ELHT foundation year tutorial programme

Calculations 3
Using formulae, molecular weight, health economics and quantity to supply

Worked answers to practice questions

1) Mr A is 180cm tall and weighs 12 stones and 7 lb. What is his BMI?

BMI = weight in kg ÷ (height in m)2

2.2 pounds = 1kg
1 stone = 14 pounds so 12 stones = (12 x 14) pounds = 168 pounds
Total weight = 168 + 7 pounds = 175 pounds
1 pound = 1 ÷ 2.2 kg
And 175 pounds = 1 ÷ 2.2 x 175 kg = 79.545kg

180cm = 1.8m
BMI = 79.5 ÷ (1.8)2 = 79.545 ÷ 3.24 = 24.6 (to one decimal place)

2) Mr B currently has a BMI of 32. He is 1.75m tall. What is his current weight in kg?

BMI = weight in kg ÷ (height in m)2

32 = weight in kg ÷ 1.752
32 = weight in kg ÷ 3.0625
Re-arranging the equation:
Weight in kg = 32 x 3.0625 = 98kg

3) Miss C has a BMI of 18. She wishes to achieve a BMI of 22. If Miss C is 1.65m tall how
much weight does she need to gain to achieve her target BMI? Give your answer to the
nearest kg.

BMI = weight in kg ÷ (height in m)2

Current weight:
18 = weight in kg ÷ 1.652, rearranging: Weight in kg = 18 x 2.7225 = 49.005kg
Desired BMI is 22 therefore desired weight:
Weight in kg = 22 x 2.7225 = 59.895kg
Miss C therefore needs to gain 59.895 – 49.005 kg = 10.89 kg
Therefore 11 kg (to the nearest kg)
 4) Mr D weighs 101kg and is 5 foot 10 inches tall. By what percentage is he over his ideal
body weight? Give your answer to the nearest whole number.

Males
IBW = 50kg + 2.3kg for every inch over 5 foot
Females
IBW = 45.5kg + 2.3kg for every inch over 5 foot

IBW = 50 + (2.3 x 10) kg = 73k

Actual weight = 101kg
Therefore 101 – 73 = 28 kg over ideal body weight
28/73 x 100 = 38.356% Therefore 38% to the nearest whole number.

5) Mrs E weighs 11 stone 3 lbs and is 5 feet 5 inches tall. By what percentage is she over her
ideal body weight? Give your answer to the nearest whole number.
Males
IBW = 50kg + 2.3kg for every inch over 5 foot
Females
IBW = 45.5kg + 2.3kg for every inch over 5 foot

Convert weight to kg:

Weight in pounds = (11 x 14) + 3 = 157 pounds
2.2 pounds = 1 kg
1 pound = 1 ÷ 2.2 kg
157 pounds = 1 ÷ 2.2 x 157 kg = 71.36 kg

Ideal body weight = 45.5 + (2.3 x 5) = 45.5 + 11.5 = 57 kg

Amount over IBW = 71.36 – 57 = 14.36 kg

Percentage over IBW = 14.36 ÷ 57 x 100 = 25% (to nearest whole number)

OR Percentage over IBW =[ (actual weight ÷ IBW) x 100] – 100

6) Miss F weighs 61kg and is 1.65m tall. What is her BSA (use Mosteller’s formula)? Give your
answer to 2 decimal places.

BSA(m2) = height (cm) x weight (kg)

3600

Convert 1.65m to centimetres = 165 cm

BSA (m2) = SQR [( 165 x 61) ÷ 3600]
= 1.67 m2
7) Rosie is a 4 year-old child weighing 12kg who requires oral dexamethasone at a dose of
500 micrograms/m2 every 12 hours. An oral solution is available containing 2mg/5mL.
What volume of this oral solution is required for each dose? Give your answer to one
decimal place.
You will need to use the body surface area tables available in the children’s BNF

From BNF BSA is 0.56m2

Therefore each dose is 500 x 0.56 micrograms = 280 micrograms
Convert to mg = 0.28 mg
Oral solution is 2mg = 5mL
Therefore 1mg = 5 ÷ 2 mL
And 0.28 mg = 5 ÷ 2 x 0.28 mL
= 0.7mL

8) Mr G has been prescribed fludarabine at a dose of 40mg/m2 daily for 5 days every 28
days for 6 cycles, for the treatment of advanced B-cell chronic lymphocytic leukaemia. Mr B
is 1.83m tall and weighs 78kg. Fludarabine 10mg tablets are available. How many tablets
will Mr B require for the full course of 6 cycles?

BSA(m2) = height (cm) x weight (kg)

3600

BSA for Mr G = SQR [(183 x 78) ÷3600] = 1.9912307 m 2

Dose per day = 1.9912307 x 40 mg = 79.649228 mg
Only 10mg tablets are available, therefore round dose to 80mg
Therefore 8 tablets per day
Per cycle = 8 x 5 = 40 tablets
For 6 cycles = 40 x 6 = 240 tablets
9) Mr H, who has Parkinson’s disease, has been admitted to hospital for surgery. The
surgery will last for around 4 hours and the anaesthetist wishes to convert his anti-
Parkinsonian medication to a rotigotine patch prior to surgery.

Mr H’s current medication is as follows:

Co-beneldopa 25/100 MR capsules One at bedtime
Co-beneldopa 12.5/50 dispersible tablets One each morning
Co-beneldopa 25/100 capsules One at 8am, noon, 4pm and 8pm

The following information is given in the Guideline: Emergency management of

patients with Parkinson’s published on the Parkinsons UK website

Guide for estimating equivalent levodopa dosages for rotigotine patches.

1. Calculate Adjusted Levodopa Equivalent Daily dose (LEDD):

[(A) + (B)] x 0.55 = ____ mg

(A)Total adjusted daily levodopa dose B)Total adjusted daily dopamine agonist
Total daily levodopa dose in mg (excluding estimate levodopa equivalent dose
benserazide or carbidopa) Total daily dopamine agonist in mg
(e.g. Madopar 125mg QDS = 4 x 100 = X 100 (if on pramipexole/
400mg/24 hours) cabergoline/pergolide)
x20 (if on ropinirole/rotigotine)
X 0.7 (if MR/CR preparation) or x10 (if on apomorphine/bromocriptine)
X 1.3 (if on COMT inhibitor) or
X 0.91 (if MR/CR preparation and on COMT = ___ mg
inhibitor)
(the above figures refer to each
= ____ mg medication’s levodopa equivalent factor)

2. Calculate dosage for rotigotine patch

= Adjusted LEDD/20 = ____ mg

Round to nearest 2mg (to maximum of 16mg) and prescribe as 24-hour patch
Calculate the amount of rotigotine (in patch form) that should be prescribed for Mr H

Total adjusted daily levodopa dose:

Co-beneldopa 25/100 MR contains 100 mg levodopa
Need to multiply this by 0.7 as it is a modified release preparation, therefore 70mg in 24
hours
Co-beneldopa 12.5/50 dispersible = 50 mg levodopa per day
Co-beneldopa 25/100 capsules four times a day, therefore 100 x 4 mg per day = 400mg
Total = 70 + 50 + 400 = 520mg levodopa per day

Adjusted levodopa equivalent daily dose = 520mg x 0.55 = 286 mg

Dosage for rotigotine patch = 286 ÷ 20 = 14.3 mg
To nearest 2mg = 14mg
10) Mrs I, who has Parkinson’s disease, has been admitted to hospital for surgery and her
anaesthetist wishes to convert her current anti-Parkinsonian medication to rotigotine
patches prior to surgery.
Her current medication is as follows:
Stalevo 75mg/18.75mg/200mg One tablet four times daily

Calculate the amount of rotigotine (in patch form) that should be prescribed for
Mrs I

Stalevo 75mg/18.7mg/200mg contains 75mg levodopa

Four times daily so total daily dose levodopa = 4 x 75 = 300mg
As Stalevo contains entacapone:
Total adjusted levodopa equivalent dose = 300 x 1.3 = 390 mg
Adjusted levopdopa equivalent dose = 390 x 0.55 = 214.5mg
Dosage for rotigotine patch = 214.5 ÷ 20 = 10.725mg
To nearest 2mg = 10mg (to nearest mg = 11mg)
11) Miss J has anaemia due to iron deficiency and cannot tolerate oral ferrous sulphate. She
weighs 64kg and has an actual haemoglobin level of 88g/L. Calculate the total dose of
Venofer (in mL) Miss J requires. Give your answer to the nearest 0.5mL.

Calculation of dosage
The total cumulative dose of Venofer, equivalent to the total iron deficit (mg), is determined
by the haemoglobin level (Hb) and body weight (BW). The dose of Venofer must be
individually calculated for each patient according to the total iron deficit calculated with the
following Ganzoni formula, for example:

Total iron deficit [mg] = BW [kg] x (target Hb - actual Hb) [g/dl] x 2.4* + storage iron [mg]
• Below 35 kg BW: Target Hb = 13 g/dl and storage iron = 15 mg/kg BW
• 35 kg BW and Target Hb = 15 g/dl and storage iron = 500 mg
above:
* Factor 2.4 = 0.0034 (iron content of Hb = 0.34%) x 0.07 (blood volume = 7% of BW) x 1000
(conversion of [g] to [mg]) x 10
 Haemoglobin 88g/L – convert to g/dL = 8.8g/dL
Target Hb for Miss J is 15 g/dL
Storage iron = 500mg

Total iron deficit (mg) = 64 x (15 – 8.8) x 2.4 + 500 mg = 1,452.32mg

Total venofer to be administered (mL) = 1,452.32 ÷ 20 = 72.616 mL

To nearest 0.5mL = 72.5 mL

12) A 6-year-old child requires Picolax for bowel cleansing prior to an endoscopic procedure.
The recommended dose is 1 sachet before 8am and 0.5 sachet 4 to 6 hours later. Each
sachet contains 5mmol potassium. The atomic weight of potassium is 39. The
recommended daily intake of potassium for a child between 4 and 8 years of age is
3,800mg. What percentage of the child’s recommended daily intake is contained in the
prescribed amount of Picolax? Give your answer to one decimal place.

Each sachet contains 5mmol potassium

Total dose is 1.5 sachets, therefore 7.5mmol potassium
1 mmol potassium weighs 39mg
7.5mmol weighs (39 x 7.5) mg = 292.5mg

RDA = 3,800mg
Percentage from Picolax = 292.5 ÷ 3,800 x 100 = 7.7% (to one decimal place)
13) How many mg of sodium chloride are required to make 50mL of a 0.5 molar solution?
The atomic weight of sodium is 23 and the atomic weight of chloride is 35.5. Give your
answer to the nearest whole number.

A 0.5 molar solution contains 0.5 moles in one litre

If 1,000 mL = 0.5 moles
Then 50mL = 0.5 ÷ 1,000 x 50 moles = 0.025 moles = 25 millimoles

Molecular weight = 23 + 35.5 = 58.5

1 mmol weighs 58.5 mg
25 mmols weighs 58.5 x 25 mg = 1,463 mg (to nearest whole number)

14) Mrs K, who weighs 65kg, is currently nil by mouth and has been prescribed intravenous
fluids at an administration rate of 25mL/kg for the next 24 hours. The intravenous fluid
prescribed is sodium chloride 0.18%, glucose 4% and potassium chloride 0.15%. How
many mmols of chloride will she receive in 24 hours? Give your answer to the nearest
whole number.
Atomic weights:
Sodium 23; potassium 39; chloride 35.5

Total amount fluid = 25 x 65 = 1,625 mL

Sodium chloride 0.18% therefore 100mL = 0.18g and 1,625 mL = 2.925 g (2,925 mg)
Molecular weight sodium chloride = 23+ 35.5 = 58.5, therefore 58.5 mg = 1 mmol, 2,925mg =
49.99995 (50 mmol)
1 mmol sodium chloride contains 1mmol sodium ions and 1 mmol chloride ions
Potassium chloride 0.15%, therefore 100mL = 0.15 g and 1,625 mL = 2.4375 g (2,437.5mg)
Molecular weight potassium chloride 39 + 35.5 = 74.5, therefore 74.5 mg = 1 mmol, 2,437.5 mg =
32.718 (33 mmol)
1 mmol potassium chloride contains 1 mmol potassium ions and 1 mmol chloride ions
Therefore total mmol chloride = 50 + 33 = 83 mmol (to nearest whole number)

15) A child weighing 14kg has been prescribed potassium chloride 1mmol/kg twice daily. If
Kay Cee L syrup is to be used, which contains 75mg potassium chloride per mL, how
many mL should be administered for each dose? Give your answer to the nearest 0.5mL.
(see above for molecular weights)
Dose in mmol = 14 mmol
Molecular weight potassium chloride = 39 + 35.5 = 74.5
1 mmol = 74.5 mg
14 mmol = 74.5 x 14 mg = 1,043 mg
K Cee L : 75mg = 1mL
1,043 mg = 1,043 ÷ 75 = 13.9 mL = 14 mL (to nearest 0.5mL)
NB We generally assume that Kay Cee L contains 1mmol potassium per mL (but that would be too
easy)
16) Adam is a 13 year-old child with nephrotic cystinosis. He requires mercaptamine at a
dose of 1.3g/m2 daily in 4 divided doses. Adam weighs 35kg. Mercaptamine is available as
a 75mg capsule. How many capsules does Adam require for 28 days treatment?
 You will need to use the body surface area tables available in the children’s BNF

BSA = 1.2 m2 (from tables in BNF)

Therefore total daily dose = 1.3 x 1.2 = 1.56 g (1,560mg)
Each dose is 1,560 ÷ 4 mg = 390mg
As only 75mg capsules closest dose is 5 capsules (375mg)
Total number per day is therefore 20 (5 capsules four times daily)
And for 28 days 560 capsules (20 x 28)

17) Mrs L has recently had eye surgery and presents with the following prescription:
Prednisolone 1% eye drops:
1 drop each eye every hour for 5 days
1 drop each eye every 2 hours for 5 days
1 drop each eye six times daily for 5 days
1 drop each eye four times daily for 5 days
1 drop each eye twice daily for 5 days

If no doses are missed, how many 5mL bottles of prednisolone 1% are required?
Assume 20 drops = 1 mL

1 drop each eye every hour for 5 days = 2 x 24 x 5 = 240 drops

1 drop each eye every 2 hours for 5 days = 2 x 12 x 5 = 120 drops
1 drop each eye six times daily for 5 days = 2 x 6 x 5 = 60 drops
1 drop each eye four times daily for 5 days = 2 x 4 x 5 = 40 drops
1 drop each eye twice daily for 5 days = 2 x 2 x 5 = 20 drops
Total number of drops = 480 drops
20 drops = 1mL
480 drops = 24 mL
Therefore 5 x 5mL bottles required
18) Ranitidine oral solution contains ranitidine 75mg/5mL. How many mg of ranitidine
hydrochloride are required to make 100mL? Give your answer to the nearest whole
number.
(molecular weight ranitidine hydrochloride = 350.9; ranitidine 314.4)

How much ranitidine is needed?

5mL = 75mg
1mL = 75 ÷ 5, 100mL = 75 ÷ 5 x 100 = 1,500mg
The weights needed will be proportionate to the molecular weights
Let X be the weight of ranitidine hydrochloride needed:
X = 350.9
1,500 314.4

Cross multiply
314.4X = 350.9 x 1,500
X = (350.9 x 1,500) ÷ 314.4
= 1,674mg (to nearest whole number)
 19) A GP practice has decided to discontinue the practice of prescribing soluble prednisolone
for use in children under the age of ten as the ordinary prednisolone tablets will dissolve
in water. If there are 22 patients on long term treatment with 5mg prednisolone daily
and the practice, on average, prescribes 30mg prednisolone daily for 7 days for 25
patients annually, how many pounds will be saved each year ?
Prednisolone 5mg tablets - £0.88 for 28 tablets
Soluble prednisolone 5mg tablets - £53.48 for 28 tablets
Work on the basis of 52 weeks per year
Give your answer to the nearest whole pound.
Soluble prednisolone Prednisolone
22 patients 5mg daily for 52 weeks (22 x 13 x 53.48) £15,295.28 (22 x 13 x 0.88) £251.68

25 patients 30mg daily for 7 days = 42 tablets [(53.48 + 53.48/2) x 25] [(0.88 + 0.88/2) x 25]
£33
£2,005.50

Saving = total soluble prednisolone – total prednisolone:

(£15,295.28+ £2,005.50) – (£251.68 + £33) = £17,300.78 - £284.68 = £17,016 (to nearest whole
pound)
20) Mr K is to be commenced on amiodarone. He is prescribed a loading regimen as follows:
200mg three times daily for one week, 200mg twice daily for one week, then 200mg daily
thereafter. How many tablets will Mr K require for the first 30 days of treatment?

200mg tablets so:

Week 1 = 21 tablets, week two = 14 tablets.
16 days remaining, at once a day,
So total is 21 + 14 +16 = 51 tablets

21) Mrs L has been prescribed a reducing regimen of prednisolone as follows:

60mg once daily for 3 days
50mg once daily for 3 days
40mg once daily for 3 days
30mg once daily for 3 days
25mg once daily for 7 days
20mg once daily for 7 days
15mg once daily for 7 days
10mg once daily thereafter

How many prednisolone 5mg tablets are required for the next 56 days?

60mg for 3 days = 12 x 3 = 36 tablets

50mg for 3 days = 10 x 3 = 30 tablets
40mg for 3 days = 8 x 3 = 24 tablets
30mg for 3 days = 6 x 3 = 18
25mg for 7 days = 5 x 7 = 35
20mg for 7 days = 4 x 7 = 28
15mg for 7 days = 3 x 7 = 21
This accounts for 33 days, therefore 23 days left at 10mg daily = 2 x 23 = 46

Total = 36 + 30 + 24+ 18 + 35 + 28 + 21 + 46 = 238 tablets

22) Charlie is a 4 year-old child weighing 11kg who requires oral dexamethasone at a dose of
500 micrograms/m2 every 12 hours. An oral solution is available containing 2mg/5mL. If
each dose is rounded to the nearest 0.5mL. What volume of this oral solution is required
for a 14 day supply? Give your answer to the nearest mL.
You will need to use the body surface area tables available in the children’s BNF

BSA (from cBNF) = 0.53m2

Dose = 0.53 x 500 = 265 micrograms = 0.265 mg
2mg = 5mL
1mg = 5 ÷ 2mL
0.265mg = 5 ÷ 2 x 0.265 mL = 0.6625 = 0.5mL (to nearest 0.5mL)
Twice daily so 1mL per day and therefore 14mL for 14 days.

23) Miss N has been prescribed 10 mL twice daily of ferrous fumarate oral solution. The oral
solution contains 28mg per mL of ferrous fumarate. How much iron (in mg) will Miss N
receive in 7 days of treatment? Give your answer to the nearest whole number.
Atomic weight iron is 56; molecular weight ferrous fumarate is 169.9

Volume of ferrous fumarate oral solution = 10 x 2 x 7 = 140mL

Amount ferrous fumarate = 28 x 140 = 3,920 mg

The weight of iron will be in proportion to the molecular weights:

Let the weight of iron be X

X = 56
3,920 169.9

Cross multiply:
X (169.9) = 56 x 3,920
X = (56 x 3,920) ÷ 169.9 mg
= 1,292 mg
24) Saffiya, a 12 year-old child, has been prescribed acyclovir 800mg 5 times daily for 7 days
for the treatment of varicella zoster infection. As she is unable to swallow tablets
acyclovir oral suspension, 40mg per mL, has been prescribed. What volume is required
for the course of treatment?

40mg = 1mL, therefore 800mg = 20mL (800 ÷ 40)

Total volume therefore 20 x 5 x 7 = 700mL

25) A new tiotropium inhaler (tiotropium caphaler) has been granted a UK product license
and the respiratory consultant asks you to determine whether there are any potential
savings associated with switching to the new inhaler from the Spiriva handihaler. The
consultant issues prescriptions for the first three months (90 days) of treatment for each
new patient. On average he initiates treatment for 230 patients annually. The current
prices are as follows:
Spiriva 30 capsules plus handihaler £34.87
Spiriva 30 capsules £33.50
Tiotropium caphaler £12.50
Tiotropium caphaler 30 capsules £26.12

How much would be saved in the first year? Give your answer to the nearest pound.

Cost of Spiriva per patient = £34.87 + (2 x £33.50) = £101.87

For 230 patients = £23,430.10

Cost Tiotropium per patient = £12.50 + (3 x £26.12) = £90.86

For 230 patients = £20,897.80

Saving = £23,430.10 - £20,897.80 = £2,532 (to the nearest pound)

26) A GP wishes to change all his patients who are currently taking tolterodine 2mg twice
daily to tolterodine MR 4mg daily. If there are currently 34 patients on tolterodine 2mg
twice daily what would the annual (52 weeks) increase in expenditure be? Give your
answer to the nearest pound.
Tolterodine tablets 2mg 56 capsules £2.22
Tolterodine MR 4mg 56 capsules £25.78

Cost of 34 patients on tolterodine 2mg twice daily for 52 weeks:

[(52 x 7 x2) ÷ 56] x 34 x 2.22 = £981.24
Cost of 34 patients on tolterodine MR 4mg daily for 52 weeks:
[(52 x 7) ÷ 56] x 34 x 25.78 = £5,697.38

£5,697.78 - £981.24 = £4,716.14 = £4,716 to nearest pound

27) Mr O requires topical Betnovate RD cream for the eczema on both hands, arms and legs.
He is to apply the cream twice daily. What is the maximum number of 100g tubes of
Betnovate RD cream he will require for one month’s treatment?
Below is the table from the BNF with recommended amounts for an adult for a single
daily application for 2 weeks:
Area of body Quantity of creams and ointments
Face and neck 15 to 30 g
Both hands 15 to 30g
Scalp 15 to 30g
Both arms 30 to 60g
Both legs 100g
Trunk 100g
Groins and genitalia 15 to 30g

Amounts in table are for once daily – therefore multiply by 2

Amounts in table are for 2 weeks – therefore multiply by 2 for 1 month.
Maximum amounts = 30g (for hands) + 60g (for arms) + 100g (for legs) = 190 g
190 x 2 x2 = 760 grams required
Therefore 8 tubes of 100g
28) Mr P’s LDL (low-density lipoprotein cholesterol) is currently 4.6mmol/L. His GP wants to
achieve a target level of 2.9mmol/L with the minimum dose of simvastatin. Below is a
table of predicted reductions achieved with different doses of simvastatin. What is the
lowest dose (of the strengths of simvastatin available) that is likely to achieve the target?

Daily dose simvastatin Predicted reduction in LDL cholesterol

10mg 27%
20mg 32%
40mg 37%
80mg 42%

Reduction required is 4.6 – 2.9 = 1.7 mmol/L

As a percentage this is 1.7 ÷ 4.6 x 100 = 36.96%
Therefore the lowest dose simvastatin likely to achieve this is 40mg

29) Mr Q has been diagnosed with chronic thromboembolic pulmonary hypertension

following surgery and is being initiated on riociguat in accordance with the following
regimen:
1mg three times daily for 2 weeks, increased in steps of 0.5mg 3 times daily every two
weeks.
Only 500 microgram tablets are available. How many 500 microgram tablets will Mr Q
need for the first 6 weeks of treatment?

1mg (2 tablets) three times daily for 2 weeks = 84 tablets

1.5mg (3 tablets) three times daily for two weeks = 126 tablets
2mg (4 tablets) three times daily for two weeks = 168 tablets
Total number tablets required = 378 tablets

30) Ellie is 4 –years-old and weighs 17kg. She has been prescribed clarithromycin 7.5mg/kg
twice daily for 7 days for the treatment of otitis media. If the dose is rounded to the
nearest mL, how many mL of clarithromycin 125mg in 5mL will be required to complete
the course?

Dose = 17 x 7.5 = 127.5 mg

Volume : 125mg = 5mL, therefore 127.5mg = 5 ÷ 125 x 127.5 = 5.1 mL
Therefore 5mL to nearest mL
Twice daily for 7 days – therefore 10mL x 7 = 70mL
31) Suhail is a 10-year-old boy, weighing 31kg, who has been prescribed magnesium
glycerophosphate at a dose of 50mg/kg three times daily, for hypomagnesaemia.
Magnesium glycerophosphate 1g is equivalent to approximately 4 mmol of magnesium.
If a liquid magnesium glycerophosphate preparation is supplied of strength 5mmol
magnesium per 5mL, and each dose is rounded to the nearest 0.5mL, what volume will
be required for 5 days?

Each dose = 31 x 50 = 1,550 mg

Magnesium glycerophosphate 1g = 4 mmol
1.55g = 4 x 1.55 = 6.2 mmol
Liquid preparation is 1mmol = 1mL, therefore 6.2mmol = 6.2 mL
Therefore 6mL to nearest mL
Three times daily – so 18mL per day
For five days – 18 x 5 = 90 mL

32) A 5-month-old child, weighing 6.25kg, has a recurrent urinary tract infection and has
been prescribed trimethoprim 4mg/kg twice daily for 5 days then 2mg/kg as a single dose
at bedtime for a further 23 days. If the trimethoprim suspension is of strength 50mg in
5mL what volume of trimethoprim suspension is required for the course of treatment to
the nearest mL?
Dose for acute infection = 4 x 6.25 = 25mg, therefore 2.5mL per dose, 5mL per day and 25mL
for 5 days
Dose for prophylaxis 2 x 6.25 = 12.5mg, therefore 1.25mL per dose, 28.75 mL for 23 days
Total volume 53.75mL – 54mL to nearest mL

33) In a clinical trial of a statin for the prevention of cardiovascular events over a two year
period an absolute risk increase of 0.43% in the incidence of diabetes type 2 was
observed. What is the NNH (number needed to harm)? Give your answer to the nearest
whole number.

Convert percentage to number 0.43% = 0.0043

NNH = 1 ÷ ARI (absolute risk increase)
= 1 ÷ 0.0043
= 232.558 = 232 – always round DOWN for NNH

34) A patient, weighing 98kg, has been prescribed tinzaparin 175 units/kg/day (rounded to
the nearest 1,000 units), for the treatment of a deep vein thrombosis. How many 2mL
vials of tinzaparin 20,000 units/mL are required for 28 days treatment? Tinzaparin vials
should be discarded 14 days after first opening.

Dose = 175 x 98 = 17,150 units, therefore 17,000 units to nearest 1,000 units
Tinzaparin is 20,0000 units = 1mL
Therefore 17,000 units = 1 ÷ 20,000 x 17,000 = 0.85 mL
Total volume required = 0.85 x 28 = 23.8 mL
Each vial is 2mL (and multidose) – therefore minimum number vials required is 12 vials.
35) Mrs R has been admitted to hospital following a suspected overdose of digoxin tablets.
Her digoxin level is 5.9 micrograms/L. If Mrs R weighs 65kg, how many whole DigiFab
vials should be used to treat Mrs R?

Dose (in number of vials) = (Serum digoxin concentration in ng/mL) x(weight in kg)
100
Check units:
5.9 micrograms/L = 5.9 ng/mL
(to convert 5.9 micrograms to nanograms we would multiply by 1,000, but then divide by
1,000 to convert from Litres to mL)
Number of vials = 5.9 x 65
100
= 3.835
Therefore 4 vials (round to nearest whole number)

36) Mrs S has been prescribed citalopram for panic disorder. The prescribed dose 8mg (4
drops) once daily for 1 week, then 16mg (8 drops) thereafter. How many 15mL bottles of
citalopram 40mg/mL will be required for 56 days treatment?
8mg x 7 for week one = 56mg
16mg x 49 days for the remaining 49 days = 784 mg
Total = 840mg
40mg = 1mL
840mg = 21 mL – therefore 2 x 15mL bottles required.
37) A child, weighing 15kg is prescribed intravenous cefuroxime at a dose of 20mg/kg every 8
hours. The infusions, which must be prepared immediately before use, will be prepared
on the ward. If only 250mg cefuroxime vials are available, how many vials will be
required for 3 days treatment?

Dose = 20 x 15 = 300mg
Therefore require 2 vials for each dose.
2 vials three times daily = 6 vials
6 vials daily for 3 days = 18 vials

38) Mr T is currently receiving an alfentanil infusion at a rate of 2mg per hour for analgesia
and respiratory suppression as he is being mechanically ventilated. An appropriate dose
of alfentanil for 24 hours is being diluted with a suitable volume of glucose 5% and
administered continuously via a volumetric pump. Once prepared each infusion must be
used within 24 hours. How many 1mL alfentanil ampoules of strength 5mg/mL would
need to be supplied to the ward to last for 3 days?

2mg per hour – so 48mg per 24 hours.

5mg alfentanil = 1mL
So 10 ampoules needed for each 24 hour infusion bag
So 30 ampoules for 3 days
39) A clinical trial comparing a new drug to standard treatment with clopidogrel for
secondary prevention of stroke produced the following results over 5 years

No who had a stroke Total number treated

New Drug 10 250

Clopidogrel 17 333

Calculate the number needed to treat with the new drug instead of clopidogrel to prevent
one person having a second stroke. Give your answer to the nearest whole number

EER = 10 ÷ 250 = 0.04

CER = 17 ÷ 333 = 0.051
ARR = 0.051 – 0.04 = 0.011
NNT = 1 ÷ 0.011 = 90.91
= 91 always round UP for NNT

40) Mrs Adams would like her medication to be synchronised. Below is a list of her current
medication and how much of each medicine she currently has. How many furosemide
tablets are required to synchronise Mrs Adams medication?

Drug name and strength Dose and frequency Amount she currently has
Apixaban 5mg 5mg twice daily 84 tablets
Ramipril 10mg 10mg once daily 56 tablets
Bisoprolol 10mg 10mg once daily 56 tablets
Furosemide 20mg 40mg morning and 20mg 84 tablets
lunchtime
Braltus 10 microgram 10 micrograms once daily 45 capsules
capsules for use with the
Zonda® inhaler
Salbutamol inhaler 100 Two puffs when required 2 full inhalers and 1 partly
microgram per inhaler (200 (she is currently taking two used inhaler with about 10
dose) puffs four times a day) doses remaining

The medications with the greatest number of day’s supply are ramipril and bisoprolol.
The patient has 56 day’s supply of both of these.
At a dose of 3 tablets per day the patient has 28 day’s supply of furosemide 20mg tablets.
To make the supply up to a 56 day supply another 28 day’s supply will be required.
28 days at a dose of 3 tablets daily is another 84 tablets.