7: Calculation of Doses: General Considerations

Practice Problems
 
Doses: Solid Dosage Forms
 
 
1. The ascending dose schedule of ropinirole (REQUIP) in the treatment of Parkinson's
disease is:
  How many 0.25-mg tablets would provide the 4 weeks of treatment?
 
 
2. The following regimen for oral prednisone is prescribed for a patient: 50 mg/day × 10
days; 25 mg/day × 10 days; 12.5 mg/day × 10 days; and 5 mg/day × 10 weeks. How many
scored 25-mg tablets and how many 5-mg tablets should be dispensed to meet the dosing
requirements?
 
 
3. A physician reduces a patient's once-daily dose of conjugated estrogen (PREMARIN)
from tablets containing 0.625 mg to tablets containing 0.45 mg. What is the total reduction
in conjugated estrogens taken, in milligrams, during a 30-day month?
 
 
4. A fixed-dose combination product contains amlodipine besylate and atorvastatin calcium
(CADUET) for the treatment of both hypertension and hypercholesterolemia. If a
physician starts a patient on a 5-mg/10-mg dose for 14 days and then raises the dose to 10
mg/20 mg, how many milligrams of each drug will the patient take during the first 30 days?
 
 
5. A patient cuts 100-mg scored tablets to take his 50-mg prescribed daily dose. A
prescription for thirty 100-mg tablets costs $45, and a prescription for thirty 50-mg tablets
costs $40. The patient asked the pharmacist to weigh an uncut tablet on an electronic
balance into two “halves.” The uncut tablet was found to weigh 240 mg, and the cut
“halves” weighed 125 mg and 115 mg, respectively. (a) How much money did the patient
save on a monthly basis by dosing with half tablets? (b) What was the percentage error in
the weight of the cut tablets compared with “exact halves”?
 
 
6. The recommended dose of memantine HCl (NAMENDA) is:
  How many 5-mg tablets must be dispensed for a 4-week supply of the medication?
 
 
7. Prior to a colonoscopy, a patient is instructed to take OSMOPREP tablets each of which
contains 1.102 g sodium phosphate monobasic monohydrate and 0.398 g sodium phosphate
dibasic anhydrous. The dose is:  

  The evening before the procedure: 4 tablets with 8 ounces of clear liquids every 15
minutes for 5 cycles
  Starting 3 hours before the procedure: 4 tablets with 8 ounces of clear liquids every 15
minutes for 3 cycle
 
How many tablets, how much liquid, and how much total sodium phosphates are taken?
a. 8 tablets, 16 ounces liquid, 2 g sodium phosphates
b. 16 tablets, 1000 mL liquid, 32 g sodium phosphates
c. 32 tablets, 1 quart liquid, 40 g sodium phosphates
d. 32 tablets, 0.5 gallon liquid, 48 g sodium phosphates
 
 

8. Varenicline tartrate (CHANTIX), for smoking cessation, is available in two strengths,

0.5-mg and 1-mg tablets. The dose is:  

  Days 1 to 3: 0.5 mg once daily

  Days 4 to 7: 0.5 mg twice daily (am and pm)
  Days 8 to end of treatment: 1 mg twice daily (am and pm)
 
The treatment period is 12 weeks. How many 0.5-mg tablets and 1-mg tablets should be
dispensed?
a. 7 0.5-mg tablets and 11 1-mg tablets
b. 8 0.5-mg tablets and 84 1-mg tablets
c. 10 0.5-mg tablets and 84 1-mg tablets
d. 11 0.5-mg tablets and 154 1-mg tablets
 
Doses: Drops
 
 
9. A ciprofloxacin otic solution contains 0.5 mg of ciprofloxacin in a 0.25-mL single-dose
package. Based on 20 drops/mL, (a) how many drops would be administered and (b) how
many micrograms of ciprofloxacin would be in each drop?
 
 

10.  

Acetaminophen oral drops

 Disp. 15 mL
Sig. 0.5 mL t.i.d.
a. If acetaminophen oral drops contain 1.5 g of acetaminophen per 15-mL container, how
many milligrams are there in each prescribed dose?
b. If the dropper is calibrated to deliver 22 drops/mL, how many drops should be administered
per dose?
 
 
11. RESTASIS ophthalmic emulsion contains 0.05% w/v cyclosporin. If a dose of one drop
measures 28 μL, how many micrograms of cyclosporin are present?
 
 
12. 21 The oral dose of a drug is 2.5 mg. If a solution contains 0.5% w/v of the drug in a
dropper bottle that delivers 12 drops/mL, how many drops would supply the dose?
 
 
13. Infants' MYLICON antigas drops contain 2 g of simethicone in a 30-mL container. (a)
How many milligrams of simethicone are contained in each 0.3-mL dose? And if 12 doses
per day are not to be exceeded, calculate the corresponding 12-dose (b) volume and (c)
simethicone content.
 
Doses: Oral Liquids
 
 
14. Rimantadine HCl syrup contains 2.4 g of rimantadine HCl in each 240 mL of syrup.
How many milligrams of rimantadine HCl would there be in 2.5 mL delivered by oral
dispenser?
 
 
15. If a liquid medicine is to be taken three times daily, and if 180 mL are to be taken in 4
days, how many tablespoonfuls should be prescribed for each dose?
 
 
16. The usual starting dose of sodium oxybate is 4.5 g per night in two equally divided
doses, taken 2.4 to 4 hours apart. A sodium oxybate oral solution is available in 180-mL
bottles, containing sodium oxybate, 50% w/v. How many divided doses are available in
each container?
 
 
17. The dose of posaconazole in the treatment of oropharyngeal candidiasis is 100 mg twice
a day on the first day and then 100 mg once a day for the next 13 days. Posaconazole oral
suspension (posaconazole, 40 mg/mL) is available in 4-fluidounce bottles. How many bottles
should be dispensed to meet the dosing requirements?
 
 
18. A physician prescribes tetracycline HCl syrup for a patient who is to take 2
teaspoonfuls four times per day for 4 days, and then 1 teaspoonful four times per day for 2
days. How many milliliters of the syrup should be dispensed to provide the quantity for the
prescribed dosage regimen?
 
 

19. Ipecac oral solution has the following formula:  

Powdered
  70 g
ipecac
Glycerin  100 mL
Syrup ad 1000 mL
 
Powdered ipecac contains 2 grams of the combined alkaloids emetine and cephaeline in
each 100 grams of powder. Calculate the quantity of these alkaloids, in milligrams, in each
5-mL dose of ipecac oral solution.
 
 
20. A dose of digoxin for rapid digitalization is a total of 1 mg, divided into two or more
portions at intervals of 6 to 8 hours. How many milliliters of digoxin elixir containing 50
μg/mL would provide the 1 mg dose?
 
 
21. Ciprofloxacin (CIPRO) oral suspension contains 250 mg of ciprofloxacin per 5 mL. A
physician prescribed 125 mg of ciprofloxacin q.i.d. × 10 days. (a) How many doses are
needed? (b) How many milliliters should be given per dose? (c) How many milliliters of
ciprofloxacin oral suspension containing 250 mg per 5 mL should be dispensed?
 
 
22. A patient has been instructed to take 15 mL of alumina and magnesium oral suspension
every other hour for four doses daily. How many days will two 12-fl. oz. bottles of the
suspension last?
 

23.  

Dextromethorphan HBr  50 mg/tsp

Guaifenesin syrup ad 120 mL
Sig. ʒi q.i.d. a.c. & h.s.
 
How many grams of dextromethorphan HBr would be needed to fill the prescription?
 
 
24. The dose of AUGMENTIN oral suspension for a patient is 5 mL b.i.d. Each 5 mL of
suspension contains 400 mg of amoxicillin and 57 mg of clavulanic acid. If the suspension is
to be taken for 10 days and is available in 50-mL, 75-mL, and 100-mL containers, calculate
(a) the least wasteful package size to dispense and (b) total quantity of amoxicillin taken
during the treatment period.
 
Doses: Injections
 
 
25. A physician ordered 20 mg of MEPERGAN and 0.3 mg of atropine sulfate to be
administered preoperatively to a patient. MEPERGAN is available in a syringe containing
25 mg/mL, and atropine sulfate is in an ampul containing 0.4 mg per 0.5 mL. How many
milliliters of each should be used in filling the medication order?
 
 
26. How many milliliters of an injection containing 250 mg of aminophylline in each 10 mL
should be used in filling a medication order calling for 15 mg of aminophylline?
 
 
27. 22 Pediatric LANOXIN injection contains digoxin, 100 mcg/mL. What volume must be
administered to provide a dose of 0.04 mg?
 
 
28. In treating Crohn's disease, the recommended dose of the monoclonal antibody
adalimumab (HUMIRA) is 160 mg as the first dose, a second dose of 80 mg 2 weeks later,
then a third dose of 40 mg 2 weeks after the second dose, and followed by a maintenance
dose of 40 mg every 2 weeks. How many prefilled syringes, each containing adalimumab,
40 mg/0.8 mL, would be required for the initial 2 months of treatment?
 
 
29. BYETTA injection, as an adjunct for glycemic control in type 2 diabetes mellitus,
contains 250 mcg of exenatide in each milliliter of solution. The injection is available in 1.2-
mL prefilled pens. At a starting dose of 5 mcg b.i.d, (a) how many milliliters are injected
per dose, (b) how many doses are contained in each pen, and (c) how many days will the
dosing pen last the patient?
 
 
30. The biotechnology drug peginterferon alpha-2b is administered at a starting dose of 6
mcg for each kilogram of a patient's body weight (6 mcg/kg). The drug is available in
single-use 0.74-mL injections containing 40 mcg/0.1 mL, 60 mcg/0.1 mL, or 120 mcg/0.1
mL. Which product size would be most efficacious for administration to a 156-lb patient?
 
Doses: Other Dosage Forms
 
 
31. The recommended maintenance dose of beclomethasone dipropionate (BECLOVENT),
an aerosolized inhalant, is 100 mcg administered twice daily. The commercial inhaler
delivers 50 mcg per metered inhalation and contains 200 inhalations. How many inhalers
should be dispensed to a patient if a 60-day supply is prescribed?
 
 
32. A 10-week regimen for a brand of a nicotine patch calls for a patient to wear a 21-mg
patch each day for the first 6 weeks, followed by a 14-mg patch each day for the next 2
weeks, and then a 7-mg patch daily for the next 2 weeks to conclude the treatment regimen.
In all, how many milligrams of nicotine are administered?
 
 
33. A transdermal patch contains 5 mg of fentanyl and has a drug-release rate of 50
mcg/hour. The patch is worn for 72 hours. Calculate (a) the milligrams of fentanyl
delivered daily, (b) the milligrams of fentanyl remaining in the patch when it is removed,
and (c) the percentage of drug remaining in the patch when it is removed.
 
 
34. If a VENTOLIN inhaler contains 20 mg of albuterol, how many inhalation doses can be
delivered if each inhalation dose contains 90 mcg?
 
 
35. FLONASE nasal spray contains 50 mcg of fluticasone propionate per actuation spray in
each 100 mg of formulation. Each container provides 120 metered sprays. How many
milligrams of fluticasone propionate are contained in each container?
 
 
36. The dose of diclofenac sodium (VOLTAREN GEL), when applied to the hands in the
treatment of arthritic pain, is 2 g four times a day. The gel contains diclofenac sodium 1%
and is available in 100-g tubes. How many grams of the drug diclofenac sodium would be
administered per day, and how many days of treatment would be available per tube of gel?
a. 8 g diclofenac sodium per day for 8 days
b. 8 g diclofenac sodium per day for 12.5 days
c. 80 mg diclofenac sodium per day for 8 days
d. 0.08 g diclofenac sodium per day for 12.5 days
 
 
37. SYMBICORT 80/4.5 is an oral inhalation product containing 80 mcg of budesonide and
4.5 mcg of formoterol fumarate per inhalation. The dose is stated as “two inhalations twice
daily.” How much of each drug would be administered daily?
a. 160 mcg budesonide and 9 mcg formoterol fumarate
b. 0.32 mg budesonide and 0.18 mg formoterol fumarate
c. 320 mcg budesonide and 0.18 mg formoterol fumarate
d. 0.32 mg budesonide and 0.018 mg formoterol fumarate
 
 
38. An aerosol oral inhaler delivers, per actuation, 40 mcg of beclomethasone dipropionate.
The recommended starting dose is 40 to 80 mcg twice daily. The highest recommended dose
is 320 mcg twice daily. Compare the number of daily inhaler actuations to deliver the
lowest starting dose and the highest recommended dose.

Calcquiz
 
7.A. The ophthalmic solution ALPHAGAN P contains 0.15% brimonidine tartrate in 10-mL
containers. The recommended dose is one drop in the affected eye(s) three times daily. If a
glaucoma patient doses each eye, and the dropper used delivers 20 drops/mL, calculate the
quantity, in milligrams, of brimonidine tartrate administered each day.

7.B. The starting dose of sodium oxybate oral solution (XYREM) is 4.5 g/night divided into two
equal doses and administered 2.5 to 4 hours apart. How many milliliters of the oral solution
containing sodium oxybate, 500 mg/mL, should be administered in each divided dose?

7.C. A pediatric stool softener contains 393.3 mg of docusate sodium in each four fluid ounce
(118 mL) container. If the labeled dose is 2 tablespoonful for a 5-year-old child, how many
milligrams of docusate sodium would be contained per dose?

7.D. An oral inhalation (DULERA) to treat asthma provides in each inhalation 100 μg of
mometasone furoate and 5 μg of formoterol fumarate. The recommended dose is “two
inhalations twice daily (morning and evening).” Calculate the quantity, in milligrams, of each
drug inhaled daily.

7.E. In an experiment of tablet-splitting effectiveness, a pharmacist had a pharmacy student split

a previously weighed lisinopril tablet containing 20 mg of drug. On an electronic balance, the
whole tablet weighed 111.62 mg. After splitting, one “half tablet” weighed 51.21 mg and the
other “half,” 58.49 mg. There was residue powder remaining. Calculate (a) the percent of lost
tablet (residue), (b) the percent accuracy in actual weight (to ideal weight) for each “half tablet,”
and (c) the supposed quantity of drug, in milligrams (not assayed, of course) in each “half
tablet.”

Answers
Practice Problems
 
 
1. Two hundred ten 0.25-mg ropinirole tablets
2. Thirty-five 25-mg tablets and seventy 5-mg tablets
3. 5.25 mg conjugated estrogen
4. 230 mg amlodipine besylate and 460 mg atorvastatin calcium
 5.
a. $17.50
b. 4.2%
6. 70 tablets
7. (d) 32 tablets, 0.5 gallon liquid, 48 g sodium phosphates
8. (d) 11 0.5-mg tablets and 154 1-mg tablets
 9.  
c. 5 drops ciprofloxacin otic solution
d. 100-μg ciprofloxacin/drop
 10.  
e. 50 mg acetaminophen
f. 11 drops
11. 14 mcg cyclosporine
12. 6 drops
 13.  
g. 20 mg simethicone
h. 3.6 mL of infants' MYLICON drops
i. 240 mg simethicone
14. 25 mg rimantadine HCl
15. 1 tablespoonful
16. 40 divided doses sodium oxybate oral solution
17. 1 bottle of posaconazole oral suspension
18. 200 mL tetracycline HCl syrup
19. 7 mg alkaloids
20. 20 mL digoxin elixir
 21.  
j. 40 doses
 k. 2.5 mL/dose
l. 100 mL ciprofloxacin oral suspension
22. 11 + days
23. 1.2 g dextromethorphan HBr
 24.  
m. 100-mL package
n. 8000 mg or 8 g of amoxicillin
25. 0.8 mL MEPERGAN and 0.375 mL atropine sulfate injections
26. 0.6 mL aminophylline injection
27. 0.4 mL LANOXIN injection
28. 9 prefilled syringes, 40 mg/0.8 mL
 29.
o. 0.02 mL per dose
p. 60 doses per pen
q. 30 days
30. 60 mcg/0.1 mL
31. 2 inhalers
32. 1176 mg nicotine
 33.  
r. 1.2 mg fentanyl
s. 1.4 mg fentanyl
t. 28%
34. 222 doses
35. 6 mg fluticasone propionate
36. (d) 0.08 g diclofenac sodium per day for 12.5 days
37. (d) 0.32 mg budesonide and 0.018 mg formoterol fumarate 
38. 2 actuations (lowest daily starting dose) and 16 actuations (highest daily
recommended dose)