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Question 2 How many grams of potassium generic rosuvastatin 20mg with amex, sodium and glucose are there in a litre infusion of potassium 0 purchase 5 mg rosuvastatin otc. Question 3 How many grams of sodium chloride are there in a 500mL infusion of sodium chloride 0. For oral liquids, it is usually expressed as the number of milligrams in a standard 5mL spoonful, e. For oral doses that are less than 5mL an oral syringe would be used (see the section ‘Administration of medicines’ in Chapter 9 ‘Action and administration of medicines’, page xx). For injections, it is usually expressed as the number of milligrams per volume of the ampoule (1mL, 2mL, 5mL, 10mL and 20mL), e. Only mg/mL will be considered here, but the principles learnt here can be applied to other concentrations or strengths, e. Sometimes it may be useful to convert percentage concentrations to mg/mL concentrations. If you know the percentage concentration, an easy way of finding the strength in mg/mL is by simply multiplying the percentage by 10. Once again, if we use our original lidocaine (lignocaine) as an example: You have lidocaine (lignocaine) 2mg/mL. It usually refers to a solid dissolved in a liquid and, by agreed convention, the weight is expressed in grams and the volume in millilitres. For example: ‘1 in 1,000’ means 1g in 1,000mL ‘1 in 10,000’ means 1g in 10,000mL Therefore it can be seen that 1 in 10,000 is weaker than 1 in 1,000. The drug most commonly expressed this way is adrenaline/epinephrine: Adrenaline/epinephrine 1 in 1,000 which is equal to 1mg in 1mL Adrenaline/epinephrine 1 in 10,000 which is equal to 1mg in 10mL An easy way to remember the above is to cancel out the three zeros that appear after the comma, i. Adrenaline/epinephrine 1 in 1,000 – cancel out the three zeros after the comma: 1,000/ / /, to give: 1 in 1 which can be written as: 1mg in 1mL Similarly, for adrenaline/epinephrine 1 in 10,000 – cancel out the three zeros after the comma: 10,000/// to give: 1 in 10, which can be written as 1mg in 10mL. Just as per cent means parts of a hundred, so parts per million or ppm means parts of a million. It usually refers to a solid dissolved in a liquid but, as with percentage concentrations, it can also be used for two solids or two liquids mixed together. Once again, by agreed convention: 1 ppm means 1g in 1,000,000mL or 1mg in 1 litre (1,000mL) In terms of percentage, 1 ppm equals 0. Other equivalents include: One part per million is one second in 12 days of your life! Haz-Tabs®) are measured in terms of parts per million, such as 1,000 ppm available chlorine. Question 12 It is recommended that children should have fluoride supplements for their teeth if the fluoride content of drinking water is 0. Such large molecules are difficult to purify and so, rather than use a weight, it is more accurate to use the biological activity of the drug, which is expressed in units. The calculation of doses and their translation into suitable dosage forms are similar to the calculations elsewhere in this chapter. Infusions are usually given over 24 hours and the dose is adjusted according to laboratory results. As a result of this cumulative administration error the patient died from a brain haemorrhage which, in the opinion of the pathologist, was due to the overdose of tinzaparin. It was the prescriber’s intention that the patient should receive 9,000 units of tinzaparin each day, but this information was not written on the prescription. The ward sister told a coroner’s court hearing that the prescription was ambiguous. Insulin Injection devices (‘pens’), which hold the insulin in a cartridge and deliver the required dose, are convenient to use. However, the conventional syringe and needle are still the method of insulin administration preferred by many and are also required for insulin not available in cartridge form. Insulin comes in cartridges or vials containing 100 units/mL, and the doses prescribed are written in units. Therefore, all you have to do is to dial or draw up the required dose using a pen device or an insulin syringe. Insulin syringes are calibrated as 100 units in 1mL and are available as 1mL and 0. So if the dose is 30 units, you simply draw up to the 30 unit mark on the syringe. Displacement Values or Volumes • Dry powder injections need to be reconstituted with a diluent before they are used. Sometimes the final volume of the injection will be greater than the volume of liquid that was added to the powder. They include calculating number of tablets or capsules required, divided doses, simple drug dosages and dosages based on patient parameters, e.

You can also say that you will try to decrease the dosage after three months cheap rosuvastatin 10mg line, or even stop the drug entirely generic rosuvastatin 20 mg with visa. Patient 37 (boy with pneumonia) The patient’s mother should be told that the penicillin will need some time to kill the bacteria. If the course of treatment is stopped too soon, the stronger ones will survive, and cause a second, possibly more serious infection. Knowing that any side effects will disappear soon will increase the likelihood of adherence to treatment. She should also be told to contact you immediately if a rash, itching or rising fever occur. Patient 38 (migraine) In addition to other information the important instruction here is that the drug (preferably a suppository) should be taken 20 minutes before the analgesic, to prevent vomiting. Because of possible sedation and loss of coordination she should be warned not to drive a car or handle dangerous machinery. Drug will prevent complications of high blood pressure (angina, heart attack, cerebrovascular accident). Angina pectoris: decreases blood pressure, prevents the heart from working too hard, preventing chest pain. Angina pectoris: within one month, earlier if attacks occur more frequently, or become more severe. Angina pectoris: in case frequency or severity of the attacks increase, more diagnostic tests or other treatment are needed. Your personal formulary During your medical studies you should continue to expand your list of common complaints and diseases, with your P-drugs and P-treatments. However, very soon you will notice that many drugs are used for more than one indication. Examples are analgesics, certain antibiotics, and even more specific drugs like beta-blockers (used for hypertension and angina pectoris). You can, of course, repeat the necessary drug information with each disease or complaint, but it may be easier to make a separate section in your personal formulary where you collect the necessary information for each of your P-drugs. It is good advice to note the essential instructions and warnings with each P- drug in your personal formulary. If you do this for every new drug you learn to use, the formulary will be reasonably complete and ready for use by the time you finish your medical studies. An example of the contents of such a personal formulary is given on the previous page. Please note that this is not a published text, but should be your personal (handwritten? Effects of the drug Which symptoms will disappear; and when; how important is it to take the drug; what happens if it is not taken; 2. Side effects Which side effects may occur; how to recognize them; how long will they remain; how serious they are; what to do if they occur; 3. Instructions When to take; how to take; how to store; how long to continue the treatment; what to do in case of problems; 4. Warnings What not to do (driving, machinery); maximum dose (toxic drugs); need to continue treatment (antibiotics); 5. Next appointment When to come back (or not); when to come earlier; what to do with left-over drugs; what information will be needed; 6. Monitoring the treatment enables you to determine whether it has been successful or whether additional action is needed. To do this you need to keep in touch with your patient, and this can be done in two ways. Passive monitoring means that you explain to the patient what to do if the treatment is not effective, is inconvenient or if too many side effects occur. Active monitoring means that you make an appointment to determine yourself whether the treatment has been effective. You will need to determine a monitoring interval, which depends on the type of illness, the duration of treatment, and the maximum quantity of drugs to prescribe. At the start of treatment the interval is usually short; it may gradually become longer, if needed. Even with active monitoring the patient will still need the information discussed in Chapter 10. You should use the same criteria for monitoring the effect, but in practice they can be condensed into two questions: is the treatment effective? History taking, physical examination and laboratory tests will usually provide the information you need to determine the effectiveness of treatment. If the disease is not yet cured or chronic, and the treatment is effective and without side effects, it can be continued.

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You have a 250mg vial that needs to be reconstituted to 5mL with Water for Injections discount rosuvastatin 10 mg visa. What are moles and millimoles 95 • A one molar (1 M) solution has one mole of the substance dissolved in each litre of solution (equivalent to 1mmol per mL) discount rosuvastatin 5 mg online. These are measurements carried out by chemical pathology and the units used are usually millimoles or micromoles. The millimole unit is also encountered with infusions when electrolytes have been added. This section will explain what moles and millimoles are, and how to do calculations involving millimoles. However, the concept of moles and millimoles is difficult to explain and to understand; you need to be familiar with basic chemistry. These are too small to be counted individually, so the mole is the unit used by chemists to make counting and measuring a lot easier. Just as the word ‘dozen’ represents the number 12, the mole also represents a number – 6 × 1023. The atomic mass of potassium is 39; so 1 mole of potassium has a mass of 39 g (which is the same as saying that 6 × 1023 atoms of potassium have a total mass of 39g). For 96 Moles and millimoles example, one hundred 1p coins weigh 356 g; it is quicker to weigh 356g of 1p coins than to count a hundred coins. Now consider a single molecule of sodium chloride (NaCl) which consists of one sodium ion (Na+) and one chloride ion (Cl–). NaCl = molecule Na+ Cl– = ions Since moles can refer to ions as well as molecules, it can be seen that one mole of sodium chloride contains one mole of sodium ions and one mole of chloride ions. From tables (see the end of this section), the relative ionic masses are: sodium (Na) 23 chloride (Cl) 35. The ‘2’ after the ‘Cl’ means two ions of chlorine: CaCl2 = molecule Ca2+ Cl– +Cl– = ions The molecular mass of calcium chloride is 147. The reason why the molecular mass does not always equal the sum of the atomic masses of the individual ions is because water forms a part of each calcium chloride molecule. From the molecular formula and knowledge of the atomic weights it can be seen that calcium chloride contains: 1moleofCa=40g 2 moles of Cl = 71g 2 moles of H2O, each mole of water = 18g; 2 × 18 = 36g What are moles and millimoles 97 So adding everything together: (40 + 71 +36) = 147 i. One millimole is equal to one- thousandth of a mole One micromole is equal to one- thousandth of a millimole It follows that: 1 mole contains1,000 millimoles (mmol) 1 millimole contains1,000 micromoles (mcmol) So, in the above explanation, you can substitute millimoles for moles and 98 Moles and millimoles milligrams for grams. For our purposes: Sodium chloride would give sodium + chloride 1 mole or 1 mole or 1 mole or 1 millimole 1 millimole 1 millimole 58. It is unlikely that you will encounter these types of calculations on the ward, but it is useful to know how they are done and they can be used for reference if necessary. So it follows that the amount (in milligrams) equal to 1 millimole of sodium chloride will give 1 millimole of sodium. In this case, calculate the total amount (in milligrams) of sodium chloride and convert this to millimoles to find out the number of millimoles of sodium. Calculations involving moles and millimoles 99 So 1 millimole of sodium chloride (NaCl) will weigh 58. First work out the number of millimoles for 1 mg of sodium chloride, and then the number for the total amount. Alternatively, a formula can be used: mg/mL total number of millimoles = × volume(mL) mg of substtance containing 1mmol where, in this case mg/mL = 1. Conversion of percentage strength (% w/v) to millimoles Sometimes it may be necessary to convert percentage strength to the number of millimoles. All you need to do is to convert the percentage strength to the number of milligrams in the required volume, then follow the steps as before. So, the amount (in milligrams) equal to 1 millimole of sodium chloride will give 1 millimole of sodium. A formula can be devised: percentage strength (% w/v) mmol = × 10 × volume (mL) mg of substance ccontaining 1mmol In this example: percentage strength (% w/v) = 0. When moles of substances are dissolved in water to make solutions, the unit of concentration is molarity and the solutions are known as molar solutions. When one mole of a substance is dissolved in one litre of solution, it is known as a one molar (1M) solution. If 2 moles of a substance are made up to 1 litre (or 1 mole to 500mL), the solution is said to be a two molar (2M) solution. To do this, you need to calculate the equivalent number of moles per litre (1,000mL). Alternatively, a formula can be derived: number of moles concentration (mol/L or M) = volume in litres The number of moles is calculated from the weight (in g) and the molecular mass: weight (g) moles = molecular mass Molar solutions and molarity 103 To convert the volume (in mL) to litres, divide by 1,000: volume in litres = Putting these together gives the following formula: number of moles concentration (mol/L or M)= = volume in litres Re-writing this gives: concentration (mol/L or M)= In this example: weight (g) = 18 molecular mass = 294 volume (mL) = 200 Substitute the figures into the formula: concentration = = 0. Alternatively, a formula can be derived: number of moles concentration (mol/L or M) = volume in litres so: number of moles = concentration (mol/L or M) × volume in litres We want to go a step further and calculate a weight (in grams) instead of number of moles.

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