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LPN INTENSIVE CALCULATIONS�� TUTORIAL SEVEN�� INTENSIVE GPHC Exam revision � programme

LONDON PHARMACIST NETWORK (LPN)

INTENSIVE REVISION FOR

GPHC EXAM.

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OPENING REMARKS

Book sign means resource questions
USE LAPTOP OR DESKTOP
CALC SESSION 7 of 10
GET CALCULATOR. GET NOTES PAD and PEN
PAID REVISION SESSION so , DO NOT SHARE LINK/ MATERIALS for this session.
MENTAL BREAK 5 – 10 MINS
YOU WILL BE SENT PRACTICE QUESTIONS AFTER SESSION
STAY ACTIVE ATTEMPT QUESTIONS AND ASK QUESTIONS

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TODAY’S TOPICS

QUANTITY TO SUPPLY✅
HEALTH REGISTER ✅
OXYGEN CYLINDER CAPACITY ✅
CHILD PUGH SCORE ✅
BREASTFEEDING CHILD ✅

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QUANTITY TO SUPPLY - QUESTION 1

Mr. Boris presents a prescription for Pregabalin 150mg capsules.

Take one capsule BD on day 1 , then one capsule TDS daily for 3 days, then 2 capsules TDS for 4 days then 3 capsules BD for three days then 4 capsules TDS for a month. You supply your total stock of 78 capsules.

Calculate how many capsules are owed to Mr. Boris ?

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QUANTITY TO SUPPLY - ANSWER 1

1 x 2 = 2
3 x3 = 9
6 x 4 = 24
6 x 3 = 18
12 x 28 = 336

389 – 78 = 311
ANSWER 311

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QUANTITY TO SUPPLY - QUESTION 2

Mr. Tom presents a prescription for prednisolone 5mg tablets.
You calculate the total quantity he needs before appointment.
If you supply your total stock of 32 tablets, how many tablets are owed to Mr. Tom?

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QUANTITY TO SUPPLY – ANSWER 2

4 x 21 days = 84
3 x 21 = 63
2 x 42 = 84

84 plus 63 plus 84 = 231

231 – 32 = 199

ANSWER 199 TABLETS

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QUANTITY TO SUPPLY - QUESTION 3

A 16-year-old female patient , who weighs 50kg, needs IV cefepime 10 mg/kg every 12 hours as recommended by the doctor for a urinary tract infection. The required number of 1g vial has been reconstituted with 50 mL of water for injection by the nurse, ready for IV infusion administration. Calculate how many ml of the reconstituted cefepime she will require for each dose?

Give your answer to 1.d.p . Look at SPC under section 6.6

Renapime 2g Powder for solution for injection/infusion - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

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QUANTITY TO SUPPLY - ANSWER 3

Patient weighs 50kg
50kg x 10mg = 500mg

Then look at SPC under section 6.6
After reconstitution , concentration is 19mg = 1ml
500mg = 26.3ml

ANSWER = 26.3 ml

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QUANTITY TO SUPPLY - QUESTION 4

A patient requires a daily dose of Phenytoin 500mg, an IV medicine that is available as a 5mg/mL solution. The drug will be given in two equally divided doses each day. The medicine can be diluted to a concentration of between 1mg/mL and 4mg/mL with glucose 5% solution. The minimum volume that a dose of the drug can be infused in is 50ml. You have been instructed to dilute a dose of phenytoin to a concentration of 2mg/ml with glucose 5% before it is given to the patient . What volume of glucose 5% solution is required for dilution of each dose ? ANSWER in ml as whole number.

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QUANTITY TO SUPPLY – ANSWER 4

Each dose is 250mg
5mg = 1 ml
250mg = 50 ml of phenytoin
final concentration is 2mg = 1ml
so 250mg = x ml
x 125ml
So 125ml – 50ml = 75ml of glucose 5%
ANSWER = 75ml

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QUANTITY TO SUPPLY - QUESTION 5

A patient requires a daily dose of vancomycin 600mg, an IV medicine that is available as a 5mg/mL solution. The drug will be given in three equally divided doses each day. The medicine can be diluted to a concentration of between 1mg/mL and 4mg/mL with glucose 5% solution. The minimum volume that a dose of the drug can be infused in is 40ml. You have been instructed to dilute a dose of vancomycin to a concentration of 2mg/ml with glucose 5% before it is given to the patient . What volume of glucose 5% solution is required for this dilution ? ANSWER in Litres to 2.d.p

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QUANTITY TO SUPPLY - QUESTION 5

DAILY DOSE = 600mg
EACH DOSE = 600mg/3 = 200mg
CONCENTRATION TO BE GIVEN = 2mg / ml
Hence , 200mg = X
X = 100ml ( total solution)
vancomycin available as 5mg in 1 ml , so 200mg will be in 40ml
Total solution of 100ml – 40ml of vancomycin = 60ml of glucose 5% solution
ANSWER = 60ml to Litres = 0.06 Litres

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HEALTH REGISTER - QUESTION 1

Assuming In year 2010, the death rate from all causes in a UK village was approximately 1 per 10 persons living in the village and of these , 10% were elderly patients . Calculate how many elderly patients died in that village in 2010? Note in 2010 the population of the village was 4000 people.
Answer as a whole number of people.

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HEALTH REGISTER - QUESTION 1

Number of total deaths = 1/10 x 4000 = 400

Number of Elderly deaths
= 10/100 x 400 = 40

ANSWER = 40 patients

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HEALTH REGISTER - QUESTION 2

Assuming In 2018 year, the death rate from all causes in England was approximately 2000 per 100,000 and of these , 12% were due to myocardial infarction . Calculate how many people died in England from M.I. in 2018? Note population of England in 2018 was 42 million people.
Answer as a whole number of people

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HEALTH REGISTER – ANSWER 2

Number of total deaths 2000/100000 x 42000000 = 840,000

Number of deaths from M.I
= 12/100 x 840,000 = 100,800
Final answer.
ANSWER = 100,800

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HEALTH REGISTER - QUESTION 3

In one year , approximately 396 per 100,000 people in the UK are diagnosed with headaches, and of these 1 out of 4 are diagnosed with cluster headaches. Given that the UK population is 64 million approximately how many people in the UK were diagnosed with cluster headaches in that year?
Answer as a whole number of people

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HEALTH REGISTER – ANSWER 3

For headache
396/100,000 x 64, 000,000 = 253440
for cluster headache
1/4 x 253440 = x
ANSWER = 63360 people

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HEALTH REGISTER - QUESTION 4

Assuming In year 2020, the death rate from all causes in a UK town was approximately 2 in 10 persons living in the town and of these , 5.5% were deaths due to respiratory disease . Calculate how many patients died of respiratory disease in that town in 2020? Note in 2020 the population of the town was 12500 people.
Answer as a whole number of people.

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HEALTH REGISTER - QUESTION 4

Number of total deaths = 2/10 x 12500 = 2500

Number of respiratory deaths is 5.5%
= 0.055 x 2500 = 137.5
ANSWER = 138 patients

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BREASTFEEDING CHILD - QUESTION 1

Miss. D. a 39-year-old who weighs 65kg has been prescribed apixaban 5mg twice daily. She currently breastfeeds her 11-month-old child who weighs 10kg.
Percentage relative infant dose (%RID) is 5%.
Using the formula below, calculate the amount of drug the child received via breast milk in one day. Answer in mg to 2.d.p.

NOTE : UNITS TO USE

RID
Infant daily dose per kg via milk in mg/kg/day
Maternal daily dose per kg in mg/kg/day

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BREASTFEEDING CHILD - QUESTION 1

RID = 5/100 = 0.05
MATERNAL DAILY DOSE/Kg = 10mg / 65 = 0.153846mg/kg

0.05 = infant daily dose/kg

0.153846

0.05 x 0.152846 = 0.00769231 mg/ kg

0.00769231 x 10kg = 0.0769231

ANSWER = 0.08mg

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BREASTFEEDING CHILD - QUESTION 2

Ms. J. a 28-year-old is a breastfeeding mother who weighs 60kg and takes Apixaban 5mg twice a day. She mentions to you that she breastfeeds her 9-month-old baby who weighs 10kg.
Using the formular below calculate the Relative infant dose in percentage (%RID) assuming Ms. J’s child receives 0.0625mg of apixaban daily via breast milk. ANSWER to nearest 0.1.

RID unit in %
Infant daily dose per kg via milk in ug/kg/day
Maternal daily dose per kg in ug/kg/day

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BREASTFEEDING CHILD - QUESTION 2

NB- CHILD DOSE - Change to the correct units

0.0625mg per day
0.0625/ 10kg = 0.00625mg per kg/day same as 6.25 ug/kg/day

MOTHER dose = 10mg / 60kg = 0.16667mg/kg/day same as 166.67 ug/kg/day

Formula RID = 6.25/166.6667 x 100 = 3.75%

ANSWER = 3.8%

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BREASTFEEDING CHILD - QUESTION 3

Ms. K. a 37-year-old who weighs 70kg has been prescribed enalapril 20mg daily to manage hypertension. She currently breastfeeds her 10-month-old child who weighs 9kg. Percentage relative infant dose (%RID) is 5%. Using the formula below, calculate the amount of drug the child received via breast milk in one day. Answer in mg to 2.d.p.

NOTE : UNITS TO USE

RID
Infant daily dose per kg via milk in mg/kg/day
Maternal daily dose per kg in mg/kg/day

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BREASTFEEDING CHILD – ANSWER 3

RID = 5/100 = 0.05
MATERNAL DAILY DOSE/Kg = 20mg / 70 = 0.28571mg/kg

0.05 = infant daily dose/kg

0.28571

0.05 x 0.28571 = 0.0142855 mg/ kg

0.0142855 x 9kg = 0.1285695

ANSWER = 0.13mg

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OXYGEN THERAPY�QUESTION 1

Ms. Y. a 36-year-old is to be treated with 100% oxygen to abort cluster headache attacks. Whilst in hospital she suffered three separate attacks and will be treated as follows

Treatment 1 – Administer 100% oxygen at a rate of 15 litres /minute for 20 minutes
Treatment 2 – Administer 100% oxygen at a rate of 12 litres /minute for 18 minutes
Treatment 3 - Administer 100% oxygen at a rate of 10 litres/minute for 15 minutes.
Calculate how many cylinders of oxygen required for the entire treatment using oxygen cylinder size C in your stock.

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OXYGEN THERAPY - QUESTION 1

RX 1 = 15 X 20 = 300 LITRES
Rx 2 = 12 x 18 = 216 litres
Rx 3 = 10 x15 = 150 LITRES

TOTAL = 666 LITRES

oxygen cylinder size C = 170 LITRE PER cylinder

HENCE, we need 4 cylinders.

Answer = 4

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OXYGEN THERAPY�QUESTION � 2

Mr. Terry is due to receive 100% oxygen for cluster headache treatment. Oxygen should be given at a rate of 10–15 litres/minute for 10–20 minutes.

Calculate how long required for minimum dose treatment to take place using the entire oxygen in cylinder size D in your stock.

ANSWER IN MINUTES AS WHOLE MINUTE.

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OXYGEN THERAPY - QUESTION 2

Minimum dose = 10 litres per minute
OXYGEN CYLINDER D HAS A CAPACITY OF 340 LITRES.
HENCE, 10 LITRES = 1 min
340 LITRES = X

X = 34

ANSWER = 34 MINUTES

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CHILD- PUGH SCORE

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QUESTION 1 – CHILD-PUGH SCORE

Alan a- 59-year-old patient has been prescribed Apixaban 5mg BD which he has been taking for 6 months . He is to be prescribed a long-term dose for DVT which he developed six months ago. You notice that his pugh score is 5. Using the resource provided on whatsapp, calculate the number of tablets required to cover a 56-day treatment period and state which strength you would recommend .
Apixaban Strengths available are 2.5mg and 5mg tablets.

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QUESTION 1

PATIENTS Pugh score of 5 indicates low severity of liver impairment
From the resource, for DVT prevention, after 6 months give Apixaban 2.5mg BD

Hence, we will supply 2.5mg tablets twice a day for 56 days

ANSWER = 112 tablets of Apixaban 2.5mg tablets

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QUESTION 2 – CHILD-PUGH SCORE

Mary a- 35-year-old patient weighs 90kg and is to be prescribed Dalteparin injections to treat VTE in pregnancy . You are informed that her pugh score is 8. Using the resource provided, calculate the correct units of dalteparin she is supposed to be prescribed for 4 doses . Dalteparin sodium | Drugs | BNF | NICE

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CHILD- PUGH SCORE

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QUESTION 2

From resource , dose is usually 10,000 units twice a day.
But due to Child-pugh score
Half dose , so 10000 units/ 2 = 5000 units
5000 units x 4
20000 units ANSWER

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