Calculations of Doses

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Calculations ! " #
of Doses
Areej Abu Hanieh
Aug. 24, 2017 • 58 likes • 26,587 views
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Calculations of Doses
patient parameters
Health & Medicine
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! Calculations of Doses
1. CALCULATION OF DOSES PATIENT
PARAMETERS
2. PREFACE • For certain drugs and for certain
patients, drug dosage is determined on the
basis of specific patient parameters: • Age, •
Weight, • Body surface area, • Nutritional and
functional status. • Among patients requiring
individualized dosage are: • Neonates and
other pediatric patients, • Elderly patients
with diminished biologic functions, •
Individuals of all age groups with
compromised liver and/or kidney function, •
Critically ill patients, • Patients being treated
with highly toxic chemotherapeutic agents. •
Patients being treated with certain drugs with
a narrow therapeutic window.
3. PEDIATRIC PATIENTS • Pediatrics is the
branch of medicine that deals with disease in
children from birth through adolescence. •
The inclusive groups are defined further as
follows: • Neonate (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. • A neonate is considered premature if
born at less than 37 weeks’ gestation.
4. PEDIATRIC PATIENTS • Proper drug dosing
of the pediatric patient depends on: • Age and
weight, • Overall health status, • The condition
of such biologic functions as respiration and
circulation, • The stage of development of
body systems for drug metabolism (e.g., liver
enzymes) and drug elimination (e.g., renal
system). • In the neonate, these biologic
functions and systems are underdeveloped: •
Renal function, for example, develops over
the span of the first 2 years of life. • This fact is
particularly important because the most
commonly used drugs in neonates, infants,
and young children are antimicrobial agents,
which are eliminated primarily through the
kidneys. • If the rate of drug elimination is not
properly considered, drug accumulation in
the body could occur, leading to drug
overdosage and toxicity.
5. PEDIATRIC PATIENTS
6. PEDIATRIC PATIENTS
7. GERIATRIC PATIENTS • Geriatric medicine or
geriatrics is the field that encompasses the
management of illness in the elderly. •
Functional capacities of most organ systems
decline throughout adulthood, • Important
changes in drug response occur with
advancing age. • Most age-related physiologic
functions peak before age 30 years, 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. • Renal blood flow
diminishes nearly 1% per year a!er age 30,
making the cumulative decline in most
persons 60 to 70 years of age, about 30% to
40%, a value that is even greater in older
persons. • Start with low dose; monitor for
need of dose adjustment.
8. GERIATRIC PATIENTS • Other common
features of medication use in the elderly: •
The long-term use of maintenance drugs, •
The need for multidrug therapy, • with the
attendant increased possibility of drug
interactions and adverse drug e"ects; •
Di"iculties in patient compliance, due to: •
impaired cognition, • confusion over the
various dosing schedules of multiple
medications, • depression or apathy, •
economic reasons.
9. DOSAGE FORMS APPLICABLE TO PEDIATRIC
AND GERIATRIC PATIENTS • In the general
population, solid dosage forms, such as
tablets and capsules, are preferred for the oral
administration of drugs. • because of their
convenience, ease of administration, etc.. •
However, solid dosage forms are o!en
di"icult or impossible for the pediatric,
geriatric, or infirm patient to swallow. • liquid
forms are preferred, such as oral solutions,
syrups, suspensions, and drops. • liquid forms
of medication may be administered by oral
feeding tube. • the dose can easily be adjusted
by changing the volume of liquid
administered.
10. DOSAGE FORMS APPLICABLE TO
PEDIATRIC AND GERIATRIC PATIENTS • Many
options for individuals unable or unwilling to
swallow whole tablets: • Compound an oral
liquid from a counterpart solid dosage form
when a liquid product is not available. •
Chewable tablets and solid gel forms that
disintegrate or dissolve in the mouth. • Tablet
splitting and tablet crushing. • For systemic
e"ects, injections may be used rather than
the oral route of administration when needed
for pediatric and elderly patients.
11. DRUG DOSAGE BASED ON AGE • Before the
physiologic di"erences between adult and
pediatric patients were clarified, the latter
were treated with drugs as if they were merely
miniature adults. • Various rules of dosage in
which the pediatric dose was a fraction of the
adult dose, based on relative age, were
created for youngsters.
12. DRUG DOSAGE BASED ON AGE • Today
these rules are not in general use, because
age alone is no longer considered a singularly
valid criterion in the determination of
accurate dosage for a child. • Currently, when
age is considered in determining dosage of a
potent therapeutic agent, it is used generally
in conjunction with another factor, such as
weight. • Example; the dose of digoxin is
determined by a combination of the patient’s
age and weight.
13. EXAMPLE CALCULATIONS OF DOSE BASED
ON AGE • 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? • From the data in Table 8.1,
calculate the dosage range for digoxin for a
20-month-old infant weighing 6.8 kg.
14. DRUG DOSAGE BASED ON AGE • Some OTC
non potent medications include labeling
instructions that provide guidelines for safe
and e"ective dosing. • For pediatric use, doses
generally are based on age groupings; e.g. • 2
years of age or younger “consult your
physician” • 2 to 6 years old give X1 mg • 6 to
12 years old give X2 mg • over 12 years of
age give X3 mg
15. DRUG DOSAGE BASED ON BODY WEIGHT
** The patient’s weight is an important factor
in dosing since the size of the body influences
the drug’s concentration in the body fluids
and at its site of action.
ON BODY WEIGHT • 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.? • The usual dose
of sulfisoxazole for infants over 2 months of
age and children is 60 to 75 mg/kg of body
weight. What would be the usual range for a
child weighing 44 lb.?
ON BODY WEIGHT
ON BODY WEIGHT • Using Table 8.2 and a daily
dose of 0.5 mg/kg, how many 20- mg capsules
of the drug product should be dispensed to a
patient weighing 176 lb. if the dosage regimen
calls for 15 weeks of therapy?
19. 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, • Pediatric patients, •
with the general exception of neonates, who
are usually dosed on a weight basis with
consideration of other factors. • The average
adult is considered to have a BSA of 1.73 m2.
20. DRUG DOSAGE BASED ON BODY SURFACE
AREA
ON BODY SURFACE AREA • If the adult dose of
a drug is 100 mg, calculate the approximate
dose for a child with a BSA of 0.83 m2, using
(a) the equation and (b) Table 8.3. • Using
Table 8.4, find the dose of the hypothetical
drug at a dose level of 300 mg/m2 for a child
determined to have a BSA of 1.25 m2.
Calculate to verify.
ON BODY SURFACE AREA • If the adult dose of
a drug is 75 mg, what would be the dose for a
child weighing 40 lb. and measuring 32 in. in
height? • The usual pediatric dose of a drug is
stated as 25 mg/m2. Calculate the dose for a
child weighing 18 kg and measuring 82 cm in
height. • If the usual adult dose of a drug is
120 mg, what would be the dose based on
BSA for a person measuring 6 !. tall and
weighing 200 lb.? • If the dose of a drug is 5
mg/m2, what would be the dose for a patient
with a BSA of 1.9 m2?
23. DOSAGE BASED ON THE MEDICAL
CONDITION TO BE TREATED • By using Table
8.5, calculate the IV drug dose for a 3-pound
3- ounce neonate.
24. 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
e"ective in widespread or metastatic cancer,
whereas treatments such as surgery and
radiation therapy are limited to specific body
sites. • O!en combination therapy is used,
with more than a single treatment modality
included in a patient’s treatment plan (e.g.
radiation plus chemotherapy).
CANCER CHEMOTHERAPY • Chemotherapeutic
agents most o!en are administered: • orally, •
by intravenous injection, • by continuous
intravenous infusion; • Other routes of
administration may be used: • intraarterial
(artery), • intrathecal (around spinal column
endings), • intramuscular, • subcutaneous
injection. • Administration to a specific site: •
the lung (intrapleural), • the abdomen
(intraperitoneal), • the skin (topical), etc..
CANCER CHEMOTHERAPY • Although a single
anticancer drug may be used in a patient’s
treatment plan, combination chemotherapy
perhaps is more usual. • By using
combinations of drugs having di"erent
mechanisms of action against the target
cancer cells: • the e"ectiveness of treatment
may be enhanced, • lower doses used, • side
e"ects reduced. • The combination
chemotherapy plans o!en include: • two-
agent regimens, • three-agent regimens, •
four-agent regimens.
CANCER CHEMOTHERAPY Cancer
chemotherapy is unique in the following
ways: • It may involve single or multiple drugs
of well-established drug therapy regimens or
protocols, or it may involve the use of
investigational drugs as a part of a clinical
trial. • Combinations of drugs may be given by
the same or di"erent routes of
administration, most o!en oral and/or
intravenous. • The drugs may be administered
concomitantly or alternately on the same or
di"erent days during a prescribed treatment
cycle (e.g., 28 days). • The days of treatment
generally follow a prescribed format of
written instructions, with D for ‘‘day,’’
followed by the day(s) of treatment during a
cycle, with a dash (–) meaning ‘‘to’’ and a
comma (,) meaning ‘‘and.’’ • Thus, D 1–4
means ‘‘days 1 to 4,’’ and D1,4 means ‘‘days 1
and 4.’
CANCER CHEMOTHERAPY • The drugs used in
combination chemotherapy o!en fit into a
standard drug/dosage regimen identified by
abbreviations or acronyms. For example; • a
treatment for bladder cancer referred to as
MVAC consists of methotrexate + vinblastine +
doxorubicin (or actinomycin) + cisplatin; • a
treatment for colorectal cancer called FU/LU
consists of fluorouracil + leucovorin; • a
treatment for lung cancer called PC consists
of paclitaxel + carboplatin; • a treatment for
ovarian cancer called CHAD consists of
cyclophosphamide + hexamethylmelamine +
adriamycin + diamminedichloroplatinum
(cisplatin).
CANCER CHEMOTHERAPY • In addition to the
use of abbreviations for the drug therapy
regimens, the drugs themselves are
commonly abbreviated in medication orders,
such as: • MTX for ‘‘methotrexate”, DOX for
‘‘doxirubicin’’, VLB for ‘‘vinblastine’’, and
CDDP for ‘‘cisplatin.’’ • For systemic action,
chemotherapeutic agents are usually dosed
based either on body weight or on body
surface area. • O!en, the drug doses stated in
standard regimens must be reduced, based
on a particular patient’s diminished kidney or
liver function. • Doses may also be reduced
based on patient’s CBC (platelets & WBC
count).
CANCER CHEMOTHERAPY • To help prevent
errors in chemotherapy, pharmacists must: •
Correctly interpret medication orders for the
chemotherapeutic agents prescribed, • Follow
the individualized dosing regimens, •
Calculate the doses of each medication
prescribed, • Dispense the appropriate dosage
forms and quantities/strengths required.
31. EXAMPLE CALCULATIONS OF
CHEMOTHERAPY DOSAGE REGIMENS •
Regimen: VC Cycle: 28 d; repeat for 2–8 cycles
Vinorelbine, 25 mg/m2, IV, D 1,8,15,22
Cisplatin, 100 mg/m2, IV, D 1. For each of
vinorelbine and cisplatin, calculate the total
intravenous dose per cycle for a patient
measuring 5 !. 11 in. in height and weighing
175 lb.
CHEMOTHERAPY DOSAGE REGIMENS •
Regimen: CMF Cycle: 28 d Cyclophosphamide,
100 mg/m2/d po, D 1–14. Methotrexate, 40
mg/m2, IV, D 2,8. Fluorouracil, 600 mg/m2, IV,
D 1,8. Calculate the total cycle dose for
cyclophosphamide, methotrexate, and
fluorouracil for a patient having a BSA of 1.5
m2.
CHEMOTHERAPY DOSAGE REGIMENS
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