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A physician prescribed dimenhydrinate to treat a 48-lb child. The
labeled intramuscular injection dose of the drug is 1.25 mg/kg. The
available injectable solution contains dimenhydrinate, 50 mg/mL.
Prior to administering the solution, the floor nurse decides to check
her calculated dose of 0.55 mL with the hospital pharmacist. Were
her calculations correct?
Calculate the number of tablets to dispense to a patient weighing
147 lb.
A physician desires a dose of 10 mcg/kg of digoxin for an 8-lb
newborn child. How many milliliters of an injection containing
0.25 mg of digoxin per milliliter should be given?
Intravenous digitalizing doses of digoxin in children are 80% of
oral digitalizing doses. Calculate the intravenous dose for a 5-yearold child weighing 40 lb if the oral dose is determined to be 10
mcg/kg.
An intratracheal suspension for breathing enhancement in
premature infants is dosed at 2.5 mL/kg of birth weight. How many
milliliters of the suspension should be administered to a neonate
weighing 3 lb?
A 142-lb patient was receiving filgrastim (NEUPOGEN) in doses
of 10 mcg/kg/day when, as a result of successful blood tests, the
dose was lowered to 6 mcg/kg/day. Using an injection containing
0.3 mg filgrastim per 0.5 mL, calculate the previous and new dose
to be administered.
a. 17.7 mL and 64.6 mL
b. 5.23 mL and 3.14 mL
c. 1.08 mL and 0.65 mL
d. 3.87 mL and 2.3 mL
A 25-lb child is to receive 4 mg of phenytoin per kilogram of body
weight daily as an anticonvulsant. How many milliliters of
pediatric phenytoin suspension containing 30 mg per 5 mL should
the child receive?
The loading dose of digoxin in premature infants with a birth
weight of <1.5 kg is 8 mcg/kg administered in three unequally
divided doses (½, ¼, ¼) at 8-hour intervals. What would be the
initial dose for an infant weighing 1.2 kg?
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The pediatric dose of cefadroxil is 30 mg/kg/day. If a child was
given a daily dose of 2 teaspoonfuls of a pediatric suspension
containing 125 mg of cefadroxil per 5 mL, what was the weight, in
pounds, of the child?
How many milliliters of an injection containing 1 mg of drug per
milliliter of injection should be administered to a 6-month-old child
weighing 16 lb to achieve a dose of 0.01 mg/kg?
Prior to hip replacement surgery, a patient receives an injection of
an anticoagulant drug at a dose of 30 mg. Following the patient’s
surgery, the drug is injected at 1 mg/kg. For a 140-lb patient,
calculate the total of the pre- and postsurgical doses.
Using Table 8.2 and a daily dose of 2 mg/kg, how many 20-mg
capsules would a 176-lb patient be instructed to take per dose if the
daily dose is to be taken in divided doses, q.i.d.?
For a 22-lb pediatric patient, the dose of cefdinir was determined to
be 7 mg/kg. What quantity of an oral suspension containing 125
mg of cefdinir in each 5 mL should be administered?
a. 2.8 mL
b. 5.6 mL
c. 8.9 mL
d. 13.6 mL
The dose of deferiprone in treating iron overdose is 75 mg/kg/day
given in three divided doses. What is the single dose for a patient
weighing 248 lbs?
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?
Cannabidiol (EPIDOLEX) is indicated for the treatment of epilepsy
and should be administered at a dose of 2.5 mg/kg twice daily. How
much of a solution containing 100 mg/mL of the drug should be
administered to a male patient who is 5′11″ tall and weighs 213
pounds?
A medication order calls for tobramycin sulfate, 1 mg/kg of body
weight, to be administered by IM injection to a patient weighing
220 lb. Tobramycin sulfate is available in a vial containing 80 mg
per 2 mL. How many milliliters of the injection should the patient
receive?
The usual pediatric dose of acyclovir is 10 mg/kg administered by
infusion and repeated every 8 hours. What would be the single
dose, in milligrams, for a child weighing 33 lb?
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If the recommended dose of tobramycin for a premature infant is 4
mg/kg/day, divided into two equal doses administered every 12
hours, how many milligrams of the drug should be given every 12
hours to a 2.2-lb infant?
If a 3-year-old child weighing 35 lb accidentally ingested twenty
81-mg aspirin tablets, how much aspirin did the child ingest on a
milligram per kilogram basis?
The recommended pediatric dose of epinephrine for allergic
emergencies is 0.01 mg/kg. If a physician, utilizing this dose,
administered 0.15 mg, what was the weight of the patient in
pounds?
The initial maintenance dose of vancomycin for infants <1 week
old is 15 mg/kg every 18 hours.
a. What would be the dose, in milligrams, for an infant weighing
2500 g?
b. How many milliliters of an injection containing 500 mg per 25
mL should be administered to obtain this dose?
The loading dose of indomethacin to treat patent ductus arteriosus
in neonates is 0.2 mg/kg of body weight by intravenous infusion.
a. What would be the dose for a neonate weighing 6 lb 4 oz?
b. How many milliliters of an injection containing 1 mg of
indomethacin per 0.5 mL should be administered to obtain this
dose?
a. How many milligrams of metronidazole will the patient receive
per dose?
b. How many milliliters of the prescription should be prepared and
dispensed?
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c. If metronidazole is available in 250-mg tablets, how many tablets
will be needed to fill the prescription?
a. If the dose of EES is 50 mg/kg/day, how many milliliters would
provide each dose?
b. How many days would the prescription last the patient?
Calculations Based on Body Surface Area
NOTE: For the problems in this section, use the nomograms in
Figures 8.2 and 8.3 to determine BSA unless otherwise stated in the
problem.
If the daily dose of a drug is given in the literature as 8 mg/kg of
body weight or 350 mg/m2, calculate the dose on each basis for a
patient weighing 150 lb and measuring 5 feet 8 inches in height.
If the dose of a drug is 10 mg/m2/day, what would be the daily
dose, in milligrams, for a child weighing 30 lb and measuring 26
inches in height?
The dose of mitomycin injection is 20 mg/m2/day. Determine the
daily dose for a patient who weighs 144 lb and measures 68 inches
in height.
The pediatric starting dose of ritonavir (NORVIR) is 250 mg/m2 by
mouth twice daily. The available oral solution contains 600 mg of
ritonavir in each 7.5 mL of solution. The correct volume and
corresponding quantity of ritonavir to be administered to a child
with a body surface area of 0.75 m2/dose is:
a. 5.6 mL (450.4 mg)
b. 2.8 mL (450.4 mg)
c. 2.8 mL (225.2 mg)
d. 2.3 mL (187.5 mg)
Calculate the dose for a child 4 years of age, 39 inches in height,
and weighing 32 lb for a drug with an adult dose of 100 mg, using
the following: (a) Young’s rule, (b) Cowling’s rule, (c) Clark’s rule,
and (d) BSA (use the BSA equation).
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The daily dose of diphenhydramine HCl for a child may be
determined on the basis of 5 mg/kg of body weight or on the basis
of 150 mg/m2. Calculate the dose on each basis for a child
weighing 55 lb and measuring 40 inches in height.
Calculations of Chemotherapeutic Regimens
The drug cabazitaxel is used treating prostate cancer in doses of 25
mg/m2. Calculate the dose for a patient measuring 73 inches in
height and weighing 190 lb. Use the Mosteller formula to calculate
BSA.
Calculate the quantities of each drug administered to a patient on
day 1 of the EOX protocol in Table 8.6 if the patient’s BSA is 1.64
m2.
Calculate the quantities of cyclophosphamide and doxorubicin for a
patient on the CAV protocol in Table 8.6 if the patient measures
150 cm and weighs 48 kg.
The drug carboplatin for ovarian carcinoma is administered
intravenously at a dose of 360 mg/m2 except in patients with
impaired kidney function, in which case the dose is reduced by
30%. How many milligrams of the drug should be administered to
a renally impaired patient measuring 5 feet 2 inches and weighing
110 lb? Use the Mosteller formula to determine BSA.
A high-dose treatment of osteosarcoma includes the use of
methotrexate at a starting dose of 12 g/m2 as a 4-hour intravenous
infusion. For a patient having a BSA of 1.7 m2 and weighing 162
lb, calculate the dose on the basis of mg/kg/min.
A two-agent dosage regimen, termed MP, for the treatment of
multiple myeloma is as follows11:
a. Calculate the total milligrams each of melphalan and prednisone
taken per week by a patient who weighs 165 lb.
b. If melphalan is available in 2-mg tablets, how many tablets are
required to dose this patient for the entire treatment cycle?
c. If the patient prefers prednisone oral solution to prednisone
tablets, how many milliliters of the solution (5 mg/mL) should
be dispensed weekly?
A three-agent dosage regimen, termed VAD, for the treatment of
multiple myeloma includes the following drugs taken over a 28-day
cycle11:
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Calculate the total quantity of each drug administered over the
course of the treatment cycle for a patient with a BSA of 1.65 m2.
A four-agent dosage regimen, termed MOPP, for the treatment of
Hodgkin’s lymphoma includes the following drugs taken over a 28-
day cycle11:
Calculate the total number of 20-mg tablets of prednisone and 50mg tablets of procarbazine to dispense to treat a patient with a BSA
of 1.5 m2 during the course of one treatment cycle.
The oncolytic agent lapatinib (TYKERB) is administered in the
treatment of breast cancer in daily doses of 1250 mg for 21
consecutive days in combination with the drug capecitabine
(XELODA), which is administered in doses of 2000 mg/m2/day
divided into 2 doses given 12 hours apart during days 1 to 14 of the
21-day treatment cycle. Calculate the total quantity of each drug to
be administered during the treatment cycle to a 5-feet 2-inch
woman weighing 110 lb.
Among the single chemotherapeutic agents for breast cancer is
docetaxel (TAXOTERE), which is administered @ 60 mg/m2 IV
every 3 weeks. Calculate the dose for a 5-feet-4-inch patient who
weighs 160 lb. Use the Mosteller formula to determine BSA.
Based on the dose calculated in problem 50, how many milliliters
of an injection containing 80 mg/4 mL docetaxel would be
administered per dose?
The chemotherapy regimen “TAC” during a 21-day cycle is11:
Calculate the dose of each drug/cycle for a patient with a BSA of
1.9 m2.
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Miscellaneous Practice Problems
The literature states the pediatric dose of the antibiotic
clarithromycin as “7.5 mg/kg q12h.” Calculate the daily dose in
milligrams for a child weighing 55 lb.
If, in problem 53, the medication is administered as a suspension
containing 125 mg clarithromycin/5 mL, what volume should be
administered for each single dose?
The recommended initial dose of the neurologic drug divalproex
sodium is 15 mg/kg/day in treating absence seizures, to be
increased as indicated to an absolute maximum dose of 60
mg/kg/day. Calculate these quantities for a 182-lb patient.
Divalproex sodium is available in 250-mg and 500-mg strength
tablets. From the information in problem 55, what strength tablet
and quantity could a pharmacist recommend for an initial dose?
The recommended pediatric dose of leuprolide acetate suspension
for intramuscular injection is 7.5 mg, once per month, for a child
weighing 25 kg. What is the equivalent dose, based on mg/m2, for
this child measuring 36 inches in height? Use the BSA equation as
needed.
Sotalol hydrochloride (BETAPACE) should be given for
ventricular arrhythmias in children at a dose of 90 mg/m2/day in 3
divided doses. What would be the single dose for a 10-year-old
male patient who is 4′9″ tall and weighs 86 lbs? (Use the Mosteller
equation to determine BSA.)
Beractant intratracheal sterile suspension (SURVANTA) may be
administered to premature neonates within 15 minutes of birth, as
indicated, for the prevention and treatment of respiratory distress
syndrome. The suspension is available in 4-mL and 8-mL vials
containing 25 mg of drug per milliliter. The dose is 100 mg/kg of
birth weight. Calculate the dose of the suspension for a newborn
weighing 1800 g.
The dose of the drug ixabepilone is 40 mg/m2, but if a patient’s
BSA is above 2.2 m2, the dose is calculated based on 2.2 m2. Using
Figure 8.3, determine which dose parameter should be used for a
patient who is 6 feet tall and weighs 200 lb.
The pediatric dose of levothyroxine sodium is based on both age
and body weight, according to the following:
0 to 3 months, 10 to 15 mcg/kg/day
3 to 6 months, 8 to 10 mcg/kg/day
6 to 12 months, 6 to 8 mcg/kg/day
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1 to 5 years, 5 to 6 mcg/kg/day
6 to 12 years, 4 to 5 mcg/kg/day
Verify the correctness of a physician’s order for the dispensing of
100-mcg tablets to be taken once a day by a 6-year-old child
weighing 48 lb.
Levothyroxine sodium tablets may be crushed and suspended in
water and administered by spoon or drop to infants and children
who cannot swallow intact tablets. From the information in
problem 61, should a 25-mcg tablet, a 50-mcg tablet, or a 75-mcg
tablet be crushed and suspended for administration to a 10-month-
old infant weighing 17 lb?
The pediatric dose of nelarabine is 650 mg/m2 administered
intravenously over a period of 1 hour daily for 5 consecutive days.
The drug is available in vials containing nelarabine, 250 mg/50
mL. Using Figure 8.2, calculate (a) the daily dose of drug, in
milligrams, for a child weighing 15 kg and measuring 100 cm in
height, and (b) the total volume of injection to infuse per treatment
period.
The oral dose of topotecan in the treatment of small cell lung
cancer is 2.3 mg/m2/day once daily for 5 consecutive days,
repeated every 21 days. The medication is available in 0.25 mg and
1 mg capsules. Recommend the strength and number of capsules to
dispense for the initial course of treatment of a patient who weighs
165 lb and measures 5 feet 11 inches in height. Use the BSA
equation.
A patient who is 6 feet tall and weighs 187 lb has been given 170
mg of a medication based on a 2 mg/kg basis. Calculate the same
dose, based on mg/m2. Use the BSA equation as needed.
The dose of tocilizumab in treating cytokine release syndrome is 12
mg/kg for patients weighing less than 30 kg and 8 mg/kg for
patients weighing 30 kg and above. What would be the dose for a
patient weighing 172 pounds?
Cefixime, an anti-infective agent, is available in oral suspensions of
the following strengths: 100 mg/5 mL, 200 mg/5 mL, and 500 mg/5
mL. The pediatric dose is 8 mg/kg/day, administered in divided
dosage. Calculate (a) the daily dose of cefixime for a 55-lb patient,
(b) the most appropriate product strength to dispense, and (c) the
quantity of oral suspension, in milliliters, required for a 10-day
course of treatment.
Pertuzumab, for the treatment of late-stage breast cancer, is
administered at an initial dose of 840 mg by intravenous infusion.
It is coadministered every 3 weeks with trastuzumab 8 mg/kg and
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docetaxel 75 mg/m2. Calculate the doses of trastuzumab and
docetaxel for a patient who is 60 inches in height and weighs 158
lb. Use the BSA equation as needed.
CALCQUIZ
8.A. The drug eribulin mesylate is used in late-stage metastatic
breast cancer at an intravenous dose of 1.4 mg/m2. It is
administered on days 1 and 8 of a 21-day cycle. The dose is
reduced by 20% for patients with moderate renal impairment.
Calculate the reduced dose, in (a) mg/m2, (b) mg/kg, and (c) the
treatment-day dose, in milligrams, for a 110-lb patient
measuring 5 feet 2 inches in height.
8.B. A parent takes her 5- and 7-year-old boys to the pediatrician,
both with pharyngitis. The boys weigh 40 and 50 lb,
respectively. The doctor prescribes an oral suspension of
cefuroxime axetil (CEFTIN) at a dose of 20 mg/kg/day divided
b.i.d. × 10 days. The suspension has a cefuroxime axetil
concentration of 125 mg/mL. How many milliliters of
suspension will be needed during the course of treatment?
8.C. The first-day loading dose of a drug is 70 mg/m2 followed by a
dose of 50 mg/m2 daily thereafter. Irrespective of the patient’s
BSA, a dose is not to exceed 70 mg. For a 5-feet 8-inch 150-lb
patient, calculate the (a) BSA using the Mosteller formula, (b)
loading dose, and (c) maintenance dose, and indicate whether
each dose is within the safe limit.
8.D. The pediatric oral dose of ciprofloxacin is given as 10 to 20
mg/kg every 12 hours, not to exceed a single dose of 750 mg
irrespective of body weight. If a child weighing 55 lb is
prescribed a one-teaspoonful dose of a 5% ciprofloxacin oral
suspension every 12 hours, calculate whether or not the dose
prescribed is within the therapeutic range.
8.E. The drug peginterferon alfa-2b is administered according to a
“step-down” protocol if a patient is experiencing toxicity. A
usual starting dose of 6 mcg/kg/week is reduced to 3
mcg/kg/week, then to 2 mcg/kg/week, then to 1 mcg/kg/week.
Calculate these doses for a 5-feet 5-inch 132-lb patient (a) in
micrograms and (b) on a mcg/m2 basis.
ANSWERS TO “CASE IN POINT” AND
PRACTICE PROBLEMS
Case in Point 8.1
The metric weight of a 3-lb 7-oz neonate is calculated:
1 lb = 454 g; 1 oz = 28.35 g
3 lb × 454 g/lb = 1362 g
7 oz × 28.35 g/oz = 198.45 g
1362 g + 198.45 g = 1560.45 g, weight of the neonate
According to the dosing table, the dose for a 3-day-old neonate
weighing <2000 g is 10 mg/kg/day divided every 12 hours.
The dose, in mg, may be calculated by dimensional analysis:
Since the daily dose is administered in two divided doses, each divided
dose is:
The volume of injectable solution is then calculated:
Case in Point 8.2
To calculate the oral dose of enalapril for the patient, it is necessary to
know the patient’s weight. This may be calculated from the intravenous
dose:
Then, the oral dose may be calculated:
By crushing and mixing the 2.5-mg enalapril tablet with sterile water to
make 12.5 mL, the oral dose may be calculated:
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