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Case in Point 8.3
Daily dose: 15 mg/kg × 10 kg = 150 mg
Single dose: 150 mg ÷ 3 = 50 mg
Case in Point 8.4
a. 28 inches × 2.54 cm/1 inch = 71.12 cm
22 lb × 1 kg/2.2 lb = 10 kg
230 mg (lopinavir) × 0.44 m2 = 101.2 mg
57.5 mg (ritonavir) × 0.44 m2 = 25.3 mg
Thus, 101.2 mg (lopinavir) and 25.3 mg (ritonavir)
b. 101.2 mg × 1 mL/80 mg = 1.27 mL
25.3 mg × 1 mL/20 mg = 1.27 mL
Thus, 1.27 mL or 1.3 mL oral solution (administered by
calibrated oral syringe).
c. KALETRA, 12/3 mg/kg
12 mg (lopinavir)/kg × 10 kg = 120 mg (lopinavir, single dose)
3 mg (ritonavir)/kg × 10 kg = 30 mg (ritonavir, single dose)
Thus, 120 mg × 2 (doses/day) = 240 mg (lopinavir), and 30 mg ×
2 (doses/day) = 60 mg (ritonavir).
d. 240 mg (lopinavir) × 1 mL/80 mg = 3 mL
60 mg (ritonavir) × 1 mL/20 mg = 3 mL
Thus, 3 mL oral solution, daily dose (administered by calibrated
oral syringe).
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It should be noted that since the ratio of lopinavir to ritonavir in the
oral solution is fixed—that is, 80 mg:20 mg (or 4 mg:1 mg)—the
calculation of one component will automatically yield the quantity of the
second component.
Case in Point 8.5
To calculate the dose for the patient, the pharmacist must first
determine the patient’s body surface area. The pharmacist elects to use
the following equation:
To use this equation, the patient’s weight and height are converted to
metric units:
Height: 5 feet = 60 inches × 2.54 cm/inch = 152.4 cm
Weight: 117 lb ÷ 2.2 lb/kg = 53.18 kg
Solving the equation:
The daily dose is calculated as 150 mg/m2 × 1.50 m2 = 225 mg.
To obtain 225 mg, the patient may take two 100-mg capsules, one
20-mg capsule, and one 5-mg capsule daily.
Practice Problems
12.5 mg
19.09 mg gentamicin
30 mg gentamicin
Overdose
IV: 327.27 to 545.45 mg ciprofloxacin
Oral: 363.64 to 727.27 mg ciprofloxacin
a. ½ tsp. (2.5 mL) erythromycin ethylsuccinate
b. 10 days
4.36 to 7.5 mL chlorothiazide oral suspension
6.36 mL cyclosporine
2 tsp.
Yes, calculations were correct.
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38.
18 tablets
0.15 mL digoxin injection
145.45 mcg digoxin
3.41 mL
c. 1.08 mL and 0.65 mL filgrastim injection
7.58 mL phenytoin suspension
4.8 mcg digoxin
18.33 lb
0.073 mL
93.64 mg
2 capsules
a. 2.8 mL cefdinir oral suspension
2.82 g deferiprone/dose
1363.64 mcg dactinomycin
2.42 mL cannabidiol solution
2.5 mL tobramycin injection
150 mg acyclovir
2 mg tobramycin
101.83 mg/kg aspirin
33 lb
a. 37.5 g vancomycin
b. 1.88 mL vancomycin injection
a. 0.57 mg indomethacin
b. 0.28 mL indomethacin injection
a. 150 mg metronidazole
b. 100 mL
c. 12 metronidazole tablets
a. 7.5 mL
b. 10 days
545.45 mg and 630 mg
4.5 mg
35.4 mg mitomycin
d.2.34 mL (187.5 mg) ritonavir
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a. 25 mg
b. 20.83 mg
c. 21.33 mg
d. 36.57 mg
a. 125 mg diphenhydramine HCl
b. 120 mg diphenhydramine HCl
52.73 mg cabazitaxel
82 mg epirubicin
213.2 mg oxaliplatin
2.05 g capecitabine
1.41 g cyclophosphamide
63.45 mg doxorubicin
372.69 mg carboplatin
1.15 mg/kg/min methotrexate
a. 75 mg melphalan and 600 mg prednisone
b. 225 tablets
c. 120 mL prednisone oral solution
1.6 mg vincristine
59.4 mg doxorubicin
480 mg dexamethasone
42 prednisone tablets
42 procarbazine tablets
26.25 g lapatinib and 41.44 g capecitabine
108.73 mg docetaxel
5.44 mL docetaxel injection
950 mg cyclophosphamide
95 mg doxorubicin
142.5 mg docetaxel
375 mg clarithromycin
7.5 mL clarithromycin suspension
1240.91 mg divalproex sodium, initial dose 4963.64 mg divalproex
sodium, maximum dose
Two 500-mg tablets and one 250-mg tablet
9.41 mg/m
2
37.62 mg sotalol hydrochloride/dose
7.2 mL beractant suspension
40 mg/m
2
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Correct
A 50-mcg levothyroxine sodium tablet
a. 416 mg nelarabine
b. 416 mL nelarabine injection
Twenty 1-mg topotecan capsules (4/day) and ten 0.25 mg topotecan
capsules (2/day)
81.81 mg/m
2
625.45 mg tocilizumab
a. 200 mg cefixime
b. 100 mg/5 mL
c. 100 mL cefixime suspension
574.55 mg trastuzumab and 130.77 mg docetaxel
References
Facts & Comparisons eAnswers [book online]. Baltimore, MD: Wolters Kluwer Clinical
Drug Information Inc.; 2020.
Nahata MC, Taketomo C. Pediatrics: general topics in pediatric pharmacotherapy. In:
DiPiro JT, Yee GC, Posey LM, et al., eds. Pharmacotherapy: A Pathophysiologic
Approach. 11th Ed. [book online]. New York, NY: McGraw-Hill; 2020.
The Joint Commission. Sentinel event alert. Available at:
https://www.jointcommission.org/-/media/deprecated-unorganized/importedassets/tjc/system-folders/topics-library/sea_39pdf.pdf?
db=web&hash=29D89AF0947F063B82967B81E640CBBC. Accessed October 18, 2020.
Gomella TL, Eyal FG, Bany-Mohammed F, eds. Gomella’s Neonatology: Management,
Procedures, On-Call Problems, Diseases, and Drugs. 8th Ed. New York, NY: McGrawHill; 2020.
Taketomo CK. Pediatric & Neonatal Dosage Handbook. 26th Ed. Hudson, OH:
Lexicomp/Wolters Kluwer Health Clinical Solutions; 2019–2020.
Besdine RW. Physical changes in aging. In: Merck Manual Professional Version. Available
at: https://www.merckmanuals.com/professional/geriatrics/approach-to-the-geriatric-
patient/physical-changes-with-aging. Accessed October 18, 2020.
Mosteller RD. Simplified calculation of body surface area. The New England Journal of
Medicine 1987;317:1098.
American Cancer Society. Treatment types. Available at:
https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types.html.
Accessed October 22, 2020.
Cancer Therapy Advisor. Cancer treatment regimens. Available at:
https://www.cancertherapyadvisor.com/home/cancer-treatment-regimens/. Accessed
October 22, 2020.
National Cancer Institute. A to Z list of cancer drugs. Available at:
https://www.cancer.gov/about-cancer/treatment/drugs. Accessed October 22, 2020.
Lexicomp [book online]. Baltimore, MD: Wolters Kluwer Clinical Drug Information Inc.;
2020.
Schwarz LR. Delivering cytotoxic chemotherapy safely in a community hospital. Hospital
Pharmacy 1996;31:1108–1118.
13. Beach W. College of pharmacy. Athens, GA: The University of Georgia; 2004.
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9
Calculations Involving Units of
Activity and Other Measures of
Potency
OBJECTIVE
Upon successful completion of this chapter, the student will be able
to:
Perform calculations involving units of activity and other measures
of potency.
Introduction
The potencies of some antibiotics, endocrine products, vitamins, products
derived through biotechnology, and biologics (e.g., vaccines) are based
on their activity and are expressed in terms of units of activity, in
micrograms per milligram, or in other standardized terms of
measurement. These measures of potency meet standards approved by the
Food and Drug Administration as set forth in the United States
Pharmacopeia (USP).1 In addition, the World Health Organization
(WHO) through the International Pharmacopeia (IP) provides
internationally agreed-upon standards for biological preparations, which
define potency or activity, as expressed in international units (I.U. or
IU).
2
The activity of a drug or biologic agent is determined by comparison
against a corresponding reference standard—an authenticated specimen
used in compendial tests and assays. The required potencies and
respective weight equivalents for some drugs are given in Table 9.1. A
USP Unit for one drug has no relation to a USP Unit for another drug.
TABLE 9.1 EXAMPLES OF DRUG POTENCY
EQUIVALENTS
a
Data taken or derived from various literature sources, including the United States Pharmacopeia
and the International Pharmacopeia.
Of the drugs for which potency is expressed in units, insulin is perhaps
the most common. Commercially available types of insulin vary
according to time for onset of action, peak action, and duration of action;
however, all are standardized to contain either 100 or 500 insulin units
per milliliter of solution or suspension. These products are labeled as “U100” (Fig. 9.1) or “U-500.” Insulin is dosed by the administration of a
specific number of units. Specially calibrated insulin syringes (Fig. 9.2)
or prefilled, dial-a-dose insulin pens (KwikPen [Lilly] and FlexPen
[Novo Nordisk]; Fig. 9.3) are employed.
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FIGURE 9.1 Example of a pharmaceutical product
standardized in units of activity. (Copyright © Eli Lilly and
Company. All Rights Reserved. Used with Permission.)
FIGURE 9.2 Example of an insulin syringe calibrated in Units.
(From Tenaht/Shutterstock.com)
FIGURE 9.3 Example of a prefilled pen-type of syringe for
administering insulin. (Copyright © Eli Lilly and Company. All
Rights Reserved. Used with Permission.)
CALCULATIONS CAPSULE
Units of Activity
The potency of many pharmaceutical products derived from biological
sources is based on units of activity. Units of activity are determined
against specific biologic standards and vary between products.
Generally, there is an established relationship between a product’s units
of activity and a measurable quantity (e.g., units per milligram; units
per milliliter). This relationship may be used in a ratio and proportion
to determine either the number of units of activity or the weight or
volume containing a specified number of units:
As noted previously in this text, medication errors can occur when the
term units is abbreviated with a “U.” For example, “100U” could be
mistaken for “1000” units. Thus, it is recommended that the term units be
spelled out as a matter of practice.
Another effort to reduce medication errors has been implemented by
clarifying the contents of certain packages of multidose injections. Figure
9.4 shows the dual statement of strength in the labeling of a Heparin
Sodium Injection in which the drug concentration for the entire contents
(30,000 USP Units/30 mL) and the concentration per milliliter (1,000
USP Units/mL) are displayed.
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