INTEGRATED DISPENSING PRACTICE- PHAR4812

EXTEMPORANEOUS AND DOSAGE CALCULATIONS ASSIGNMENT

INSTRUCTIONS:

Please complete ALL calculations, showing all of your steps and working out, and submit the answers (as
hard copy) together with an assignment cover sheet, to the main Faculty of Pharmacy Student
Administration Office by 3pm, Friday 6th May 2016.

This assignment must be passed in order to pass the overall unit of study mark. Pass mark is 50%.

If you have any questions, please contact Associate Professor Parisa Aslani on (02) 9036 6541 or
parisa.aslani@sydney.edu.au.

Question 1

George brings his daughter Chloe into the pharmacy. She is visibly unhappy and keeps tugging at her ear.
She also looks flushed and George says that she has a slight fever. He hands you a script to be filled for:

Amoxil Syrup Forte 250mg/5mL 4mL q8h

Chloe is 5 years old and weighs 16kg.

Upon asking George about what the doctor has told him about why Chloe will be taking the Amoxil syrup,
he says that she has a middle ear infection and has been confirmed to be caused by a bacterial infection.
George says he also wants some Panadol 1-5 years Elixir as well since he has run out.

a) Referring to the AMH, what is the dose range appropriate for Chloe to be prescribed? Express in
both mg and mLs of Amoxil Syrup Forte required per dose
b) Referring to the APF, what is the dose range appropriate for Chloe to be prescribed? Express in
both mg and mLs of Amoxil Syrup Forte required per dose
c) Looking at the Amoxil Syrup Forte Product Information, is the dose prescribed for Chloe’s middle
ear infection indicated and appropriate? Show all working.

Question 2

In your compounding lab at work, you have a 37% w/v formaldehyde solution available. You receive a
prescription for a 3% formaldehyde aqueous solution for Marianne, a patient in the nursing home that your
pharmacy provides medicines for. She is suffering from plantar warts and her doctor has prescribed her a
formaldehyde solution to soak her feet in, which may help to get rid of these warts.

a) To make up 250 mL of a 3% aqueous solution of formaldehyde, how much of the 37% solution do
you require? Show all working
b) If Marianne had a script for 37% formaldehyde solution and was instructed to make up 200mL of
3% solution by herself, to use every time she needs to soak her feet, what instructions for dilution
would you give her? Round your answer to 1 decimal place. How many 200mL batches of 3%
solution could she make from a quantity of 500mL of 37% formaldehyde aqueous solution?

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Question 3

You are a hospital pharmacist on duty. A 50 year old male patient has just been admitted, and is suffering
from acute pyelonephritis. The registrar on duty has asked for your advice on gentamicin IV.

The patient’s creatinine clearance is 75 mL/min and weighs 61kg (assume ideal body weight= 61kg).

a) What is the starting dose range for gentamicin, as specified in the AMH, that is appropriate for this
patient, when taking into consideration the information given?

b) The hospital stocks 80mg/2mL ampoules of gentamicin solution for injection. After conveying the
information derived in part a) to the doctor, the doctor agrees to a dose of 4.25mg/kg daily to be
administered to the patient. How many ampoules are required to obtain the daily dose for this
patient? How many mLs of the solution for injection do you require?

c) The doctor has asked you to prepare a dilution so that the gentamicin dose can be infused over a
period of 30 minutes. The registrar has specifically requested that the total daily dose be
administered in 3 equal doses at different times of the day. The concentration of the infusion
required is 0.8mg/mL, where the gentamicin solution for injection is to be diluted with sterile saline
solution. How much saline solution (in mLs) do you require to perform the dilution to make up each
dose? Show all working.

Question 4

You work at a compounding pharmacy, the only one that is accessible to patients within a 10km radius. A
script comes in one morning for Vitamin D3 (colecalciferol) capsules from the endocrinologist practising at
the hospital in the next suburb:

1.2mg colecalciferol capsules- Mitte 12

a) Express this dose in International Units (IU). Show all working.

b) You know that there are different strengths of colecalciferol available that can be used to
compound these capsules. In the compounding lab, the active ingredient colecalciferol is available
in a dry powder for use. Each gram of this particular dry powder is equivalent to 100,000 IU
colecalciferol. Calculate how much dry powder you would need to weigh out to make these
capsules. What is the mass of the active ingredient powder required per capsule?

Question 5

Thomas suffers from severe bouts of acute asthma. His mother presents to you a script for Ventolin
nebules and Atrovent Unit Dose nebules.

Thomas is currently 12.5 months and weighs 9kg.

a) What is the recommended dose of Ventolin and Atrovent for Thomas, taking into account Thomas’
age and weight.
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 b) The doctor has annotated on the script that the Ventolin and Atrovent doses may be mixed if
needed. What is considered to be a suitable final volume for use in a nebuliser? How much NaCl
solution is required for dilution if Ventolin and Atrovent are to be administered together as a single
dose? How much saline solution is required to make a suitable final volume if diluting a Ventolin
dose individually for nebulisation?

Question 6

Natalie, a young woman, comes in late one night as you are about to close up. She hands you a script from
the hospital, that is within walking distance to your pharmacy, for:

Prednisolone 25mg and 5mg

50mg tds for 4 days then taper dose by 5mg every 2 days until zero then cease.

Mitte 1 month supply

Natalie tells you that she has had this medicine before. She is currently experiencing a flare up of her SLE
and has scheduled an appointment with her rheumatologist in 3 week’s time, once the flare up is under
control, to see what needs to be done in future to better manage her condition. At this appointment, her
rheumatologist will also decide whether or not she needs to continue to take prednisolone after the month
is up.

Calculate how many prednisolone tablets of each strength you will dispense for Natalie which will equate
to a month’s supply, allowing her to finish the course prescribed.

(You may wish to construct a table to help you determine the month’s supply required)

Question 7

A mother has just walked into the pharmacy and has wandered over to the cough and cold section of your
pharmacy. When coming to assist her, she tells you that she has previously bought a few bottles of the
Nurofen for Children Baby 3+ months from the pharmacy.

Her son Ben is 20 months old and she tells you that she is confused about the difference between the
Nurofen for Children Baby 3+ months liquid (baby drops) and the Nurofen for Children 1–5 years liquid.

a) What concentration of ibuprofen does each product contain?

b) Why would the baby drops have a higher concentration of ibuprofen per mL?
c) The mother asks you what the dose for her child would be. Ben weighs 16kg. Since she still has
some of the Nurofen for Children Baby 3+ months at home, she wants to finish these before buying
the Nurofen for Children 1–5 years liquid. Calculate the appropriate dose (amount in mL of Nurofen
for Children Baby 3+ months needed per dose) for Ben’s weight.
d) What is the maximum number of doses, as calculated in part c), that can be administered to Ben
medically unsupervised?

END OF QUESTIONS

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