Mariano Marcos State University

College of Health Sciences

Pharmacy Department
City of Batac 2906 Ilocos Norte

PHARM 132: Pharmaceutical Calculations and Techniques

1st Semester of A.Y. 2020-2021

TITLE
Chapter 10: Calculation of Doses: Patient Parameters (Part 1)
Pediatric and Geriatric Patient Dosage Forms

Introduction

For certain drugs and for certain patients, drug dosage is determined on the basis of
specific patient parameters. These parameters include the age, weight, body surface area and
nutritional and functional status of the patient. Drug selection and drug dosage in patients who
are pregnant and in nursing mothers are specially important considerations due to potential
harm to the fetus.
Among patients requiring individualized dosages are neonates and other pediatric
patients, elderly patients with diminished biologic functions, individuals of all age groups with
compromised liver or kidney functions, critically ill patients and patients with highly toxic
chemotherapeutic agents.

PRESENTATION OF OUTCOMES
At the end of the lesson, the students must have:

1. Executed competence in calculation of dosages based on general considerations.

2. Calculated doses based on factors of age, body weight and body surface area.
3. Performed calculations pertaining to the quantity of a dose, the dose regimen and the supply
of medication required for the prescribed period.

WARM-UP ACTIVITY

Divide 30 by 1/2 and add 10. What’s the answer?

CENTRAL ACTIVITY

Learning Input (Lecture)

Pharmaceutical Calculations and Techniques 1

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:
Neonate (newborn): from birth to one month
Infant: one month to one year
Early childhood: one year through five years
Late childhood: Six years through twelve years
Adolescence: Thirteen years through seventeen years of age
A neonate is considered premature if born at less than 37 weeks’ gestation

Proper drug dosing of the pediatric patient depends on a number of factors like:
1. Age and weight of the patient
2. Overall health status
3. Stage of development of body systems for drug metabolism (liver enzymes)
4. Drug elimination (renal system)

Special Considerations in Dose Determinations for Pediatric Patients

Majority of medications commercially available are formulated and labeled for adult use.
When used for the pediatric patient, appropriate dosage calculations must be made and often,
so must adjustments to the concentration of the medication. In the absence of suitable
commercial preparation, pharmacists may be called upon to compound a medication for a
pediatric patient.

Special Consideration in pediatric dosing

1. Doses should be based on accepted clinical studies as reported in the literature.
2. Doses should be age appropriate and based on body weight or BSA.
3. Pediatric patients should be weighed as closely as possible to the time of admittance to a
health care facility and that weight recorded in kilograms.
4. As available, pediatric formulations rather than dose intended for adult should be
administered.
5. All calculations of dose should be double-checked by a second health professional.
6. All caregivers should be properly advised with regards to dosage, dose administration and
important clinical signs to observe.
7. Calibrated oral syringes should be used to measure and administer oral liquids.

Example:

A hospital pharmacist is asked to determine the dose of clindamycin for a 3-day-old neonate
weighing 3 lb 7 oz. In checking, the pharmacist determines that the dose is listed as follows:

Pharmaceutical Calculations and Techniques 2

 < 1200 g: 10mg/kg/day divided q 12h
< 2000 g and 0 to 7 days old: 10 mg/kg/day divided q 12h
< 2000 g and > 7 days old: 15 mg/kg/day divided q 8h
> 2000 g and 0 to 7 days old: 15 mg/kg/day q 8h
> 2000 g and > days old: 20 to 30 mg/kg/day divided q 12h

Each divided dose is to be added to an intravenous infusion at the scheduled hour and
infused a period of 20 minutes.
The product shown was used to prepare an IV bag containing 600 mg/50 mL of
injectable solution. How many milliliters of this solution should be given for each divided dose?

Product Label showing the drug concentration in mg/mL for an injectable product
https://dailymed.nlm.nih.gov/dailymed/image.cfm?setid=d157983f-4794-400d-a3cf-c515d0c24b62&name=cleocin-05.jpg

Solution:
The metric weight of 3-lb 7-oz neonate is calculated:
1 lb= 454 g; 1 oz = 28.35 g
3 lb x 454 g/lb = 1362 g
7 oz x 28.35 g/oz = 198.45 g
1362 g + 198.45 g = 1560.45 weight of the neonate
According to the dosing table, the dose for a neonate weighing less than 2000 g is 10
mg/kg/day divided every 12 hours.
The dose, in mg, maybe calculated by dimensional analysis :

1kg x 10 mg x 1560.45 g
1000 g 1 kg/day
= 15.6 mg

Since the daily dose is administered into two divided doses, each divided dose is:

15.6 mg
2
= 7.8 mg

Pharmaceutical Calculations and Techniques 3

 The volume of injectable solution is calculated as:

50 mL x 7.8 mg = 0.65 mL
600 mg

Geriatric Patients
The term elderly is subject to varying definition with regard to chronologically 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.
In addition to medical conditions affecting all age groups, some conditions are common
to elderly include degenerative osteoarthritis, congestive heart failure, venous and arterial
insufficiency, stroke, urinary incontinence, prostatic carcinoma, parkinsonism, Alzheimer’s
disease. Many elderly patients have coexisting pathologies that require multiple-drug therapies.
Most age-related physiologic functions peak before age 30, with subsequent gradual
linear decline. Reductions in physiologic capacity and function are cumulative, becoming more
profound with age. Kidney function is a major consideration in drug dosing in the elderly
because reduced function results in reduced drug elimination.
Because reduced kidney function increases the possibility of toxic levels in the body and
adverse drug effects, initial drug dosing in the elderly patient often reflects a downward
variance from the usual adult dose. There is a frequent need for dosage adjustment or
medication change due to adverse effects or unsatisfactory therapeutic outcomes.

Common features of medication use in the elderly

1. Long-term use of maintenance drugs
2. The need for multi-drug therapy with the attendant increased possibility of DI and ADR
3. Difficulty of patient adherence

Special Considerations in Dose Determinations for Elderly Patients

1. Therapy is often initiated with a lower-than-usual adult dose.
2. Dose adjustment may be required based on the therapeutic response.
3. The patient’s physical condition may determine the drug dose and the route of
administration used.
4. The dose may be determined, in part, on the patient’s weight, BSA, health and disease status
and pharmacokinetic factors.
5. Concomitant drug therapy may affect drug/dose effectiveness.
6. A drug’s dose may produce undesired adverse effects and may affect patient’s adherence.
7. Complex dosage regimens of multiple drug therapy may affect patient’s adherence.

Example:
The adult dose of a drug is 500 mg every 8 hours. For an elderly patient with impaired renal
function, the dose is reduced to 250 mg every 6 hours. Calculate the reduction in the daily dose,
in milligrams.

Pharmaceutical Calculations and Techniques 4

Solution:
Daily doses: 500 mg x 3 (every 8 hours) = 1500 mg
250 mg x 4 (every 6 hours) = 1000 mg
1500 mg - 1000 mg = 500 mg

Drug Dosage Based on Age

The young and the elderly require special dosing considerations based on factors
characteristics of these groups.
Various rules of dosage in which the pediatric dose was a fraction of the adult dose,
based on relative age, were created for youngsters (Young’s rule). Today these rules are not in
general use because age alone is no longer considered a valid criterion in the determination of
accurate dosage for a child, specially when calculated from the usual adult dose, which provides
wide clinical variation in response.

Young’s Rule (based on age):

Age x Adult dose = Dose for Child
Age + 12
Cowling’s Rule:
Age at next birthday (in years) x Adult dose = Child’s Dose
24

Fried’s rule for infants:

Age (in months) x Adult dose = Child’s Dose
50

Clark’s Rule (based on weight):

Weight (in lb) x Adult dose = Child’s dose
150 (Ave. Weight of adult in lb)

Example:
An over-the-counter (OTC) cough remedy contains 120 mg dextromethrophan in a 60-mL
bottle of product. The label states the dose of 1 1/2 teaspoonfuls for a child 6 years of age.
How many milligrams of dextromethorphan are contained in the child’s dose?

Solution:
1.5 teaspoonfuls = 7.5 mL

60 mL = 7.5 mL
120 mg X
X = 15 mg

Pharmaceutical Calculations and Techniques 5

Activity 1 Lecture

1. Ordered: Keflex 250 mg PO qid for a child weighing 50 lb. You have 250-mg capsules. The
recommended daily PO dosage for a child is 25 to 50 mg/kg/day in divided doses q6 h.
a. Child’s weight is _____ kg.
b. What is the safe recommended dosage or range for this child?
c. Is the order safe?
d. If yes, how many capsules will you dispense?

2. Ordered Diuril 100 mg PO bid for a child weighing 16 lb 8 oz. You have Diuril 250 mg/5 mL.
The recommended daily PO dosage for a child is 10 to 20 mg/kg/day in divided doses bid.
A. Child’s weight is _____ kg
B. What is the safe or recommended dosage or range for this child?
C. Is the order safe?
D. If yes, how many milliliters will be administered?

3. A 10-kg child is prescribed 12 mL of Cefrozil suspension 250 mg/5 mL per day in three equal
doses. The prescriber needs to know what each dose represents in mg/kg and the total
amount of Cefrozil (in milligrams) given to the child each day.

4. From the table below, calculate the dosage range for digoxin for a 20-month old infant
weighing 6.8 kg.

Calculation of pediatric dosages of Digoxin based on age and weight

Age Digoxin Dose (mcg/kg)
Premature 15 to 25
Full term 20 to 30
1 to 24 months 30 to 50
2 to 5 years 25 to 35
5 to 10 years 15 to 30
Over 10 years 8 to 12

5. Calculate the dose of a drug to be administered to a patient if the dosing regimen is listed as
2 mg/kg/day. The patient weighs 175 lb.

Activity 2: Laboratory

1. The adult dose of a drug is 250 mg. What would be the approximate dose for a 6-year old
child weighing 60 lb? (Use Young’s Rule).

Pharmaceutical Calculations and Techniques 6

2. The child’s dose of a drug is reported as 1.2 mg/kg/body weight. What is the appropriate
dose for a child weighing 60 lb?

3. If the pediatric dose of Dactinomycin is 15 mcg/kg/day for 5 days. How many micrograms
should be administered to a 40-lb child over the course of treatment?

3. Ordered: Biaxin 300 mg PO bid for a child weighing 92 lb. Available is 125 mg/5 mL. The
recommended daily PO dosage is for a child is 15 mg/kg/day in divided doses q 12h.
A. The child’s weight is _____ kg.
B. What is the safe recommended dosage or range for this child?
C. Is the order safe?
D. If yes, how many milliliters will be administered?

4. How many capsules, each containing 250 mg of clarithromycin, are needed to provide 50
mg/kg/day for 10 days for a person weighing 176 lb.

5. The adult dose of a drug is 500 mg. What is the dose for 2-year old child? (Use Young’s Rule)

WRAP-UP ACTIVITY
1. Discussion Forum (Open-ended questions)

 You are expected to participate in the discussion forum scheduled on November 9, 2020
(unless otherwise rescheduled), Monday via the mVLE BigBlueButton BN. Please refer to
the course guide for your scheduled time.
 An invitation link will be available in the mVLE course site.
 Open-ended questions related to the topics will be asked randomly among students
during the discussion proper.
 In addition, you are also given opportunity to ask or raise clarifications during discussion.

ASSESSMENT
Online Exam
 You are required take the Post-Test mVLE Quiz Portal in Lecture and Laboratory.
 Accomplish and submit the said exam on or before 11:59 PM on November 9, 2020
(Monday)

COURSE FACILITATOR
Aileen O. Camangeg
Associate Professor V
Pharmacy Department
09175581028/ 09088904292
aocamangeg@mmsu.edu.ph

Pharmaceutical Calculations and Techniques 7