CHAPTER 2

CREATININE CLEARANCE
When using the below equations, two factors to consider
are (1) the serum creatinine is at steady state and (2) the
weight, gender, and age of the individual reflect normal
muscle mass.
Cockcroft-Gault equation
To estimate renal function for the purpose of drug
dosing, creatinine clearance should be measured or
estimated.

For males:
CrCl

140  Patient0 s age in years  Body weight in kg

72  Serum creatinine in mg=dL

For females:
CrCl 0:85  CrCl determined using formula for males
If the individual is obese or not within 30% of their ideal
body weight, other methods of calculating creatinine
clearance should be used. Ideal body weight (IBW) or
adjusted body weight (ideal body weight plus 40% of
obese weight) instead of actual body weight in the
Cockcroft-Gault equation will provide a better estimate
of creatinine clearance.

The average BSA of an adult is 1.73 m2.

CALCULATIONS FOR PEDIATRIC DOSES

Various pediatric formulas have been used historically to
calculate APPROXIMATE pediatric dosages.
Youngs rule, based on age:
Age
 Adult dose Dose for child
Age 12
Frieds rule for infants:
Age in months
 Adult dose Approx: dose for infant
150

Clarks rule, based on weight:

Weight in lb  Adult dose
Dose for child
150
BSA approximation of childs dose:
Child BSA
 Adult dose Approx: dose for child
1:73 m2

STOCK SOLUTIONS
A stock solution, commonly referred to as bulk bottle, is a
large volume of a reagent (in chemistry) or in this case,
medication. These stock solutions can be prepared by a
manufacturer or compounded in the pharmacy.
Pharmacists typically take stock solutions and use them
to prepare weaker solutions of medications or chemicals
for laboratory or clinical use.

Example:
How many mL of a 0.5% gentian violet stock solution is
needed to prepare 1 pint of a 1:2000 solution?

Solution:
Step 1: Determine the quantity of the final solution:
1 pint 946 mL,
so

1g
X grams

200 mL
946 mL
X 0:473 grams

Step 2: Determine the amount of available solution needed

to obtain the determined quantity (0.5% gentian violet
solution contains 0.5 grams in 100 mL of solution):
0:5 g
0:473 grams

100 mL
X mL
X 94:6 mL; estimate 95 mL

IBW for males in kg 50 (2.3)(Height in inches > 60)

IBW for females in kg 45 (2.3)(Height in inches > 60)

BODY SURFACE AREA

The practioner may need to take into account body
surface area as a possible variable when determining drug
dosage (e.g., chemotherapy).
Body Surface Area (BSA) The Mosteller Formula:
r
Height cm  Weight kg
2
BSAm
3600

Pharmaceutical Calculations

RECONSTITUTION OF DRY POWDERS

Many drugs (antibiotics, steroids, and biologics) that are not
stable in solution are prepared as dry-filled solids or
lyophilized powders. Prior to use, these dry powders must
be reconstituted as a solution with a suitable diluent in the
proper volume to give specified concentration (usually
provided in the package insert). Occasionally, the physician
may prescribe a final concentration different from the one
provided by the manufacturer. Also, in some cases, the
pharmacist needs to determine if the powdered drug
contributes to the final volume of the reconstituted solution
before modifying the label instructions.

Example:
The package information of a vial containing 30 million
units of penicillin G potassium specifies that when the
appropriate amount of sterile solvent is added to dry
powder, the resulting concentration is 500,000 units per
mL. How many milliliters of sterile water for injection
are needed to prepare the following solution?
(Note: the powder accounts for 8 mL of the final volume)
Penicillin G potassium 30,000,000 units
Sterile water for injection
Provide a solution containing 500,000 units per mL
500; 000 units
1 mL

30; 000; 000 units X mL

X 60 mL
60 mL  8 mL 52 mL, answer