120 ml of a 1:1000 solution?
47. A form ula calls for using 0.01% of hydrochloric acid in a form ula for 1000 m l of a topical liquid. HCl
has a specific gravity of 1.2 and is supplied as a 40% weight/weight solution. How m any m l of
hydrochloric acid are needed to prepare the 1000 m l?
48. Am ikacin Injection is supplied as 500 m g in 2 m l. Mr. Johns weighs 198 lbs and is to receive a dose
of 15 mg per kg. How many m illiliters will be needed for the dose?
49. Calcium Chloride Dihydrate Injection is supplied as a 10% solution in water. How many m illiosmoles
are present in a single 10 ml vial? Ca = 40, Cl = 35.5, H = 1, O = 16
50. Sodium Bicarbonate Injection is an 8.4% solution. How m any m illiequialents of sodium are in a
single vial of 50 ml? Na = 23, C = 12, O = 16, H = 1
51. Lidocaine Injection for cardiac use is a 4% solution. If the dose is 2 m g per m inute, how long will a
500 ml bag run?
52. I have 10 ml of a solution that contains one gram per 5 m l. How m any m l of water m ust I add to the
10 ml to m ake a solution that is 1:5000 in strength?
Page 4 of 27
53. How m any calories, from all sources, will the patient receive in 24 hours?
54. The IV set will deliver 10 drops per m l. W hat will be the flow rate, in drops per m inute, to adm inister
the form ula above over 24 hours?
55. The proper concentration of benzalkonium to prevent bacterial contam ination in an eye drop is
1:750. You have a stock solution of 17% benzalkonium chloride and a dropper that delivers 50 drops
per m l. How many drops will you need for a 30 m l bottle of eye drops?
56. A patient has been receiving oral Aminophylline Tablets. Aminophylline is 80% theophylline. The
doctor wants to change giving oral theophylline. If the patient has been receiving 500 mg of
aminophylline, and theophylline is available in tablets of 100 m g. How m any tablets will the patient
need per dose? (NOTE: Bioavailability will be the sam e for both.)
57. Dimethyl Sulfoxide Liquid is supplied as a 50% weight / weight solution with a specific gravity of
1.40. W hat is the percent weight / volum e of liquid dim ethyl sulfoxide?
The prescription to the right has inform ation for questions 58, 59 and 60.
58. Boric Acid can be used as a preservative in ophthalm ic solutions. It
can also be used to replace NaCl when m aking a product isotonic.
W hat quantity of boric acid will be needed to m ake the eye drop shown
isotonic? E values are boric acid = 0.52, indomethacin = 0.16
59. You have boric acid in a saturated solution that is 5.5% boric acid. W hat volum e of this solution will
you need to use to obtain the needed am ount of boric acid?
60. Indom ethacin is available in an injection of 1 m g powder for solution per vial. How m any vials will
you need to obtain the needed am ount of indom ethacin?
Use the white blood cell differential count shown to answer questions 61, 62 and 63.
Total W BC Count
3
14,000/m m
65
24
61. This patient is most likely to have what type of infection bacterial, viral, fungal?
I. Bacterial
II. Viral
III. Fungal
A. I only
B. III only
C. I and II only
D. II and III only
E. I, II and III only
62. W hat will be the absolute neutrophil count for a patient with the W BC result shown above?
63. W hat will be the absolute granulocyte count for a patient with the W BC result shown above?
Page 5 of 27
Ingredient
Quantity
Dextrose
200 grams
HepatAm ine
60 grams
Sodium Chloride
50 mEq
Potassium Chloride
40 mEq
Sodium Acetate
20 mEq
Magnesium Sulfate
10 mEq
Sodium Phosphate
9 m Mol
Potassium Acetate
15 mEq
Calcium Chloride
2 mEq
M ultivitam ins-12
5 ml
Trace Elem ents-5
1 mL
Vitam in K-1
0.5 mg
Pepcid
10 mg
Regular Insulin
20 units
Sterile W ater qs ad
960 ml
Flow Rate = 80 m l per hour
69. Sodium Phosphate is being added as Na 3PO 4. How m any m Eqs of sodium will be added as a result
of using sodium phosphate? Na = 23, P = 31, O = 16
70. For adults, the m axim um daily dose from a Beclovent Inhaler is 840 m icrogram s. A Beclovent
Inhaler contains 8.4 m illigram s of deliverable drug in 200 puffs. W hat is the m axim um number of
Beclovent puffs a patient may use in one day?
71. A physician has requested a 20 m L vial of Lidocaine 1% with Epinephrine 1:200,000 from your
pharmacy. The shelf spot for that product is em pty but you do have Lidocaine 1% Injection and
Epinephrine Amps, 1% . How m uch of the Epinephrine Injection m ust you add to the vial of
Lidocaine Injection to prepare the needed product?
72. Human Growth Hormone (somatropin, Nutropin-AQ) is dosed at a rate of 0.3 m g per Kg per week
given in equally divided daily doses. Nutropin-AQ Injection is supplied at a strength of 10 mg per
2 m L. W hat will be the daily dose for a patient who weighs 55 pounds?
73. On a m ercy mission to a Third W orld country you have been asked to calculate the correct amounts
of ferric gluconate injection (Ferrlecit) to adm inister to severely anem ic patients. You are given the
following form ula for such calculations. (NOTE: this is an old form ula that is no longer used.) The
first patient weighs 110 pounds and has a hem oglobin of 8 gm s/dl. Ferrlecit contains 12.5 mg
elem ental iron per m L; what volum e of drug will be given each dose?
Norm al Hgb (15 gm /dl) minus Patients Hgb (gm /dl) = Hgb deficiency
Hgb deficiency (x) Patients weight (in kg) = m illigram s of elemental iron required
Give 5% of the total dose calculated every other day
74. Ms Thomas wants to take one gram of elem ental calcium every day and thinks calcium citrate is the
best way to do so. She is confused, however, by instructions on the container she is purchasing that
say each tablet contains 560 m g of Calcium Citrate Tetrahydrate (20% calcium ) and she should take
three tablets 3 tim es a day to obtain 1 gram of elem ental calcium daily. Ms Thom as thinks this is
a very great overdose and wants you to explain the dose to her and tell her how m uch calcium the
recom mended dose would provide.
Page 6 of 27
75. You need a 1:5000 solution of benzalkonium chloride as a preservative. You have 20 ml of a 1:200
solution in stock. How m uch of the 1:5000 solution can you prepare by using all 20 m l of the 1:200
solution?
76. You need a 1:750 solution of Zephiran Chloride to disinfect the pharm acy counters. Zephiran is
available as a 17% concentrated solution. How much Zephiran concentrate will you mix with enough
water to make one gallon of the 1:750 solution you need?
77. An IV solution containing potassium chloride is being adm inistered at a rate of 30 drops per m inute
using IV tubing that delivers 15 drops per mL. At the end of 8 hours, the patient has received 30
m Eq of potassium chloride. W hat was the initial concentration of potassium chloride in the IV fluid?
K = 39, Cl = 36
78. You told your assistant to m ake a 3 percent m orphine solution but something got misunderstood
and the result is 80 m L of a 20 percent solution. How m uch water m ust you add to the 80 m L to
reduce the concentration to 3 percent?
Use the inform ation in the box provided to answer questions 79 through 81.
79. Approximately how m uch atropine sulfate, IN GRAINS, will
you need to use to com pound the prescription?
80. How m any grams of acetam inophen will you need for the 20
capsules?
Atropine Sulfate
0.4 mg
Morphine Sulfate
5 mg
Acetaminophen
325 mg
DTD: 20 caps
SIG: 1-2 caps q 4 hrs prn
Dr Anodyne
Questions 82, 83 and 84 use the sam e inform ation to dem onstrate the differences, and
sim ilarities, between m illim oles, m illiosm oles and m illiequivalents.
82. Lactated Ringers Injection contains 20 m g of calcium chloride dihydrate per 100 m l of IV fluid. How
m any m illiMoles of calcium are present in one liter of Lactated Ringers Injection? M olecular weights:
Ca = 40, Cl = 35.5, H = 1, O = 16
83. Lactated Ringers Injection contains 20 m g of calcium chloride dihydrate per 100 m l of IV fluid. How
m any milliOsm oles of calcium chloride are present in one liter of Lactated Ringers Injection?
Molecular weights: Ca = 40, Cl = 35.5, H = 1, O = 16
84. Lactated Ringers Injection contains 20 m g of calcium chloride dihydrate per 100 m l of IV fluid. How
m any m Eq of calcium are present in one liter of Lactated Ringers Injection? Molecular weights: Ca
= 40, Cl = 35.5, H = 1, O = 16
85. You dilute 1 m l of Fungizone Injection (50 m g per 10 m l) to one liter. The concentration in the
diluted solution will be
(express as N:XXXX, such as 1:1000)
86. Neupogen Injection is supplied at a concentration of 0.48 m g/1.6 m l. Your patient (weighs 132
pounds) and is to receive a dose of 5 mcg/kg/day. W hat volum e of Neupogen Injection is required
for this dose?
Page 7 of 27
87. The parents of a child cannot read or speak English and a pediatrician knows the m other is going
to give the child one teaspoonful of m edication per dose no m atter what dose is ordered. The
pediatrician wants you to add enough water to make Biaxin Oral Suspension to a concentration of
150 m g per 5 m L. You have a container of Biaxin powder for oral suspension that says that addition
of 55 mL of water will result in a final volum e of 100 m L at a concentration of 250 m g per 5 m L. How
m uch water m ust you use to change the final concentration of this container to 150 mg per 5 mL?
92. A form ulation for an oral liquid of sum atriptan succinate (Im itrex for m igraine headaches)
indicates that the final product should have a pH between 4.2 and 5.3. W hat pH would represent
the m iddle of this range?
93. A table of pKa values gives 4.75 as the pKa for acetic acid. Use the Henderson-Hasselbach Equation
to calculate the relative molar ratios of sodium acetate and acetic acid required to prepare a pH 4.75
buffer.
94. Determ ine the actual quantities, in gram s, for a buffer that uses one m ole of sodium acetate
(NaC 2H 3O 2) and the corresponding am ount of acetic acid (C 2H 4O 2). Molecular W eights: Na = 23, C
= 12, H = 1, O = 16
Page 8 of 27
98. Based on first order pharmacokinetics, what is the half life of this drug?
99. How often should a dose of the drug be adm inistered in order to m aintain the drug level at, or above,
the therapeutic level? Use the half-life calculated in No. 97.
100. Charles Fox has an IV hanging that has 40 mEq of potassium chloride in 1000 m L of Dextrose 5%
in Half Normal Saline. The IV has been running at a rate of 80 m L per hour for the past 6.5 hours.
A recent lab report indicates that Mr. Foxs serum potassium level is only 3.5 m Eq/L and his
physician wants to increase the potassium dose. The physician ask you to slow the IV flow rate to
40 m L per hour and also add enough potassium chloride injection, 14.9% , so that Mr. Fox will
receive a total of 80 mEq of potassium over the next 12 hours. K = 39, Cl = 35.5
Inform ation for questions 101 through 104. You are told to prepare a double strength Dopamine IV
drip because a patient is requiring large doses to obtain the drugs effects. The usual Dopamine drip
concentration is 400 m g in 250 m l. The patient weighs 176 pounds and needs the pressor dose level of
dopam ine (10 m cg/kg/m in). Dopam ine Injection is available as 40 m g per mL in 10 m L vials. Answer
the following questions:
101. How m any m L of the 40 m g per m L Dopam ine Injection should be added to a 500 m g bag of IV
fluid to prepare the double concentration? (Ignore volum e of the dopam ine injection.)
102. To what IV fluid should the dopam ine be added?
A. Dextrose 5% in W ater
B. Sodium Bicarbonate Injection, 5% in W ater
C. Sodium Chloride Injection, 3%
D. Sterile W ater
E. Am ino Acids Injection, 10%
103. W hat will be the dose, in ml per hour of dopamine, will the patient be receiving?
104. If the IV set delivers 15 drops per mL, what will be the flow rate for the dose ordered?
Page 9 of 27
107. W hat type of catheter will be inserted into the patients bladder and used for adm inistration of the
am photericin B bladder irrigation?
A. Swan-Ganz catheter
B. PICC catheter
C. Foley catheter
D. Central catheter
E. Robinson catheter
Inform ation for questions 108, 109 and 110.
A patient (weight, 176 pounds) in cardiology is receiving a heparin drip, currently running at 15 units
per kilogram per hour. The concentration of heparin in the IV drip is 10,000 units per 100 m L and the
IV set delivers 15 drops per m L. The m ost recent partial throm boplastin tim e (PTT) indicates that the
patient is being under dosed and that the heparin rate should be increased by 20% according to the
hospitals weight based heparin protocol. Answer the following questions:
108. W hat will be the new dosage in units per kilogram per hour?
109. W hat will be the new flow rate in drops per m inute?
110. Once the heparin drip was stopped, the physician wanted to change to a subcutaneous agent for
further anticoagulation. A possible drug for this purpose would be
A. W arfarin
B. Alteplase
D. Daltaparin
C. Argatroban
E. Lepirudin
Inform ation for questions 111 through 117 is included in
the box to the right.
A physician has found a new form ula for an IV fluid to be
adm inistered after surgery that can be described as TPN Lite.
The form ulation is shown in the box to the right. Use the
form ula provided to answer the following questions:
111. How many mLs of Dextrose Injection, 700 m g/m L, will be
needed to prepare one liter of the form ula?
Dextrose, 15%
Am ino Acids, 4%
Sod Chloride, 0.75%
Pot Chloride, 0.2%
M VI-12, 10 m L
Sterile W ater qs ad
1000 mls
Flow Rate: 1 mL per kg per hour
112. How many m Ls of Am ino Acids Injection, 10% will be needed to prepare one liter of the formula?
113. How m any m Ls of Sodium Chloride Injection, 4 m Eq per mL, will be needed to prepare one liter
of the form ula? Na = 23; Cl = 35.5
114. How many m Ls of Potassium Chloride Injection, 2 m Eq/m l, will be needed to prepare one liter of
the formula? K = 39; Cl = 35.5
115. How m any mL of water will be required to prepare one liter of the form ula?
116. The first patient to receive this IV fluid had GI tract surgery and needs to be NPO for 5 days. The
patient weighs 85 kilogram s. How m any calories from the dextrose and the am ino acids will the
patient receive in 24 hours?
117. The IV set used to adm inister this solution delivers 12 drops per m L. W hat will be the flow rate to
adm inister the solution at the dose ordered for this patient?
118. Don Smith is a 35 year old male who has been diagnosed with AIDS. Mr. Sm ith is 5 feet, 8 inches
tall and weighs 180 pounds. Mr. Sm iths physician wants to use Epivir and knows the drug m ust
have its dose adjusted based on a patients renal function. Mr. Sm iths serum creatinine is 2.6
mg/dL and has held at that sam e level for 5 days. Calculate Mr. Sm iths creatinine clearance.
Page 10 of 27
119. The dosing literature for Epivir has the following inform ation concerning use in renal failure. W hat
is the appropriate dose for Mr. McClure?
Creatine Clearance
Initial Dose
M aintenance Dose
< 5 ml/m in
50 m g
25 m g once daily
5 14 ml/m in
150 m g
50 m g once daily
15 29 ml/m in
150 m g
30 49 ml/m in
150 m g
120. Mr Sm ith is unable to take his Epivir and will have a NG tube inserted to make oral drug
administration m ore practical. If the physician prescribes Epivir Oral Solution, 10 m g per ml, what
will be the actual volume adm inistered to Mr Smith?
1.
NAPLEX will expect you to know that Aminophylline (MW = 420) is theophylline ethylenediamine
and that the am ount of theophylline (MW = 180) in am inophylline is 80% . The ethylenediamine is
the other 20% of the total m olecular weight. There are two m olecules of theophylline per molecule
of ethylene diam ine in am inophylline.
2.
3.
ALTERNATIVELY:
9 m l/hr (x) 60 drops/m l = 540 drops per hour (div by) 60 m ins/hr = 9 drops/m in
NOTE: with a pediatric IV set (delivers 60 drops per m l) m l/hour and drops/m in are the same
number.
Page 11 of 27
W hen doing flow rates you wind up expressing your answer in m l per hour, m l per m inute, or
drops per minute. The m ost com m on flow rates for large volum e IV fluids range from 75 to 125 ml
per hour but smaller and larger rates are possible to correct volum e deficits (rarely greater than
250 ml per hour) or to sim ply keep an IV line open and flowing (KVO, or keep vein open rate) at 42
m l per hour.
IV sets generally deliver 10, 12, 15 or 20 drops per m l (for adult IV sets) and 60 drops per ml (for
pediatric IV sets). Since a drop rate im plies that the nurse is going to actually count the drops
falling in the drop cham ber, ask this sim ple question how high can you count in one minute?
Few people would say they could count to 100 in one m inute, Therefore, your drops per m inute
rate must by less than 100 to be realistic and 60 is a m ore likely num ber. NOTE: W ith a pediatric
IV set (60 drops per m l) flow rate in ml per hour = drops per m inute.
If one liter (1000 ml) of fluid is to be administered, then 125 m l/hr = 8 hr; 100 ml/hr = 10 hr; 84
m l/hr = 12 hr; 75 ml/hr = 14 hr; and 42 m l/hr = 24 hr.
4.
Vd =
Dose
Co
8 m cg/m l = 8 m g/liter
Vd =
5.
6.
120 m g = 15 liters
8 mg/L
6 mg
= 24 tabs needed
0.25 mg/tab
Since liquid is 0.1 mg per ml and dose is 0.1 mg, then there will be 1 m l per dose.
7.
0.1 mg/dose (x) 2 doses per day = 0.2 mg needed per day
6 m g in Rx (div by) 0.2 mg per day = 30 days
ALTERNATIVELY:
8.
$X
=
24 tabs
9.
0.25% = 2.5 m g/gram (x) 30 gram s = 75 m g needed (div by) 40 m g/m l = 1.875 m l
10.
$ 20.00
= $ 4.80
100 tabs
1.875 m l (x) Sp Grav of 1.0 = 1.875 gram s of weight for triam cinolone injection
30 gram s total (m inus) 1.875 grams = 28.125 gram s of cold cream needed
NOTE: This problem can be changed by changing the specific gravity of the drug being added.
Always m ultiply volum e (x) specific gravity to get weight. Rearrange for other values.
Page 12 of 27
11.
234 m g
58.5 m g/m Eq
= 4 m Eq per m l
12.
13.
Best solved
by using
alligation
1000.00
169.17
15.00
1184.17
ml
ml
ml
ml
70%
X ml =
10 parts
10 parts
1015 m l
60 parts
= 169.17 ml
10%
0%
of sterile water
of dextrose 70%
of NaCl 23.4%
Total Volum e
14.
15.
16.
17.
18.
19.
20.
X m l = 2 m l = 0.8 ml needed
200 m cg
500 m cg
X ml =
300 m g
21.
22.
2 m l = 7.5 ml needed
80 m g
Page 13 of 27
23.
(MFT was once used to mean the form ula was for 15 caps but is now routinely used to simply
indicate to mix and make capsules.)
MPJE Law Note on No. 23: You probably would use C-II codeine to prepare the product, but after
mixing the codeine with other drugs you would now have a C-III product (equivalent to Tylenol No.
2 tablets.) BUT, If you simply dissolve codeine in water, cherry syrup or som e other diluent with
no active ingredients, then the product would rem ain a C-II because codeine only converts to a CIII or C-V when mixed with other active ingredients that lim it abuse of the codeine.
24.
25.
26.
MW of Li
(two)
X mg
1000 m l
5% = 50 m g/m l
MW of Li
200 m g = 4 m l needed
50 m g/m l
27.
= 1000 m g =
5000 m l
(three)
citrate = 210
X mg
=
210 m g
24.3 mMoles
3 mMoles
X ml =
1701 mg
5 m l = 28.35 m l
300 mg
per day
(NAPLEX could ask for a specific dose. In this case 10 m l TID would be a good dose.)
28.
At a concentration of 500 m g per m l, and 5 gram s of drug, there would be a total volum e of 10 ml.
But only 9.6 m l of diluent was added, so the powder contributed 0.4 m l to the final volume.
Similarly, at 250 m g/m l, there would be 20 m l of volum e and at 100 m g/m l there would be 50 ml
of volum e. In each case the am ount of diluent added was 0.4 m l less than the final volume.
Therefore, the powder will contribute 0.4 m l to the volum e.
5 grams = 5000 m g
25 m l (m inus) 0.4 m l (the powder volum e) = 24.6 m l of diluent to add to m ake 200 m g/ml
29.
Can be
done by
alligation
1%
0.1 parts
0.1%
0%
0.9 parts
1 part = 30 gram s
X grams =
0.1 parts
30 grams
1 part
= 3 grams of 1%
hydrocortisone
Page 14 of 27
29.
(cont)
30.
Another
Method
that can
be used
Alligation
again
23.4%
2.1 parts
0.9%
31.
3%
20.4 parts = 1000 m l
32.
3% NaCl = 30 mg per ml (x) 1000 mls = 30, 000 m g (or 30 gram s) per liter
MW of NaCl = 58.5 mg per millim ole (Na = 23, Cl = 35.5)
NaCl > Na + and Cl (two particles per m illim ole), so 58.5 m g = 2 m illiosm oles
X milliosm oles
30, 000 m g
2 m illiosomoles
58.5 m g
NOTE that the question asked for milliosm oles per LITER. The problem could be changed to ask
for the total num ber of m illiosm oles in the BAG .... 9000 m g from the Norm al Saline plus 24,078
mg added to the bag = 33, 078 mg in the bag, com es out to be 1130.87 milliosm oles in the bag.
33.
10 mg per 5 m l = 2 m g per 1 m l
60 m g per ml = 6% solution
6%
0.2 parts
0.2%
34.
0%
120 m l = 4.14 m l of
5.8 parts
codeine injection
35.
MW NaCl = 58.5 and monovalent; thus 58.5 m g per m Eq (x) 2.5 m Eq/m l = 146.25 m g/ml
198 m g (from No. 34) (div by) 146.25 m g per ml = 1.35 m l needed
36.
Can use
either one
X ml =
40 m cg
1 ml
= 0.4 m l
100 m cg
Page 15 of 27
37.
NOTE: W hen unsure about is the form ula for one capsule or for several capsules, just go by the
dose per capsule. In this case, 300 m g is the usual dose of acetam inophen. If you divided that by
20, you would get a dose of 20 mg for the acetam inophen and that is just too low.
38.
1/10 (x) 1
1/150
Invert and
multiply
1 (X)
10
150 = 15 tabs
1
NOTE: Hyoscine HBr is a potent alkaloid and, as such, the grain to m g equivalent is reduced to
60 mg per grain to provide a safety factor when adm inistering the drug. This sam e concept is the
usual reason for drug products where 60 m g = 1 grain. Again, with NAPLEX being m ultiple choice,
you can get the answer they want. NAPLEX would likely set up the answer to be based on the 64.8
mg grain.
39.
100%
2%
= 50 (Accuracy Factor)
40.
DTD = 20 caps (x) 7.5 mg/cap = 150 m g needed (div by) 15 m g/tab = 10 tabs needed
41.
42.
43.
1000 m g
6500 m g
7500 m g (div by) 20 = 375 mg
per capsule
$ X
= $ 62.20 = $ 0.13 (13 cents)
60 m g
28,350 m g
44.
45.
X ml =
720 mg
1 m l = 28.8 m l
25 m g
46.
Page 16 of 27
47.
48.
198 lbs (div by) 2.2 lbs/kg = 90 kg (x) 15 m g/kg = 1350 m g needed
500 m g in 2 m l = 250 m g/m l
49.
CaCl 2 * 2 H 2O = MW of 147
50.
3 m Osm s
147 m g
51.
52.
53.
54.
Page 17 of 27
55.
X mg
30 m l
1000 m g
750 m l
= 40 m g for the
30 m l
56.
50 drops
170 m g
57.
58.
Norm Saline = 0.9% or 9 mg/ml (x) 15 m l = 135 m g NaCl needed if no drug present
135 m g (m inus) 1.2 mg = 133.8 mg NaCl needed after allowing for indom ethacin
Boric Acid E-value is 0.52; thus, 1 m g of boric acid = 0.52 m g of NaCl for isotonicity
X m g Boric Acid
133.8 mg NaCl
1 m g Boric Acid
0.52 mg NaCl
59.
5.5% = 55 mg per ml
60.
61.
62.
This m eans that 70% of the white blood cells are neutrophils
W BC count = 14,000 cells per cubic m illim eter (yes, m illiMETER) (x) 0.7 = 9800 neutrophils cells
63.
Granulocytes are bands, segs, basophils and eosinophils (5 + 65 + 1 + 2 = 73) so 73% of white
blood cells are granulocytes. Thus 14,000 (x) 0.73 = 10,200
64.
200 gm (x) 3.4 cals/gm = 680 cals in 12 hrs (x) 2 = 1360 calories in 24 hours
65.
X ml
200 gm
100 m l
70 gm
= 285.7 m l
Page 18 of 27
66.
67.
40 mg per 4 m l = 10 mg per ml
68.
MW of NaCl = 58.5
69.
MW of Na phosphate = 164
70.
71.
1:200,000 = 1 gram per 200,000 m l -or- 1000 m g per 200,000 m l -or- 1 m g per 200 ml
X mg
20 m l
X ml
0.1 m g
1 mg
200 m l
1 ml
10 m g
20 m l (x) 1 mg
200 m l
0.1 m g (x) 1 m l
10 m g
= 0.1 m g
Epinephrine Amps, 1%
= 10 m g per m l
= 0.01 m l
How best to obtain such a sm all volum e? Take 1 m l of Epinephrine, dilute to 100 m l with sterile
water, then use 1 ml of the diluted solution.
72.
55 pounds
2.2 lbs/kg
X ml =
1.1 mg
73.
Ideal Hgb (15) minus Patient Hgb (8) = 7 gram Hgb deficit (x) 55 kg = 385 m g total iron needed
385 m g iron (x) 0.05 (or 5% ) = 19.25 m g iron per dose
19.25 mg per dose (div by) 12.5 m g elemental iron per m l = 1.54 m l per dose
Page 19 of 27
74.
560 m g Ca Citrate Tetrahydrate (x) 0.2 (for 20% ) = 112 m g of elemental calcium per tablet
1000 mg of elemental calcium per day
112 m g of elem ental calcium per tablet
The explanation is that the tablets are not pure calcium and most of the tablet is not calcium but
the citrate and the water.
75.
76.
X ml
100 m g
X mg
20 m l
1000 m g
200 m l
= 100 mg in
the 20 ml
X gram s
=
1 gram = 5.0467 grams per gallon of
1:750
3785 m l (1 gal)
750 m l
X ml
=
100 m l
= 29.69 m l ~ 1 ounce would be added to one gallon of water to
5.0467 gm 17 gram s (17% )
m ake the 1:750 solution
77.
No 77 continues
To change
to percent
78.
X grams
100 m l
2.25 grams
960 m l
MATHEMATICS METHOD
80 m l (x) 0.20 (= 20% ) = 16 gram s of m orphine
X ml =
16 gm s
17 = 453.33 m l
20 = 533.33 ml
100 m l
3 gm
79.
80.
325 m g (x) 20 caps = 6,500 m g (div by) 1000 m g/gram = 6.5 gram s
81.
Atropine, 8 m g + Acetam inophen, 6500 m g + M orphine 100 m g (5 m g/cap (x) 20 caps) = 6608 mg
Page 20 of 27
82.
83.
85.
200 m g (div by) 147 m g per millim ole = 1.36 m illim oles per liter
CaCl 2 = Ca ++ plus Cl plus Cl = 3 particles per m illim ole (147 m g) = 3 m illiosm oles
X particles =
200 m g
84.
2 m Eq
147 m g
50 m g in 10 ml = 5 mg in 1 ml
diluted to 1000 m l, so 5 m g in
1000 m l is the actual
concentration m ust raise the 5 m g to 1000 m g (1 gram) to
express ratio concentration; 1000 mg (div by) 5 m g = 200;
since you multiplied the 5 m g by 200, m ust also m ultiply the
1000 ml by 200
86.
87.
W eight = 132 pounds (div by) 2.2 lbs per kg = 60 kg of patient (x) 5 mcg/kg/day = 300 mcg/day
0.48 mg = 480 m cg per 1.6 ml
X ml
300 m cg
X mL
= 5 mL
5000 mg
150 m g
X mL =
1.6 ml
480 m cg
5 m L (x) 5000 m g
150 m g
= 1 m l per day
166.67 m l (new volum e) minus 100 m l (original volum e) = 66.67 m l of additional volum e needed
55 m l (original am ount to add) plus 66.67 ml (additional am ount) = 121.67 ml is amount to add
ALTERNATE METHOD:
100 m L (volum e of product) minus 55 m L (vol of water added) = 45 m L (vol of drug powder)
250 mg per 5 m l = 50 m g per m l
X mL
=
5000 mg
5 mL
150 m g
X mL =
Page 21 of 27
88.
X mL
12 drops
1 mL
15 drops
0.8 mL per m inute (x) 60 minutes per hour (x) 15 hours = 720 m L infused in 15 hours
m Eq KCl
720 m L
89.
40 mEq KCl
1000 m L
= 28.8 m Eq KCl
90.
39 + 35.5 = 74.5 m olecular weight of KCl; so 74.5 m g = 1 m illim ole (and 1 m illiequivalent)
74.5 mg per m Eq (x) 40 m Eq = 2980 m g in the 1000 m L
X mL
12 drops
m illigram s
720 m L
91.
1 mL
15 drops
=
2980 mg
1000 mL
= 2,145.6 m g
millim oles
2145.6 m g
1 m illim ole
74.5 mg
= 28.8
m illimoles
(A) Since KCl > two particles, then 1 m illim ole or milliequivalent = 2 m illiosm oles
28.8 millim oles (from Que 90) (x) 2 milliosm oles per m illim ole = 57.6 m illiosm oles for KCl
(C) One liter of Norm al Saline (0.9% NaCl) = 154 m Eq of sodium chloride; thus, one liter of half
Norm al Saline (0.45% ) = 77 m Eq of sodium chloride (154 div by 2). Further, since Na+ is
m onovalent, 1 millim ole = 1 milliquivalent
NaCl > Na+ and Cl, so 1 millim ole (or m illiequivalent) of NaCl = 2 m illiosm oles
77 millim oles of NaCl (x) 2 milliosm oles per m illim ole = 154 m illiosm oles for NaCl
TOTAL for the Answer: 57.6 (KCl) + 277.78 (dextrose) + 154 (NaCl) = 489.38 m illiosm oles
NOTE: Osm olarity of blood is 308. Thus, this solution is about 1.6 tim es hypertonic
92.
Selecting a pH of 4.75 would be choosing the middle ground. Using any of several chemical
reference texts, one can determine that acetate buffers (sodium acetate plus acetic acid) are
com monly used to achieve such a pH.
Page 22 of 27
93.
pH = pKa + log
Conc Base
Conc Acid
94.
For Sodium
Acetate:
(Na = 23 x 1) + (C = 12 x 2) + (H = 1 x 3) + (O = 16 x 2) = 23 + 24 + 3 + 32 = 82
Thus, 82 gram s = one m ole of sodium acetate
(C = 12 x 2) + (H = 1 x 4) + (O = 16 x 2) = 24 + 4 + 32 = 60
Thus, 60 gram s = one m ole of acetic acid
These quantities would be dissolved in sufficient water to make one liter to prepare the buffer
solution.
95.
96.
147 mg of Ca Chloride
2 m Eq
so, X =
10 m Eq (x) 147 m g
2 m Eq
= 735 mg is
10 mEq
735 m g
= 7.35 m l needed
100 m g/m l
10 mEq in 500 ml = 1 mEq per 50 m l = 0.5 mEq per 25 m l, so flow rate is 25 m l per hour
25 m l/hour (x) 12 drops/m l = 300 drops per hour (div by) 60 m ins/hr = 5 drops per m inute
Pharm acokinetic
data on M r. Shirrah:
Dose
Conc Orig (peak)
Vd =
97.
Vol Dist =
98.
99.
In No. 98, we found it takes two half lives for the drug level to decline to the MIC of 3 m cg per ml.
Since one half live is 3 hours, then
3 hrs (x) 2 half lives = 6 hours as tim e between doses
100. 80 m l/hr (x) 6.5 hr = 520 ml adm inistered (480 m l rem ain)
4 mEq
100 ml
Page 23 of 27
No 100 continued:
Could also do for KCl
still in the bag
X m Eq
480 m l
101.
X mg
500 ml
400 m g
250 m l
104. 30 ml/hr (x) 15 drops/m l = 450 drops per hour (div by) 60 m in/hr = 7.5 drops per m inute
(would actually run at either 7 or 8 drops per m inute
X grams
2000 m l
1 gram
5000 m l
107. W hat type of catheter will be inserted into the patients bladder and used for adm inistration of the
am photericin B bladder irrigation?
A. Swan-Ganz catheter NO, inserted thru right side of the heart into the pulm onary artery
B. PICC catheter NO, PICC means peripherally inserted central catheter; goes into a vein and
terminates just outside the heart
C. Foley catheter YES, indwelling urinary bladder catheter that would have 3 heads. Head 1
is the outflow point for the urine; Head 2 is the inflow point for the irrigation solution; Head
3 is used to inflate the ballon that keeps the catheter in the bladder.
D. Central catheter NO, goes into a vein and term inates just outside the heart
Page 24 of 27
109. W hat will be the new flow rate in drops per minute?
10,000 units (div by) 100 ml = 100 units per m l
1440 units/hr = 14.4 ml per hour (x) 15 drops/ml = 216 drops per hour (div by) 60 min/hr
100 units per ml
= 3.6 drops per m inute (NAPLEX
would increase dose to get bigger
and rounded off num ber.
110. Once the heparin drip was stopped, the physician wanted to change to a subcutaneous agent for
further anticoagulation. A possible drug for this purpose would be
A. W arfarin
NO, oral and IV only
B. Alteplase
NO, IV only
D. Daltaparin
YES, subQ route only
C. Argatroban
NO, IV only
E. Lepirudin
NO, IV only
15
X m l = 1000 m l = 214.3 m l
15 parts
70 parts
15
0
55
70 = 1000 m l
112. 10
100 m l
70 gm
Dextrose, 15%
Am ino Acids, 4%
Sod Chloride, 0.75%
Pot Chloride, 0.2%
MVI-12, 10 m l
Sterile W ater qs ad 1000 ml
Flow Rate: 1 m l per kg per hr
4
0
6
10 = 1000 m l
Page 25 of 27
214.3 m l
400 m l
32 m l
13.4 m l
10 m l
669.7 m l
Total vol
Tot additives
Water to add
1000 m l
669.7 m l
330.3 m l
Dextrose, 15%
Am ino Acids, 4%
Sod Chloride, 0.75%
Pot Chloride, 0.2%
M VI-12, 10 m l
Sterile W ater qs ad 1000 ml
Flow Rate: 1 m l per kg per hr
116. The first patient to receive this IV fluid had GI tract surgery and needs to be NPO for 5 days. The
patient weighs 85 kilogram s. How m any calories from the dextrose and the am ino acids will the
patient receive in 24 hours?
1 m l (x) 85 kg (x) 24 hrs = 2040 m l in 24 hours
2040 m l (x) 0.15 (15% dextrose) = 306 gm s of dextrose (x) 3.4 cals/gm = 1040.4 cals per 24 hrs
2040 m l (x) 0.04 (4% am ino acids) = 81.6 gm s am ino acids (x) 4 cals/gm = 326.4 cals per 24 hr
Total calories in 24 hours = 1040.4 + 326.4 = 1366.8 cals in 24 hours
117. The IV set used to adm inister this solution delivers 12 drops per m L. W hat will be the flow rate to
adm inister the solution at the dose ordered for this patient?
2040 m ls (x) 12 drops per m l = 24,480 drops in 24 hours or 1440 m inutes
(24 hr x 60 min/hr)
118. The Cockcroft-Gault equation is com m only used to estim ate the clearance of creatinine in the
kidney. If the serum creatinine is stable, the creatinine clearance is a good approxim ation of the
glom erular filtration rate. The usual form of the equation is given below:
Clcr (m L/m in) =
The weight used should be the ideal body weight (IBW ) for the patient involved. BUT, NAPLEX has not
consistently dem anded use of the ideal body weight. Since the m ath problem s on NAPLEX are multiple
choice, you should work the problem using the actual body weight given and the ideal body weight. Then
see which answer is provided as one of the choices. If both answers are provided, then choose the ideal
body weight answer.
7182
187.2
= 38.3654 m l/m in
Page 26 of 27
Several m ethods of calculating ideal body weight from actual body weight and height exist. A common
set of form ulas is as shown below:
Males 1-18 yrs and > 5 ft tall
Males > 18 yrs and > 5 ft tall
119. 150 mg once, then 150 mg once daily for a creatinine clearance between 30 and 49 m l/m in (read
this from the chart; no calculations required).
Page 27 of 27