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# Pharmacy Calculations

Workshop

Yuxin Qian
090422
Overview:

## • Solutions, Compounding, and Dose related

• Pharmacokinetics

## • Pharmacy financial assessment

• Statistics
• “give us some examples of the formulas
provided in PEBC information booklet( which are
provided in the EE exam)”
Salt
pH = pKa log
Acid
Base
pH = pKa log
Salt

Rule of nines:
I pH – pKa I = 1 ---- 90 : 10
I pH – pKa I = 2 ---- 99 : 1
I pH – pKa I = 3 ---- 99.9 : 0.1
• What is the pH of the solution containing 0.5 moles of
ephydrine and 0.05 moles of ephedrine HCl per liter of
solution? (pKb = 4.56)

Salt
pH = pKa log
Acid
Base
pH = pKa log
Salt

## Base is not in the Basement (bottom) --- it is on the top;

Acid at the bottom

## • MANON SHROFF CALCULATIONS

Provided Formulas

## • The volume V of isotonic solution that can be prepared from W g of drug

is obtained by solving this equation

## • W: the weight of the drug

• E: NaCl equivalent value
• 111.1 = 100/0.9

## • How much sodium chloride is required to render 100ml of a 1% solution

of apomorphine hydrochloride isotonic with blood serum? ( Sodium
Chloride Equivalent E = 0.14 )

## 1. Weight of drug: 100 x 1% = 1.0 g

2. V = W x E x 111.1 = 1 x 0.14 x 111.1 = 15.55 ml
3. Dissolve 1g of apomorphone hydrocloride in 15.5 ml of water and
make up this solution to 100ml with 0.9% sodium chloride solution.
Provided Formulas

## • 1st order reaction • 0 order reaction

Provided Formulas

0.693 Vd
t1/2 =
Clt
Estimating drug clearance (Cl):

## For linear pharmacokinetic drug clearance and normal renal function

Provided Formulas

IV infusion

## Multiple dose: Accumulation Rate

1
If DM is given at a dosage
DL = DM
f = e kT
e kT interval equal to the
1
elimination half-life of the
R = e kT
drug: DL = 2 DM
Fraction remaining in the body
after a dosage interval
Other Important Formulas

## Clark's rule---weight (child aged 2-17)

Weight in pound x adult dose
Dose f or child =
150 lb (avg wt of adult)

## Ideal Gas: PV = nRT P1V1 / T1 = P2V2 / T2

Calculations related to Solutions

## • Prepare Desired Concentrations;

• Tonicity Solutions:
– Freezing point

## – Sodium chloride equivalents:

• Molarity/Molality

• mEq
Allegation Problems

## • Example 1: A pharmacist has a 70% alcoholic elixir and a 20% alcoholic

elixir. He needs a 30% alcoholic elixir to use as a vehicle for medications. In
what proportion must the 70% elixir and the 20% elixir be combined to make
a 30% elixir?
• How many grams of CaCl2 are required to prepare a 480
mL solution that contains 200 meq of Ca2+? (mw CaCl2 =
111 g/mole)

## • MANON SHROFF CALCULATIONS

Normality (N) / Molarity (M) / Molality (m)

## • Normality (N): the presence of number of gram equivalent weight of

solute in 1000 ml or (1L) solution;
– For example, in a salt such as MgCl2 (1 M), there are two moles of
Cl- for every mole of Mg2+, so the concentration of Cl- is said to be 2
Molarity (M) vs Molality (m)
• Molarity (M) or molar concentration: the presence of number of
moles of solute in 1000 ml or (1L) of solution;
– A 0.5 molar solution contains 0.5 moles of solute in 1.0 liter of solution.
– This is not equivalent to 1.0 liter of solvent: either slightly more or
slightly less than 1 liter of solvent

## • Molality (m): the presence of number of moles of solute in 1000 gm

of solvent
– the number of moles of solute per kilogram of solvent (not solution).
– For instance: adding 1.0 mole of solute to 2.0 kilograms of solvent
constitutes a solution with a molality of 0.50 mol/kg.
Isotonic solutions

## • When 1 g mol wt (M-weight) of any nonelectrolyte is dissolved

in 1000g of water, the freezing point of the solution is
depressed by 1.86 ℃;
• Freezing point depression of body fluids: - 0.52 ℃;

## • So, the amount needed for preparing isotonic solution:

X = 0.52 × (M-weight) / 1.86 g
Isotonic solutions

## Sodium chloride equivalents

• Dissociation values (i) considered as 80% dissociated in weak
solutions: two ions (NaCl) 1.8; three ions (CaCl2) 2.6; four ions
3.4
• 0.9% NaCl is an isotonic fluid;

## – Calculated the mass of NaCl represented by all ingredients;

– and the mass of NaCl required to prepare an equal volume of
isotonic solution;

## – Based on the difference between those two masses, calculate the

NaCl equivalent for the prescription component.
• How many mg of NaCl are required to prepare 250 mL of 1%
boric acid solution to isotonic with eye tears? (The freezing
point of boric acid is – 0.29 ℃; FP of 0.9% NaCl - 0.58 ℃; FP
of body fluids: - 0.52 ℃)

## • MANON SHROFF CALCULATIONS

Compounding and Dose

• W/W
• Parts
• Displacement value: DV in suppositories

• Dose related:
– Abbreviations: tid, bid, qd; o.u., a.s.
– Infusion rate:
How many grams of base are required to dispense 20 suppositories of
boric acid each weighing 2 g and containing 500 mg of boric acid
(Displacement value of boric acid = 1.5)

## • MANON SHROFF CALCULATIONS

• Chloroquine can be used for prevention of malaria in areas where
the parasite is still sensitive to this drug. Smith’s family (two adults
and two 8 years old children) are going to central America for 8
weeks and they get a prescription of chloroquine: it should be used
2 week before exposure; continue weekly for 4 week after leaving
the endemic area; 7-10 y (150mg base once/week); adults (300 mg
base once/week). How many chloroquine needed for their trip (mg)?
(Therapeutic choices p1456)

Ans: (2×
×300 + 2×
×150) ×(2 + 8 + 4) = 900 ×14 = 12600 mg
• 250 mg/500 mL Rocephine solution should be administered to
a patient weighing 155 lbs. The recommended adult dose of
drug is 1.5 mcg/kg/min. What would be rate of flow in mL/min?

## • MANON SHROFF CALCULATIONS

Pharmacokinetics

• Half-life:
• Shelf-life:
• K: constant rate
• Estimated GFR
• Clearance

• Infustion rate
• Css
Provided Formulas

0.693 Vd
t1/2 =
Clt

## These formula can help us to solve most of the pharmacokinetic questions

• The initial concentration of a drug is 500 mg/mL, and
turns into 50 mg/mL after 90 mins. What is the rate of
constant if it is followed by first order kinetic?

## • MANON SHROFF CALCULATIONS

• The initial concentration of a drug is 0.002M,.
What is the half-life if it is followed by 2ed order
kinetic? (rate of constant K = 7 liter/mole min)

## • MANON SHROFF CALCULATIONS

Michaelis–Menten equation
The Michaelis? enten equation describes how the reaction rate v depends on the position
of the substrate-binding equilibrium and the rate constant k2. Michaelis and Menten
showed when k2 is much less than k-1 (called the equilibrium assumption) they could
derive the following equation:

The Michaelis-Menten equation will appear first order when the substrate concentration
[S] << Km;
The Michaelis-Menten equation will appear zero order when Km << [S].

## This is the basis for most single-substrate enzyme kinetics.

The Michaelis constant Km is defined as the concentration at which the rate of the enzyme
reaction is half Vmax.
Basic Pharcokinetics

One-compartment model
• Intravenous bolus injection:
– complete absorption; elimination : both followed first-order
• Single oral dose:
– absorption and elimination : first-order; T max depends on kA
and k
• Intravenous infusion:
– zero-order absorption; first-order elimination;
– esp useful for drugs with narrow therapeutic range.
Basic Pharcokinetics

One-compartment model
– DL = Css Vd or R/k ( R: the infusion rate; k: elimination rate constant)
• Some oral controlled-release drug:
– zero-order systemic absorption;
• Intermittent intravenous infusions:
– aminoglycoside (gentamicin), no Css
• Multiple doses:
– Dosing rate: D0 / τ (τ: interval between doses, or the frequency of
dosing)
– Certain antibiotics are given by multiple rapid intravenous bolus injections.
Cockcroft-Gault formula
• Estimated creatinine clearance rate (eCcr)

## • ( Height in cm, SCr in mg /dL)

• K: constant that depends on muscle mass varies with a child's age;
• In first year of life, for pre-term babies K=0.33; for full-term infants K=0.45
• For children between ages of 1 and 12 y, K=0.55
• What is the rate of infusion of phenytoin in a patient that
requires steady state plasma concentration of 20
mcg/mL? The elimination half-life of phenytoin is 4 hours
and an apparent volume of distribution is 15 L.

## • MANON SHROFF CALCULATIONS

Multiple IV bolus injections

## Linear Plot of Cp Versus Time

Linear Plot of drug concentration Versus Time
Showing Doses Every Six Hours
Provided Formulas

f = e kT

R = e kT

## Fraction remaining in the body

after a dosage interval
Multiple IV bolus injections

## • An example: t1/2 = 4 hr; IV dose 100 mg every 6 hours; V = 10 liter; What

are the Cpmax and Cpmin values when the plateau values are reached?

## • Cp fluctuate between 15.5 and 5.4 mg/liter

during each dosing interval when the plateau
is reached.
• A suitable DL: Cpmax • V = 15.5 x 10 = 155
mg as a bolus would give Cp = 15.5 mg/liter
• Followed by 100 mg every 6 hours to maintain
the Cpmax and Cpmin values at 15.5 and 5.5
mg/liter, respectively.
• A subject in whom the renal clearacne of inulin is 120 mL/min is
given a drug, the clearance of which is 18 mL/min. If the drug is 40%
plasma protein bound, what percentage of filtered drug must be
reabsorted in the renal tubules?
A. 10% B. 12.5% C. 25% D. 50% E. 75%

## • MANON SHROFF CALCULATIONS

Pharmacy financial assessment

• Inventory turnover,
• Gross Margin,
• Net Profit Margin;
• Price Markup and Elasticity

Reference Guide for Foreign Pharmacy Licensing Exam Questions and Answers,
by Manan H. Shroff, R. Ph, Krisman (1000 Qs)
Efficiency: Inventory Turnover

Inventory turnover rate; calculated by dividing the cost of the goods sold by the average
IN TOR
of beginning and ending inventroy. >6

NS:IN net sales to inventory: calculated by dividing the net sales by the inventory; >8

net sales to net working capital: calculated by dividing the net sales by net working
NS:NWC
capital(current assets minus current liabilities); 4 to 8
net sales to net worth: calculated by dividing the net sales by net worth(total assets total
NS:NW
liabilities); 3 to 8
accounts receivable collection time; calculated by dividing year end accounts receivable by
A/R CT
mean credit sales per day. It is a direct measure of efficient credit management. 30 days
accounts payable remitance time: calculated by year end accounts receivable devided by
A/R RT
mean purchases per day. 21 days
Gross profit margin

## • Gross profit margin is a financial ratio used to assess the profitability of a

firm's core activities, excluding fixed costs.
• The general calculation is

• The gross profit margin is related to the net profit margin, which assesses
the profitability of an organization after including fixed costs.

• Indicates the relationship between net sales revenue and the cost of goods
sold. A high gross profit margin indicates that a business can make a
reasonable profit on sales, as long as it keeps overhead costs in control.
Liquidity and solvency

also known as Qucik test ratio; calculated by dividing the sum of cash and accounts
receivable by the current liabilities;
Acid test ratio
Acid test ratio = (Current assets －
see above)
1:1 ratio represents a successful pharmacy; Current assets
Current ratio The current ratio: dividing current assets by current liabilities; minimum standard value
CA:CL would be 2

## Inventory to Net working dividing mean inventory (average

of the beginning and ending inventory) by net working
capital capital (unencumbered portion of
current assets);
IN:NWC The higher the value, the lower the liquidity; normall value: 80-100%

Profitability

## profitability: net profit to net worth ratio is the best indicator;

"net profit" the acceptable ratio for a 10 year old pharmacy : 15%, target value: 20%

## NP:NS net profit to net sales; the acceptable ratio: 5-7%

NP:NW net profit to net worth; For a new pharmacies: 40%; 15% would be acceptable for old
Return on investment pharmcies

NP:TA
net profit to total assets; It is generally useful for a new pharmacies: 10-20%;
Return on asset investment

net profit to inventory; It is generally useful for a new pharmacies: 10-20%; It is also a good
NP:IN
indicator for efficiency of the pharmacy.
Price Markup and Elasticity

## • Elasticity: coefficient of elasticity E = Q / P

– Q: % of sales quantities change;
– P: % of price change).
• Pricing:
– Rx: professional fee + cost price
– OTC: retail price = markup + cost price
– markup on cost or markup on retail price;
– Maintained markup = gross margin - cash discounts from suppliers;
Statistics

## • Mean / Median / Mode

• Degree of freedom

• Range

( Chapter 2 CPR )
• What is the median of the following values?
120, 135, 140, 118, 175, 105, 115, 190

## • Median: a middle value of an experiment;

• If the number of values are even, then the average of
middle values should be considered
• So the first step: arrange the data in order
105, 115, 118, 120, 135, 140, 175, 190
• What is the degree of freedom in a 4 X 3
contingency table in a Chi-square test?

Statistics

• p value

## • Confidence interval and Confidence region

A plot of a normal distribution (or bell curve). Each
colored band has a width of one standard deviation.

• About 68% of values drawn from a normal distribution are within one
standard deviation σ > 0 away from the mean μ (dark blue)
• 2 σ from the mean account for about 95% (medium and dark blue)
• 3 σ account for about 99.7% (light, medium, and dark blue)
• This is known as the "68-95-99.7 rule" or the "empirical rule."
First Aid for the USMLE Step 1 2008
First Aid for the USMLE Step 1 2008
Condition
(as determined by "Gold standard")

Positive Negative

False Positive
Positive True Positive → Positive predictive value
Test (Type I error, P-value)
outcome False Negative
Negative True Negative → Negative predictive value
(Type II error)

↓ ↓
Sensitivity Specificity

## First Aid for the USMLE Step 1 2008

First Aid for the USMLE Step 1 2008
Calculator used in the exam
Units Transferring

• 1 gr = 65 mg ( avoir. = apoth.)
• 1 lb (pound) = 454 g (avoir.); 373 g (apoth.)
• 1kg = 2.2 lb (avoir.)
• 1 fluid dram = 1 teaspoonful = 5 ml
• 1 fluidounces = 30 ml
• 1 pint = 480 ml
• 1 cup = 240 ml = 8 fl. oz.
• 1 gallon = 3840 ml = 8 pt = 4 qt
Final Tips

## • Using The Provided Formulas to remember related Equations

• Be Careful in calculation;

References

## • MANON SHROFF CALCULATIONS

• CPR chapter 2, 6, 36
• Reference Guide for Foreign Pharmacy Licensing Exam Questions
and Answers, by Manan H. Shroff, R. Ph, Krisman
Thanks

yuxinqian@hotmail.com