Common Liquid Volume Conversions Alligation: obtain a new strength (%) that is Ideal Body Weight (IBW)

tsp (t) 5 ml between two strengths (pg 103 in RxPrep) Males = 50 kg + (2.3 kg)(# inches over 5 ft)
tbsp (T) 15 ml - Set up X method Females = 45.5 kg + (2.3 kg)(# inches over 5 ft)
1 fl oz 30 ml 29.57 ml (actual) - Subtract along the ‘X’ lines to obtain the
1 cup 8 oz 240 ml 236.58 ml number of parts on the right Adjusted Body Weight (AdjBW)
(actual) - Add the number of parts on the right to find AdjBW = IBW + 0.4(TBW – IBW)
1 pint 16 oz 480 ml 473 ml (actual) the total number of parts
1 quart 2 pints 960 ml 946 ml (actual) - Divide the total weight by number of parts to Cockcroft-Gault Equation
1 gallon 4 quarts 3840 3785 ml (actual) obtain weight per part CrCl (ml/min) = (140 – age)(Wt in kg) x
ml Not reliable in: (72)(SCr)
1 liter 1000 ml Osmolarity - very young children x 0.85 if female
Osmolarity = Wt (g/L) x # particles x 1,000 - ESRD patients
(mOsm/L) MW (g/mole) - rapidly fluctuating/unstable renal function
Common Solid Weight Conversions
1 kg 2.2 lbs
Compound # dissociation Calculating CrCl Dosing
1 oz 28.4 g ABW < IBW ABW < IBW
particles Under-
1 lb 454 g weight à use ABW à use ABW
Dextrose 1
1 grain (gr) 65 mg 64.8 mg (actual) Normal ABW > IBW & BMI <25 If < 120% of IBW
Mannitol 1
weight à use IBW à
KCl 2 use ABW– most drugs insulin
Common Distance Conversions
NaCl 2 use IBW– amino, theo, acyclovir,
1 inch 2.54 cm levothyroxine, IVIG
Na acetate (NaC2H3O2) 2
1 meter 100 cm Over- BMI ³ 25 If ³ 120% of IBW
Ca Chloride (CaCl2) 3 à use AdjBW à
weight insulin
Na citrate (Na3C6H5O7) 4 use ABW– LMWH, UFH, vanco
Order of Operations: use AdjBW– AGs
Brackets à Parentheses à Exponents à use IBW– amino, theo, acyclovir,
Isotonicity (pg. 107)
Multiplication/Division à Addition/Subtraction levothyroxine, IVIG
Osmolarity in context of body fluids
Expressed as NaCl equivalent or “E value”
Percentage Strength *notice grams* Calculating CrCl SMX:TMP 1:5

% w/v Solid mixed g/100 ml - If underweight (ABW < IBW)

E= (58.5) (i) x o Use TBW
into a liquid
(MW of drug)(1.8) - If normal weight (ABW > IBW & BMI < 25)
% v/v Liquid mixed ml/100 ml o Use IBW
into a liquid - If overweight or obese (BMI ³ 25)
# dissociated ions Ionization (i)
% w/w Solid mixed g/100 g o Use AdjBW
1 1
into a solid
2 1.8 Weight-based Drug Dosing
3 2.6 - If underweight (ABW < IBW)
Common IV Fluids (IVFs)
4 3.4 o Use ABW for ALL medications
NS 0.9% NaCl - If normal weight (ABW < 120% IBW)
½ NS 0.45% NaCl 5 4.2
o Use ABW for MOST medications
¼ NS 0.225% NaCl o Use IBW for aminophylline, theophylline, &
Moles and Millimoles acyclovir, levothyroxine, IVIG
D5W 5% dextrose in water
mols = g x mmols = mg x - If obese (ABW ³ 120% IBW)
D20W 20% dextrose in water
MW MW o Use ABW for LMWHs, UFH, vancomycin
D5NS 5% dextrose in 0.9% NaCl o Use IBW for aminophylline, theophylline,
D5½NS 5% dextrose in 0.45% NaCl Milliequivalents acyclovir, levothyroxine, IVIG
o Use AdjBW for aminoglycosides
mEq = (x mg)(valence) or mEq = mmols x valence
Ratio Strength: One unit of solute contained in MW
the total amount of the solution or mixture (ex: Arterial Blood Gas
1:500) Compound Valence ABG: pH/pCO2/pO2/HCO3/O2 sat
Ammonium chloride 1
Converting ratio strength to percentage Reference range
KCl 1
strength pH 7.35-7.35
K gluconate 1
Percentage strength = 100 / ratio strength pCO2 35-45 mmHg
Na acetate 1
HCO3 22-26 mEq/L
Converting percentage strength to ratio Na bicarbonate 1
strength NaCl 1
Interpreting ABGs
Ratio strength = 100 / percentage strength Ca carbonate 2
1. pH < 7.35 = acidosis
Ca chloride 2
pH > 7.45 = alkalosis
Parts Per Million (PPM): The number of parts of Ferrous sulfate 2
2. Respiratory: CO2 < 35 alkalosis
the drug per 1 million parts of the whole. PPM Mg sulfate 2
CO2 > 45 acidosis
uses the same designations as percentage
Metabolic: HCO3 > 26 alkalosis
strength K, Na, & other
1 mEq = 1 mmol HCO3 < 22 acidosis
monovalent ions
Converting PPM to percentage strength Ca & other 3. Which abnormal value (CO2 or HCO3) matches
1 mEq = 0.5 mmol the pH from Step #1?
Move decimal left 4 places divalent ions
Ex: ¯ pH + ­ CO2 = respiratory acidosis
Converting percentage strength to PPM Body Mass Index Ex: ¯ pH + ¯ HCO3 = metabolic acidosis
Move decimal right 4 places BMI = weight (kg) x or weight (lb) x 703 4. What if both CO2 and HCO3 are abnormal?
[height (m)]2 [height (in)]2 Usually only 1 value will match the pH so if
Specific Gravity (SG) other goes in opposite direction from pH,
SG = g x BMI (kg/m2) Classification there is compensation.
ml x% (w/w) * SG = y% (w/v) < 18.5 Underweight
18.5 – 24.9 Normal weight
Dilution and Concentration 25 – 29.9 Overweight
(Q1)(C1) = (Q2)(C2) ³ 30 Obese
Anion Gap (AG) Protein Requirements Switching Aminophylline/Theophylline “ATM”
AG = Na – Cl – HCO3 > 12 = gap acidosis Ambulatory, non- From To Conversion
0.8 – 1 g/kg/day
hospitalized / maintenance Amino Theo Multiply by 0.8
Causes:
Hospitalized or Theo Amino Divide by 0.8
C Cyanide 1.2 – 2 g/kg/day
malnourished / critically ill Dosing is based on IBW
U Uremia Major burn 2.4 – 3 g/kg/day
T Toluene Body Surface Area (BSA) – use ABW
E Ethanol (alcoholic ketoacidosis) Nitrogen Balance #$ (&') ) *$ (+,)
D Diabetic ketoacidosis (DKA) Nitrogen intake = protein intake (g) x BSA using Mosteller (m2) = "
-.//
I Isoniazid 6.25
M Methanol
Calcium Formulations
P Propylene glycol Non-Protein Calories to Nitrogen Ratio (NPC:N)
Salt Products % Elemental
L Lactic acidosis NPC:N = Total NPC (kcal) x
Ca carbonate Tums, Oscal, 40%
E Ethylene glycol grams of N per day (with food!) Caltrate
S Salicylates
Corrected Calcium (when albumin < 3.5) Ca citrate Citracal 21%
Cacorrected = Careported + [(4 – albumin)(0.8)] Ca acetate* PhosLo, Phoslyra 25%
Dehydration
*Not to be used for Ca replacement
BUN:SCr > 20:1
Corrected Phenytoin/Valproic Acid
Iron Formulations
Nutritional Needs Correction = Total drug measuredmcg/ml x
[0.2 x albuming/dl] + 0.1 Salt % Elemental
Enteral Ferrous gluconate 12%
Usual Diet
Formulas Buffer Systems and Ionization Ferrous sulfate (65mg e in 325mg) 20%
Carbs Bread, rice Sucrose 4 kcal/g Ferrous sulfate, dried 30%
Fat Butter, oil Oil 9 kcal/g Weak acid formula: Weak base formula:
pH = pKa + log salt x pH = pKa + log base x Ferrous fumarate 33%
Protein Fish, meat Casein, soy 4 kcal/g Carbonyl iron 100%
acid salt
Parenteral Nutrition Polysaccharide iron complex 100%
or pH = (pKw – pKb) + log base
Carbs Dextrose monohydrate 3.4 kcal/g
14 salt Loop Diuretic Dose Conversions (mg)
Glycerol/Glycerin 4.3 kcal/g
Fat IVFE 10% 1.1 kcal/ml - Acids dissociate and donate protons into solution Ethacrynic acid 50
IVFE 20% 2 kcal/ml - Bases pick up, or bind, protons Furosemide 40
IVFE 30% 3 kcal/ml - When pH = pKa, half of the compound is not Torsemide 20
protonated (ionized), & half is protonated (un- Bumetanide 1
Proteins Amino Acid solution 4 kcal/g
ionized)
Clevidipine = 2 kcal/ml (soy/eggs) - Ionized (protonated) drug is soluble but cannot IV:PO conversions
Propofol = 1.1 kcal/ml easily cross membranes Furosemide 1:2 Morphine 1:3
- Most drugs are weak acids Bumetanide 1:1 Hydromorphone 1:5
TPN (short term: < 1 week) Torsemide 1:1 Digoxin 0.75-0.8:1
Acid Base
- Indication: not able to absorb adequate nutrition Ethacrynic acid 1:1 Tacrolimus (IR) 1:3-4
pH > pKa ­ ionized ­ un-ionized
via GI for > 5 days Levothyroxine 0.75:1 Keppra 1:1
pH = pKa ionized & un-ionized forms are equal
- Ex: bowel obstruction, ileus, severe diarrhea, Metoprolol 1:2.5 Phenytoin 1:1
pH < pKa ­ un-ionized ­ ionized
radiation enteritis, untreatable malabsorption Spiro:furos 100:40
- High risk of infection, thrombosis, phlebitis (use
Percent Ionization
central or PICC line) Steroid Dose Conversions (mg)
% ionization of a weak acid = 100 x
- PN itself requires filter d/t risk of precipitate Cortisoneprodrug 25
Lipids in TPN (ILE/IVFE): 1 + 100 (pKa – pH) Short -acting
Hydrocortisone 20
- Due to risk of infection, recommended hang time
% ionization of a weak base = 100 x Prednisoneprodrug 5
limit for ILE is 12 hours when infused alone, and
24 hours when combined with dextrose + AA 1 + 100 (pH – pKa) Prednisolone 5 Intermediate-
Methylpred 4 acting
- Lipids filter is usually 1.2 micron (not 0.22!) Temperature Conversions
Triamcinolone 4
°C = (°F – 32)/1.8
CaPO4 – preventing precipitation Dexamethasone 0.75 Long-acting,
°F = (°C x 1.8) + 32 highest potency
- Ca & PO4 should not exceed 45 mEq/L Betamethasone 0.6
- Choose gluconate over chloride b/c less reactive Can’t Help Physicians? Pharmacists Must Try Doing Better
Time to Burn (TTB)
and lower risk of precipitation with phosphates
- Add phosphate first (after dextrose + AA) TTB (with sunscreen in min) = SPF x TTB (normally, without sunscreen)
Statin Dose Conversions (mg)
- Add calcium near the end of preparation Pitava 2
Minimum Weighable Quantity (MWQ)
MWQ = Sensitivity Requirement x Rosuva 5
Fluid Needs Atorva 10
When weight > 20 kg: 0.05
Sensitivity requirement usually 6 mg \ MWQ = 120 mg Simva 20
1,500 ml + (20 ml)(wt in kg – 20)
Lova 40
can estimate using 30-40 ml/kg/day
Friedewald Equation Prava 40
LDL = TC – HDL – TG * *Do not use if TG > 400 Fluva 80
Total Energy Expenditure (TEE)
5 Pharmacists Rock At Saving Lives and Preventing Flu
TEE = BEE x activity factor x stress factor
Absolute Neutrophil Count Opioid Dose Conversions
Activity Activity factor
ANC = WBC* x (% segs + % bands) Drug IV/IM (mg) PO (mg)
Confined to bed 1.2
(cells/mm3) 100 Morphine 10 30
Ambulatory 1.3
*For WBC, include x106 or just multiply final answer by 1,000 Hydromorphone 1.5 7.5
State of stress Stress factor ANC < 1500 – cannot start clozapine Oxycodone – 20
Minor surgery 1.2 ANC < 1000 – NEUTROPENIA Hydrocodone – 30
Infection 1.4 - predisposes pt to infection Codeine 130 200
- cannot fill clozapine Fentanyl 0.1 –
Major trauma, sepsis, 1.5
ANC < 500 – SEVERE NEUTROPENIA Meperidine 75 300
burns up to 30% BSA
- high risk for infection Oxymorphone 1 10
Burns over 30% BSA 1.5 - 2

Carvedilol – IR 3.125 mg BID:CR 10 mg

 mcg/ml = mg/L
T1DM – Initiating Basal-Bolus Insulin Pharmacokinetics Biostatistics
1. Calculate TDD (0.6 units/kg/day using TBW)
2. Divide the TDD into 50% basal insulin and Variable Abbr. Units Mean: the average value
50% bolus insulin Absorption Bioavailability F % Preferred for continuous data that is normally distributed
3. Divide the bolus insulin among # of meals
(can divide evenly or give more insulin for larger Salt form S % Median: value in the middle of an ordered list
Preferred for ordinal data or continuous data that is skewed
meals and less insulin for smaller meals) Distribution Volume of Vd L
distribution
T2DM – Initiating Basal Insulin Mode: the value that occurs most frequently
Excretion Clearance Cl L/hr Preferred for nominal data
- Basal insulin is started at 0.1-0.2 units/kg/day
(using TBW) or 10 units/day
Elimination ke hr-1 Range: the difference between the highest and
Insulin Conversions rate constant lowest numbers
- When converting between insulins, a 1:1
(unit-per-unit) conversion of the TDD can be Bioavailability Standard deviation (SD): indicates how spread
used in most cases F (%) = 100 x AUCextravascular x DoseIV x out the data is, and to what degree the data is
- Converting from twice daily NPH to once daily AUCIV Doseextravascular dispersed away from the mean
insulin glargine à use 80% of the total daily - Large # of data values close to the mean has a
NPH dose as the initial dose of insulin glargine Dose of new = Amt absorbed from current form smaller SD.
- Converting from once daily Toujeo to once dosage form F of new dosage form - Data is that highly dispersed has a larger SD
daily Lantus/Basaglar, use 80% of the Toujeo
dose as the initial dose of Lantus/Basaglar Volume of Distribution Confidence interval = 1 – alpha (type I error)
Vd = Amt of drug in body x= Dose x - DIFFERENCE data – does it include ZERO?
Insulin-to-Carbohydrate Ratio Conc of drug in plasma Conc. rise - RATIO data – does it include ONE? (RR, OR, HR)
Rule of 500 (Rapid-Acting):
500 = grams of carbohydrate covered Clearance Risk = # subjects w/ unfavorable event in group x

TDD by 1 unit of rapid-acting insulin CL = Rate of Elimination x= (x mg)/(x hours) total # of subjects in group
Concentration x mg/L
Rule of 450 (Regular): Relative Risk or Risk Ratio (RR) = AS LIKELY
450 = grams of carbohydrate covered CL = F x Dose CL = ke x Vd RR = Risk in treatment group x
TDD by 1 unit of regular insulin AUC Risk in control group

Correction Factor (add to usual dose!) Zero Order and First Order PK Relative Risk Reduction (RRR) = LESS LIKELY
1,800 Rule (Rapid-Acting): 1st order elimination = LINEAR kinetics = RRR = (% risk control group – % risk treatment group) x
1,800 = correction factor for 1 unit constant % of drug is removed per unit of time % risk control group
TDD of rapid-acting insulin RRR = 1 – RR(must use decimal)
1,500 Rule (Regular): Zero order elimination = NON-linear kinetics =
1,500 = correction factor for 1 unit constant amount of drug (mg) is removed per Absolute Risk Reduction (ARR)
TDD of regular insulin unit of time – non-linear ARR = (% risk in control group) – (% risk treatment group)

Correction Dose Most drugs follow 1st order (linear) kinetics Number Needed To Treat or Harm (NNT, NNH)
Correction dose = (BG now) – (target BG) - At steady state, doubling the dose will NNT or NNH = 1 x
correction factor ~double the serum concentration ARR* expressed as decimal
NNT – round up
Room Temperature Stability of Insulin and Michaelis-Menten Kinetics NNH – round down
Injectable Diabetes Medications Non-linear, saturable, or mixed order kinetics
Vials that are not 28 days - PHT initially follows first-order elimination Odds Ratio (OR)
Humulin vials (R, N, 70/30) 31 days - Once enzymes are saturated, PHT follows OR = AD x= (012 1)342561,
(012 1)342561,
012 45$&4'1)∗(94 1)342561, 94 45$&4'1)
94 45$&4'1)∗(94 1)342561, 012 45$&4'1)
Humulin U-500 vials 40 days zero order elimination BC
Novolin vials 42 days - Double the dose may more than double the
Levemir vial 42 days serum concentration Hazard Ratio (HR)
- The rate of metabolism approaches zero HR = Hazard rate in the treatment group x
Pens that are not 28 days
order at higher concentrations Hazard rate in the control group
Humalog Mix pen 10 days
- Increase in dose leads to a disproportionate
Humulin Mix pen 10 days Sensitivity
increase in drug concentration at steady state
Humulin N pen 14 days Sensitivity = A x 100 = TrueP x 100
- Ex: phenytoin, theophylline, voriconazole
Novolog Mix pen 14 days A+C TrueP + FalseN
Toujeo pen 42 days Elimination Rate Constant
Levemir pen 42 days Specificity
ke = CL xx ke = 0.693 x Specificity = B x 100 = TrueN x 100
Tresiba pen 56 days Vd t½
Others B+D TrueN + FalseP
Afrezza – opened strips 3 days Half-Life and Steady State Test HAVE No
Afrezza – unopened 10 days t½ = 0.693 x Result condition condition
Trulicity, Adlyxin 14 days ke Have outcome Do not have
outcome
Xultophy (degludec + liraglutide) 21 days
Positive A B
Bydureon, Soliqua (glargine + lixisenatide) 28 days Steady state: where rate of drug intake equals (yes- (TP) (FP)
Byetta, Victoza, Symlin 30 days rate of drug elimination exposure)
Negative C D
Ozempic 56 days (no-exposure) (FN) (TN)
~5 half-lives to reach steady state
Total A+C B+D
U-200:
- Humalog KwikPen (& U-100) ~5 half-lives are required to eliminated >95% of “It makes SENSe to be positive”
- Tresiba FlexTouch (& U-100) the drug
U-300: Sensitivity = true positive … disease present
- Toujeo Solostar/Max Solostar snOUT- sensitive test when negative rules OUT the disease
Loading Dose (LD)
U-500: LD = Desired concentration x Vd x Specificity = true negative … disease not present
- Humulin R (& U-100) F spIN- specific test when positive rules IN the disease
target levels are provided on naplex. maybe just know the target vs. indication for digoxin & vancomycin.
also maybe know whether which level you’re measuring (peak or trough) for the ones indicated

Digoxin HF: 0.5-0.9 ng/ml (no loading) Non-Sterile Compounding:

Afib: 0.8-2 ng/ml (can load) Formulation BUD Storage
Lithium 0.6-1.2 mEq/L (up to 1.5 for acute sx) Water-containing oral 14 days Refrigerator
trough formulations
(such as an oral
Phenytoin Total: 10-20 mcg/ml
suspension)
^Correct if low albumin (<3.5 & CrCl £10)
Water-containing 30 days Room
Free 1-2.5 mcg/ml (don’t correct) topical/dermal and temperature
VPA Total: 50-100 mcg/ml mucosal liquid and
(up to 150 in some pts) semisolid formulations
Correct if albumin is low (<3.5) AKA cream bases
CBZ 4-12 mcg/ml Non-aqueous 6 months Room
Phenobar 20-40 mcg/ml (adults) formulations or earliest temperature
AGs Genta/Tobra Traditional Dosing: (a drug in petrolatum) expiration of
Peak: 5-10 mcg/ml any API
Trough: < 2 mcg/ml
Vanco 15-20 mcg/ml for most serious Sterile Compounding:
infections (POEM-B); RT Fridge Freezer
10-15 mcg/ml for others Low 48 hours 14 days 45 days
Theopeak 5-15 mcg/ml Medium 30 hours 9 days 45 days
High 24 hours 3 days 45 days
Warfarin Tablet Colors (mg) SCA 12 hours 12 hours -
Immediate-use 1 hour - -
Please Pink 1
Single-dose
Let Lavender 2 1 hour
ampule
Grandma Green 2.5 u Single-dose Non-ISO 5 environment: 1 hour
Brown Brown/Tan 3 other ISO 5 environment: 6 hours
Bring Blue 4 Multi-dose 28 days or per manufacturer
Peaches Peach 5
To Teal 6
Your Yellow 7.5
Wedding White 10 Calcium & Vitamin D intake recommendations
for diff. populations (after merging everything)
Levothyroxine Tablet Colors (mcg)
Orangutans Orange 25 Adults:
Will White 50 - Calcium recommend: 1 – 1.2 g/day
Vomit Violet 75 elemental (DNE 500-600 mg/dose)
On Olive 88 - Vitamin D
You Yellow 100 NOF recommends 800-1,000 IU daily for ³
Right Rose 112 50 years
Before Brown 125 Endocrinologists: 800-2,000 IU daily
They Turquoise 137 - Women of CBA: folate 400 mcg/day
Become Blue 150
Large Lilac 175 Pregnant:
Proud Pink 200 - Folate 600 mcg/day (start 1 month prior)
Giants Green 300 - Calcium 1,000 mg/day
Full replacement dose = 1.6 mcg/kg/day (IBW) - Vitamin D 600 IU/day
12.5-25 mcg/day if CAD
< 1 mcg/kg/day if elderly Partially/Fully Breast-Fed Babies
Increase dose by 30-50% during pregnancy - Vitamin D 400 IU until consuming at least 1
L of vitamin D-fortified formula/day
- Iron 1 mg/kg/daily during months 4-6
HLA-B allele testing
1502 = CBZ (Tegretol) / OXC (Trileptal) Vitamin D deficiency (D3 or D2)
- Avoid PHT as well - Daily 5,000-7,000 IU or
5701 = abacavir (Ziagen) - Weekly 50,000 IU x 8-12 weeks
5801 = allopurinol (Zyloprim)
Calcium & Vit D supplementation in:
- Osteoporosis (needed for drugs to work)
LDL HDL TG - Epilepsy
- Pregnancy
Statins ¯ ­ ¯
Ezetimibe ¯ ­ ¯
Bile Acid ¯ ­ –/­
TG > 300- don’t start

Fibrates ¯ / ­when TG high ­ ¯

Niacin ¯ ­ ¯
Fish oils ­ Lovaza, Epanova ­ ¯
(not Vascepa)
PCSK9(-) ¯
Don’t use in pregnancy – statins, ezetimibe, lomitapide
Don’t use in nursing – fibrates