MOCK CALCUTAON 8

Adekolo Umbayaka is a 67 year-old men who weighs 60kg, who attends a pre-admission clinic at your hospital 1-month prior to having an orthopaedic surgery. He is found to have moderate anaemia and his haematology consultant decides to prescribes a course of subcutaneous epoetin alfa to reduce the risk of operative bleeding and blood loss. (The monograph of epoetin alfa from the BNF can be seen in Appendix B). Calculate the total units given for the duration of the course that will be given to Mr Umbayaka:

Miss Sarah Willis is a 3-year-old girl weighing 22kg. She suffers from renal disease and

her paediatric consultant doctor wants her to start taking alfacalcidol to prevent vitamin D deficiency. The senior paediatric registrar decides to prescribe her 25nanograms/kg once daily for the first two weeks and then 15nanograms/kg thereafter. One drop of alfacalcidol (2mcg/ml) oral drops contains approximately (0.1mcg of alfacalcidol). How many drops of the alfacalcidol oral drops will Miss Willis use in the first 2 months? Give your answer to the nearest whole drop.

Mr MA has been diagnosed with stage IV Non-Hodgkin’s lymphoma and at a stage where the cancer is uncurable, the consultant oncologist has decided to commence palliative care treatment for Mr MA and has been referred to the pain team. The pain team have visited Mr RT who has been taking 80mg MST® tabs BD and 15ml Oramorph® oral solution QQH PRN. Over the past week he has been taking Oramorph® (in addition to his MST) two or three times a day. The pain team decide it would be bet-ter if he was started on a fentanyl patch. Unfortunately, they didn’t suggest a strength to the GP who has now called you to suggest the strength of fentanyl patch. Below shows the monogram of patch equivalence from the BNF:

You are working in a pharmaceutical manufacturing company as a quality assurance pharmacist and required to produce isotonic solution of 0.5% chloramphenicol eye drops using NaCl. Each chloramphenicol eye drop is produced as a 10ml. Calculate the amount of NaCl in micrograms that is required to produce a 10ml bottle of 0.5% chloramphenicol isotonic, given that the 0.5% chloramphenicol solutions freezes at -0.05 °C and a 0.5% w/v NaCl solution freezes at -0.676 °C. (NB: isotonic solution freezes at -0.52°C)

You a pharmacist working a community setting and undertake extemporaneous dispensing of medicines. You receive a prescription for digoxin 40mcg od for 25 days. The lowest strength of digoxin available to you is 62.5mcg tablets each weighing 50mg. You decide to make 120mg powders each containing 40mcg of digoxin using lactose as a diluent. What weight of lactose in grams is required to supply this Rx?

Master Brian Collins who weighs 22lb, has been admitted to hospital and has been

diagnosed with nephrotic syndrome. The specialist doctor prescribes

spironolactone 25mg/5ml at a dose of 3mg/kg daily in two divided doses.

How many mL of spironolactone 25mg/5ml should Master B.Collins receive for each

dose? (NB: Give your answer to nearest whole number)

You are junior pharmacist working on the renal transplant ward have been asked by the FY1 doctor on call to recommend a dose of gentamicin as a loading dose for a 65 year old female patient with neutropenic sepsis that has been admitted to your ward. The hospital policy is to base the dose upon the patients Creatinine Clearance (as below). The patient weighs 55kg and has a serum creatinine that has been taken today of 107 micromol/L. Her height is 5’6. What dose and what volume of Cidomycin® injection would you recommend, if the ward has syringes graduated to 0.1ml? Cidomycin® injection is available in 40mg/ml vial. (NB: Give your answer to one decimal place)

Mrs Maxine Adams is 77-year-old women with medical history of hypertension, hypercholesterolaemia, osteoarthritis. She has attended at the outpatient nephrology clinic to evaluate her declining renal function that has been alarmed by her regular GP after conducting blood results for the past few months and whether her declining renal function requires to alter the dose of her regular medications. She is 5 feet and 6 inches tall and her biochemistry results are provided below:

The formula for Ideal Body Weight is given below:

Ideal Body Weight, kg, Men = 50 + (2.3 for every inch over 5 feet)

Ideal Body Weight, kg, Women = 45.5 + (2.3 for every inch over 5 feet)

The Cockcroft and Gault Formula is given below:

Estimated Creatinine Clearance = (140-age) x Weight (kg) x Constant In mL/min

Serum Creatinine

Constant = 1.23 Men; 1.04 Women

What is the estimated creatinine clearance for Ms R? (Give your answer to the

nearest whole number.)

Mr Adrian Smith is 70-year-old man who has received a prescription for 20 x 1g suppositories each containing 10mg of bisacodyl to treat his chronic constipation. You are required to prepare the suppositories extemporaneously using certain excipients and ingredients. Bisacodyl has displacement value of 1.2 and 1.2g of glycogelatin base is equal to a 1g of Theobroma oil base. You are required to make a 20% excess to allow for losses in preparation and use the glycogelatin base. Calculate the final weight in grams of each suppository? (N.B Give your answer to one decimal place)

You working as a locum pharmacist with a second-year undergraduate pharmacy student currently undertaking their work-based placement. The student has asked you to explain and help them understand on tackling suppositories calculations and explaining the displacement value as the number of parts of suppository ingredients that displace 1 gram of the base. The approximate cocoa butter displacement value for zinc oxide is 5, which means 5 g of this ingredient will displace 1g of the cocoa butter base. Calculate the quantity of cocoa butter in grams required to make ten suppositories (3-g mould) each containing 100mg of zinc oxide.

A junior doctor on the gynaecology ward prescribes ceftriaxone 250mg as a single dose for the treatment of acute uncomplicated gonorrhoea to be given by deep intramuscular injection. Ceftriaxone is available as 1-g vial. Each 1-g vial has a displacement volume of 0.45mL. The nurse adds 2.5mL of 1% lidocaine injection BP to reconstitute the contents of the vial. What quantity in mL of the reconstituted solution must the nurse administer? (Give your answer to one decimal place)

You are working in a pharmacy where extemporaneous dispensing of certain products are needed to be batched and produced for patients/suppliers. You have just received an order from one of your supplies from derma-skin care to extemporaneously prepare 10% w/v of salicylic ointment. Due to shortage of supply of certain strengths of salicylic ointments you only have 5% salicylic acid ointment in stock. Calculate the amount in grams of salicylic acid should be added to 40g of stock ointment to produce a 10% w/v ointment. (N.B Give your answer to two decimal places).

You are on your first day of your aseptic training as a pre-registration pharmacist at your hospital. The senior aseptic pharmacist has asked you to prepare a hydrogen peroxide solution required to be used for skin disinfection for MRSA screening. You have been told by the senior pharmacist that you need to mix together 350ml of hydrogen peroxide solution BP 6% and 250ml of hydrogen peroxide solution BP 10 vols. What will be the final concentration % v/v of the resulting solution?

You are working in pharmaceutical manufacturing company manufacturing ointments and creams for patients with psoriasis and dermatitis and you are given a set formula and set amount ingredients to be mixed to

produce a standard size cream/ointment. In order to produce a standard ointment you are required to mix together 160g of 5% w/w calamine in white soft paraffin (WSP), 375g of 1% w/w calamine in WSP and 95g of WSP. What is the %w/w concentration of calamine in the mixture to two decimal places?

You are working on-call on the surgical unit where one of the nurses calls you from the neonatal intensive care unit regarding starter parenteral nutrition for 2-week pre-term neonate. Earlier in the day your pharmacy department supplied the ward with a 50-mL vial of glucose 50% and a 500-mL bag of glucose 10%. The nurse needs to make up a 50-mL syringe containing 30% glucose. How many mL of glucose 50% will the nurse need to use? Give your answer to one decimal place.

You are working as an aseptic pharmacist and have been made aware that there is a shortage of 0.9% normal saline solution in the hospital and you are required to use alternative stock solution available to produce that sufficient supply of 0.9% normal saline solution for the hospital. The chief pharmacist has made you aware that in order to meet the supply and demand of the hospital you will be required to produce a 70-L batch of normal saline (0.9% w/v) to fulfil the hospital demand for patients. You have available to you a 10% w/v concentrate. How much of this concentrate do you need to use in order to produce a 70-L batch of the required 0.9% normal saline solution?

You are pharmacy student currently undertaking your work-based placement rotations as part of your MPharm undergraduate degree to gain experience and achieve the GPhC pharmacy standards for pharmacy professionals. As part of the standards you are required to be able to deal and be confident in pharmaceutical calculations. During your work-based placement a senior pharmacist you are shadowing has assigned you to a calculation task where a stock solution containing 25% w/v of chlorhexidine gluconate is used to prepare an antiseptic such that when the antiseptic is diluted 1 in 25, a 1 in 500 wash solution is obtained which is ready for use by the patient. How many mLs of the stock solution of chlorhexidine gluconate is required to prepare 7 litres of the antiseptic to fulfil a bulk manufacturing order for the hospital to use as part of their MRSA screening on the wards?

You are currently working as a pharmacy pre-registration placement at one of the pharmaceutical manufacturing companies that produces detergents and household antiseptics on a large scale. One of the senior quality assurance pharmacist has approached you to solve a dilution calculation for the production of chloroxylenol which is the main detergent used in Dettol antiseptic cleaning product. The pharmacist has asked you to calculate the volume of water that must be added to 250ml of a 10%w/v solution of chloroxylenol to produce a 1:20 of chloroxylenol solution that is found in standard size of Dettol antiseptic liquid sold in retail.

A 5-year old child has been having trouble with inhaler technique and coordination of their salbutamol inhaler and has been switched from salbutamol inhaler to salbutamol solution. The consultant has prescribed the child 300ml of salbutamol solution 2mg/5ml solution. The outpatient pharmacy in the hospital produces this solution extemporaneously and only has salbutamol sulphate available to produce the solution. Work out how much salbutamol sulphate in grams would be needed to produce the above solution with the following information shown below to prepare the solution extemporaneously?

Molecular weights:

– Salbutamol C13H21NO3 = 239

– Salbutamol sulphate (C13H21NO3)2H2SO4 = 576

Harbhajan Singh is a 9-year-old child on the children’s surgery unit. The nutrition team on the ward saw Mr Singh and has prescribed the following TPN prescription shown below:

The aseptic unit has the following table of molecular masses for the compounds commonly used to make up the TPN:

How many millilitres of calcium chloride dihydrate solution 13.4% w/v will be required to get the necessary calcium requirements for Mr Singh above TPN regimen? (NB: Give your answers to the nearest whole millilitre)

Mr Jaspreet Pandey, a 28-year-old athlete who weighs 75kg visits his pharmacy to buy three packs of O.R.S hydration soluble tablets to prevent dehydration. He is currently preparing to run the marathon in extremely hot conditions for his triathlon competition. Each O.R.S hydration soluble tablet pack contains 24 tablets. Mr JP mentions to you that he finishes the three packs in one week during his normal routine training for the competition.

(NB: Weight of one tablet: 3 grams, Molecular mass of sodium chloride: 58.5 g/mol, Molecular mass of potassium chloride: 74.5 g/mol)

Work out the amount of millimoles of chloride that Mr J.P will have received from the O.R.S hydration tablets during the course of one week?

Mrs Maya Janes is a 55-year-old patient on the oncology ward who weighs 62kg and a height of 1.63 metres. Mrs M.J has recently been diagnosed with advanced stage B-cell chronic lymphocytic leukaemia (CLL). The oncologist registrar has decided to start Mrs M.J on fludarbine phosphate by intravenous infusion using 50mg/2ml injection vials in 0.9% NaCl solution. Once the vials are reconstituted, each vial is stable for at least 8 hours only. The drug monograph for fludarbine phosphate can be seen in Appendix C.

The formula for calculating body surface area is provided below:

If Mrs M.J is given the maximum full length of treatment to achieve a successful response, how many vials will be required for the duration of the chemotherapy treatment ?

Miss Rebecca Hayes is 28 weeks’ pregnant and has been diagnosed with anaemia from iron deficiency. She was prescribed a trial of oral ferrous gluconate from her GP but she has failed to produce a clinically relevant response. She has been admitted on the gynaecology ward due to her rapid decline in iron levels and the obstetric team now want to trial her on IV Venofer to achieve a haemoglobin level of 15g/dL. Miss R.H’s notes contain the following information:

Age: 21 years Height: 5 feet 3 inches

Weight before pregnancy: 64kg

Gestation: 28 weeks

Iron: 3.8 micromol/L

Haemoglobin: 7.6g/dL

BP: 128/91mmHg

Calculate the volume of Venofer Miss R will need over the course of her treatment. Give your answer to the nearest whole millilitre. The SPC for Venofer can be used to support your calculations: http://www.medicines.org.uk/emc/medicine/24168

You are working as an aseptic pharmacist and required to make a 0.5ml unit dose of pilocarpine 2% eye drop isotonic. Note 1% w/v pilocarpine solution freezes at -0.14 ◦C and 1% w/v of NaCl solution freezes at -0.576 ◦C and isotonic solution freezes at -0.52 ◦C. Calculate the mass in milligrams of NaCl required to make a 0.5ml unit dose of pilocarphine 2% eye drop isotonic.(NB: Give your answers to one decimal point).

The amount of an adjusting substance required to make a solution isotonic can be calculated using proportionality sets or as follows:

W = (0.52 – a)/b

W = % w/v of adjusting substance in the final solution

a = freezing point depression of unadjusted solution

b = freezing point depression of water caused by 1% w/v of adjusting substance

Mike Travis is a 38-year-old man who presents to the emergency room with a presenting complaint of fever for the past 24 hours. He indicates that he has been taking 500 mg of paracetamol around the clock with no relief and that he does not take any other medications. After careful deliberation, the A&E consultant diagnoses MT with fever of unknown origin and decides to empirically treat for viral encephalitis. He orders aciclovir 30 mg/kg/day divided every 8 hours and requests you to assist with dosing. MT’s chart indicates that he weighs 180 lb and is 188 cm tall. The dosing for aciclovir required ideal body weight (IBW). Calculate MT’s aciclovir dose for every 8 hours treat for viral encephalitis.

Formula to calculate IBW:

Men: 50 kg + (2.3 kg x the number of inches over 5 feet)

Women: 45.5 kg + (2.3 kg x the number of inches over 5 feet)

Mrs Penelope Rodriguez is 55 year old mother who weighs 55kg has been admitted to the intensive care unit ward in the emergency department. The emergency medicine consultant has decided to prescribe the patient propofol (Diprivan 1%) after consulting the anaesthesia for sedation in preparing for life-threatening surgery of a punctured thorax. The emergency medicine consultant has been advised to prescribe Diprivan 1% via continuous infusion at a dose of 2.0mg/kg/hour. Diprivan 1% is available as a 100ml vial and needs to be diluted with dextrose 5% to 2mg/ml prior administration. The emergency medicine consultant has asked you what the suitable infusion flow rate in mL/minute for the administration of Diprivan 1% is needed to be given to Mrs P.Rodriguez ? (NB: give your answer to two decimal places).

Mrs Samina Qureshi 43-year-old women has been admitted to neurosurgery ICU ward after severe car accident that has led to aneurysmal subarachnoid haemorrhage. the senior neurosurgeon registrate has decided to initiate IV nimodipine infusion that needs to be delivered at dose of 5mg/kg/hour for 2 hours. After 2 hours of the IV infusion Mrs Qureshi blood pressure showed no signs of decrease in blood pressure hence the dose was decreased to 2.5mg/kg/hour. The neurosurgeon registrar has asked you to work out how long would a 100ml infusion bag at a concentration of 100mg/0.5ml last if the patient weighs 75kg? (NB: Answer to the nearest whole number)

An infusion of ketamine is to be delivered at a dose of 4.5mg/kg/hour for the induction and maintenance of anaesthesia for a patient undergoing a coronary artery bypass graft. The total length of the procedure is 5hrs. The patient is administered a dose of 4.5mg/kg/hour for the first 3 hours of the procedure after this time the dose is decreased to 2mg/kg/hour until the end of the procedure, after this administration change.

How long would it take for the remainder of a 500ml infusion bag at a concentration of 2.5mg/ml to be administered if the patient weighs 142 pounds?

(Give your answer to the nearest minute)

Mr TK who weighs 92kg is admitted in the cardiac ICU ward after coronary bypass surgery and is in stable condition however requires to be administered a saline drop with a fixed drop size and adjustable flow at a rate of 1.5 litres of saline 0.9% over 12 hours due complications of the coronary bypass surgery.

Assuming that 1ml is equivalent to 15 drops, what should the drop rate be set to in drops/min? Give your answer to a whole number.

You are working as a pharmacist in clinical trials and conducting a trial on a placebo drug X for the treatment of rheumatoid arthritis. Patient A weighing 60kg is to be given Drug X by intramuscular administration. The calculated volume of distribution of Drug X is 15 L/kg and maximum blood levels are reached between 30 and 90 minutes after an intramuscular dose. Drug X is also estimated to have a half-life of 20 hours. Patient A is administered a dose of 100mg in 2mL by intramuscular injection. As it undergoes first pass metabolism, it has a bioavailability of 80%.What would be the expected concentration in mcg/L in Patient A’s blood after 60 minutes of administering Drug X assuming maximum blood concentration has been achieved? (N.B Give your answer to one decimal place.)

Mrs Pamela Jenkins has been admitted to your hospital after suffering a stroke. She regularly takes Digoxin tablets 250mcg once daily to control the rate of her heart but as she can no longer swallow tablets her doctor wants to change her onto an equivalent dose of Digoxin elixir. What dose of the digoxin elixir will provide the equivalence dose of her tablets? (N.B Give your answer to the nearest whole number).

Bioavailability drug X, elixir = 0.6

Bioavailability drug X, tablets = 0.7

Mrs Diane Burke has been diagnosed with atrial fibrillation and requires an oral loading dose of digoxin. She is 65 years old and weighs 50Kg. The junior doctor on the cardiology ward has asked you to calculate the loading dose would you recommend for Mrs D.B? Following information for Mrs D.B can be seen below:

Volume of distribution 6Litres/Kg;

therapeutic range 1-2micrograms per L;

Bioavailability digoxin tablets = 0.9;

salt fraction = 1