LPN INTENSIVE CALCULATIONS�� CALCULATIONS WORKBOOK ONE ��� INTENSIVE GPHC Exam revision � programme

LONDON PHARMACIST NETWORK (LPN)

INTENSIVE REVISION FOR

GPHC EXAM.

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TODAY’S TOPICS

• INFUSION RATES ✅
• BMI ✅
• HEALTH ECONOMICS ✅
• CREON QUESTIONS ✅
• SYNCHRONISE PRESCRIPTIONS ✅

QUESTION ONE- INFUSION RATES

• Mrs. PJ is a 35-year-old lady (weighing 70 kg) who is prescribed phenytoin at a dose of 12 mg/kg intravenously over 20 minutes. Phenytoin is available in 50mg/mL solution.

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• Calculate the rate in mL/hour at which the phenytoin solution must be infused.

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• Provide your answer to one decimal place.

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QUESTION 2- INFUSION RATES

• Mr. Sam is admitted to acute coronary care unit (CCU) following myocardial infarction and severe hypotension. He is prescribed a dopamine infusion to increase cardiac output. He weighs 56kg and the infusion is set to begin at the initial administration dose and rate via syringe for severe cases as per SmPC below, without any gradual increase in the dose or the rate.
• Given that the infusion syringe contains 300 mg dopamine in 50 mL normal saline, calculate the infusion rate in mL/hr. Give your answer to one decimal place.

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INFUSION RATES – QUESTION 3

A patient is due to receive 500ml of glucose 5.5%w/v solution over 24 hours. The patient is 65 years old and weighs 120 pounds. Calculate the infusion rate in mg/kg/min this patient will receive. Assume 0.45kg = 1Lb

• Give your final answer to 1.d.p.

LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 4- INFUSION RATES

• A 20kg infant requires 20mg/kg of Amoxicillin to treat a chest infection. A 5ml vial of 50mg/ml of amoxicillin is available in stock for dilution before infusion. You are given instructions to dilute the dose required by this patient up to 100ml with purified water. The infusion rate must not exceed 3mg/kg/minute.
• Calculate the maximum infusion rate in ml/minute for this infusion . Answer as whole number.
• London Pharmacist Network calculations

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INFUSION RATES – QUESTION 5

• Maria weighs 43kg and is to receive DRUG X via infusion at a dose of 1.6g/kg/24 hours. The infusion rate is to be set at 2ml/minute. Given that drug X infusion contains 65.3g/L, what will be the total infusion time in hours. Give your answer as number of whole hours (complete hours only).
• LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 6- INFUSION RATES

• Mr. Brown , 50 years, is prescribed 1500ml of glucose 5% via infusion over 12 hours. You are required to calculate the rate of infusion. What is the rate of infusion in drops per minute . Round your answer to nearest ten.
• London pharmacist Network calculations

INFUSION RATES – QUESTION 7

Mr. Ahmed is a 55year old man who weighs 11 stones5lb, he regularly takes sodium valproate tablets for epilepsy. He is admitted in hospital and is due to be administered sodium valproate by I.V. injection for 5 minutes at a dose of 9mg/kg. Sodium valproate injection is available as a 400mg vial which is reconstituted with 4ml of water for injections prior to administration to yield a concentration of 95mg/ml.

• Calculate the infusion rate in ml/min. Give your answer to 1.d.p

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QUESTION 8 - INFUSION RATES

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• You are the pharmacist today who is covering intensive care unit (ICU). One of the nurses asks you to review dopexamine prescription and advise on drug administration for a patient with an exacerbation of chronic heart failure. The anesthetist has prescribed a dose of 500 nanogram/kg/minute for a Mr. James who weighs 75 kg. ICU keeps 5 mL Dopacard solution (10 mg/mL dopexamine) in stock which has been diluted from 5 mL to 40 mL by the nurse.

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• Calculate the rate in mL/hour at which the infusion should be set. Give your answer to one decimal place.

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QUESTION 9 – INFUSION RATES

• A 10kg infant requires 20mg/kg of Amoxicillin to treat a chest infection. A 5ml vial of 50mg/ml of amoxicillin is available in stock for dilution before infusion. You are given instructions to dilute the dose required by this patient up to 100ml with purified water. The infusion rate must not exceed 2mg/kg/minute.

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• Calculate the maximum infusion rate in ml/minute for this infusion . Answer as whole number.

QUESTION 10 – INFUSION RATE

• Ms. P has been prescribed flucloxacillin 0.5 mg/kg/hour as treatment dose for cellulitis and it is to be administered via continuous intravenous infusion. The nurse on duty adds a 10ml ampoule containing 250mg solution of flucloxacillin into 500 mL glucose 5%. Ms. P weighs 50 kg and is 6 ft tall.
• You are required to calculate infusion rate in ml/min to 2.d.p ?

LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

QUESTION 11�CALCULATE�ANSWER IN MINUTES

QUESTION 12- INFUSION RATES

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QUESTION 13 – INFUSION RATES

A 60-year-old patient has been prescribed a dopamine infusion according the dosing information in the resource. He weighs 80kg and is 1.80m tall.

• Dopamine Infusion as follows

Dosing Information:

• - 4 mg/m2/min for 30 mins
• - 3.75 mg/m2/min for 1 hour
• - 3.5 mg/m2/min for 2 hours
• - 3 mg/m2/min for 1 hour
• - 2.75 mg/m2/min for 2 hours
• - 500 micrograms/m2/min for remaining time.
• Using the information provided, calculate the total amount of dopamine, in g, received by the patient in 8 hours to 2.d.p
• London Pharmacist Network Calculations

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INFUSION RATES – QUESTION 14

• You work as a pharmacist in a hospital on the geriatric ward. An elderly patient is prescribed an antibiotic via intravenous infusion at a dose of 7mg/kg/min . The patient weighs 180 lbs and is 182cm tall. You have the drug available at a concentration of 0.1g/10ml solution.

1lb = 0.45kg

• Use the information provided to calculate the infusion rate for this patient in Litre /hour.

State your answer to nearest 0.5

London pharmacist network Tutorials

INFUSION RATES – QUESTION 15

Andre a 6-year-old boy weighing 10kg is to start receiving a 300ml infusion at 9pm on Saturday evening at a rate of 7.50ml per hour. Just as you are about to set up the infusion you receive instructions to change the infusion rate to ensure that the infusion finishes at 4pm on Sunday to ensure that Andre is discharged on time as planned by the doctor. Calculate the infusion rate in ml/min/kg you need to set the infusion to ensure it finishes at 4pm on Sunday.

• Answer to 2.d.p.

LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 16

• A 60-year-old woman weighing 56 kg has a gunshot to her abdomen and now urgently requires a blood plasma infusion. You are a pharmacist working in the Accident & Emergency department and have been asked to advise on the infusion for this patient. The registrar wants her to have 360ml of plasma over 6 hours total.
• Calculate the IV rate in drops/min. Give your answer to the nearest whole number.

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INFUSION RATES – QUESTION 17

• You work as a pharmacist in a hospital on the geriatric ward. An elderly patient is prescribed an antibiotic via intravenous infusion at a dose of 7mg/kg/min . The patient weighs 180 lbs and is 182cm tall. You have the drug available at a concentration of 0.1g/10ml solution.

1lb = 0.45kg

• Use the information provided to calculate the infusion rate for this patient in Litre /hour.

State your answer to nearest 0.5

QUESTION 18

• A 21kg child has hypokalemia. He requires potassium chloride 2mmol/kg to be given via IV infusion over 12 hours. An infusion bag containing sodium chloride 0.9% and potassium chloride 0.3% will be given to the patient. Calculate the infusion rate in ml/minute for this infusion in order for the correct dose to be delivered . Use the resource provided. Answer to nearest 0.05ml.
• London Pharmacist Network

Question 18 RESOURCE

QUESTION 20- INFUSION RATES

Walter a young child requires infusion of 1 gram of amoxicillin via IV twice a day. You have been instructed to give him 7.5mg per minute via a syringe driver. Given that the infusion bag contains 500mg of amoxicillin in a 100ml, what would the rate be ? Give answer in ml/min as nearest whole number.

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A. 4ml / min

B. 2 ml / min

C. 2.5 ml/ min

D. 1.5 ml / min

E. 5 ml / min

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BMI – QUESTION 1

MS. Happy is a 49-year-old woman who is worried about her weight. She currently weighs 18 stones 5lb and height is 6ft tall. She is otherwise fit and healthy. She is considering bariatric surgery on the NHS. You are required to

1. Calculate her BMI as a whole number.
2. State if she qualifies for bariatric surgery on the NHS

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BMI - QUESTION 2

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• Mr. KFC a 45-year-old Patient weighs 225lbs and has a height of 1.70m. He has recently started a new diet and exercise regimen and has been following it accordingly. Given that the ideal BMI is 18.5 -24.9kg/m2 and Mr. KFC loses weight according to the diet plan, how much weight in kg does he need to lose to reach an ideal BMI? Give your answer in kg to nearest 5kg.
• 1 lb = 0.45kg

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BMI - QUESTION 3

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Brenda a 30-year-old female is keen to lose weight as she will be getting married in a couple of months. She has decided to follow a strict diet. Her current BMI is 28.5kg/m2. Calculate how much weight in Kg, Brenda needs to lose in order to reach a body mass index of 24.9kg/m2 given that she is 165cm tall.

1 lb = 0.45kg 1 stone = 6.35kg 1 ft = 30.48cm

Give your final answer in 1.d.p.

• London Pharmacist network on YouTube

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BODY MASS INDEX QUESTION 4

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Tim a 20-year-old student who is keen to lose weight and has hired a personal trainer at the local gym. He currently weighs 13 stone and is 165cm tall. Calculate how much weight in Kg, Tim needs to lose in order to reach a body mass index of 24.9kg/m2. 1 lb = 0.45kg 1 stone = 6.35kg 1 ft = 30.48cm

Give your final answer in 1.d.p.

• London Pharmacist network on YouTube

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BMI - QUESTION 5

• Mrs. Meatballs a 55-year-old Patient weighs 190lbs and has a height of 1.70m. She has recently started a new diet and exercise regimen and has been following it accordingly. Given that the ideal BMI is 18.5 -24.9kg/m2 and she loses weight according to the diet plan, how much weight in kg does she need to lose to reach an ideal BMI?
• Give your answer in kg to the nearest 0.5kg.
• 1 lb = 0.45kg

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• WATCH LONDON PHARMACIST NETWORK ON YOUTUBE

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HEALTH ECONOMICS – QUESTION 1

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You work in a GP surgery. 3000 patients are prescribed one MART inhaler each, every single month. 75% of them are prescribed Symbicort Brand (£16.00) and the rest are prescribed Fostair inhaler (£12.50). How much would be saved per 6 months if 10% of patients currently prescribed Symbicort are switched to Fostair inhaler.

Give your final answer to nearest £10.

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LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 2- HEALTH ECONOMICS

• You work in a GP surgery, and you are required to make savings . You have reviewed 54 patients who are prescribed Doxazosin 4mg I.R. tablets once daily and you identify 22 of them who you would like to switch to Doxazosin 4mg XL tablets once daily.

Doxazosin 4mg XL tablets - £11.20 per 42 tabs

Doxazosin 4mg I.R. tablets - £22.50 per 14 tabs

• NOTE – each repeat prescription lasts for 56 days
• How much will be saved in 4 repeat prescriptions assuming 50% of suitable patients switch to using Doxazosin 4mg XL tablets. Answer to nearest pound.
• LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 3

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• You are the manager of a community pharmacy. You usually dispense about 60 packs of Amoxicillin 500mg capsules per month. Wholesaler A offers you amoxicillin capsules at a cost of 80% of the drug traffic price. The DT price is £1.50 for a pack of 21 capsules. Another wholesaler called AAH provides these at 40% of DT price.
• How much would you save over 6 months by buying from the cheaper wholesaler? Give your answer to the nearest ten pound.
• LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 4- HEALTH ECONOMICS

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• You work as a Pharmacist in a GP surgery. You have been asked to switch 10 eligible patients on Keppra 500mg tablets to the generic levetiracetam 500mg tablets. Out of the 10 patients, 2 patients are prescribed 120 tablets per patient every month, 7 patients are prescribed 60 tablets per patient every month and 1 patient is prescribed 30 tablets every month. Assuming Keppra 500mg costs £60 for a box of 60 tablets and generic levetiracetam costs £30 for a box of 60 tablets, calculate the cost savings per month if all ten patients are switched to generic levetiracetam. Answer in pounds as whole number.
• LONDON PHARMACIST NETWORK

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QUESTION 5 - HEALTH ECONOMICS

• You work in a GP surgery. 87 patients (group A) are prescribed dispersible omeprazole tablets at a dose of 20mg once daily. Also, there are 36 patients (group B) who are prescribed omeprazole 20mg dispersible tablets at a dose of 20mg twice a day.
• omeprazole 20mg dispersible tablets - £11.60 per 28 tabs
• Lansoprazole dispersible tablets - £2.32 per 28 tabs
• NOTE – each repeat prescription lasts for 28 days
• How much will be saved in 6 repeat prescriptions if group B patients are moved to lansoprazole 15mg dispersible tablets at same dose regimen. Answer to nearest 5 pound.

HEALTH ECONOMICS- QUESTION 6

• Amy is a 7-year-old patient who usually takes omeprazole 10mg dispersible tablets BD. He develops side-effects to the dispersible tablets and his doctor decides to switch him to omeprazole 10mg/5ml oral suspension. Each 100ml bottle costs £49 on the drug tarrif. How much will be spent by the surgery if the doctor writes a prescription for omeprazole suspension for 28 days ? Note – original container must be dispensed.

QUESTION 7

• You are a pharmacist in a GP surgery and have been asked to review the prescribing of oxycodone capsules. You discover that last year, a total of 300 patients at your surgery were prescribed oxycodone 5mg capsules OD. 60% of the patients were prescribed the brand OXYNORM. You realize that a cheaper generic version of the drug exists
• OXYNORM 5MG CAPSULES (56) - COST £ 84
• GENERIC OXYCODONE 5MG CAPS (28) – COST £ 34
• How much would you save over 12 months by Switching 80% of patients on OXYNORM BRAND TO the GENERIC version. Assume each month is 28 days. Answer to nearest £100 . LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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QUESTION 8 - HEALTH ECONOMICS

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You work in a GP surgery. 240 patients are prescribed one box of tamsulosin 30 tablets each, every single month. 50% of them are prescribed Flomax brand (£67.00 for 60 tablets) and the rest are prescribed Contiflo (£25.80 for 30 tablets). How much would be saved per annum if 90% of patients currently prescribed flomax are switched to contiflo. Give your final answer to nearest hundred.

• LONDON PHARMACIST NETWORK CALCULATIONS (LPN)

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CREON- QUESTION ONE

• Mr. T a 68-year-old male had his pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. He weighs 62.5kg and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules he can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

CREON QUESTION TWO

• Mrs. D a 78-year-old female had her pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. She weighs 65kg and is 5 foot tall. Using the resource provided, calculate the maximum number of creon capsules she can take a day to stay within the limit of amylase recommended. Do not exceed 9,000 amylase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

CREON - QUESTION 3

• Mr. Romeo a 58-year-old male had his pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. He weighs 310 lb and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules he can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

CREON- QUESTION 4

• Mr. T a 68-year-old male had his pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. He weighs 160 lb and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules he can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

QUESTION 5 - CREON

• Mr. Jerry a 68-year-old male had his pancreas removed due to pancreatic cancer and has to take Creon 25000 capsules as a result. He weighs 320 lb and is 6 foot tall. Using the resource provided, calculate the maximum number of creon capsules he can take a day to stay within the limit of lipase recommended. Do not exceed 10,000 lipase units per kg. Give your answer as whole number. 1lb = 0.45kg
• Creon 25000 Capsules - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)

1. HOW TO SYNCHRONISE A PRESCRIPTION

You are working in a community pharmacy and one of the patients complained to you that she runs out of two of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below. Synchronise ramipril tablets

• DRUG & STRENGTH DOSE REMAINDER stock
• CITALOPRAM 20MG 1 OD 30
• CO-CODAMOL 8/500MG 2 QDS 336
• RAMIPRIL 2.5MG 1 BD 16
• LANSOPRAZOLE 15MG 1 BD 80
• LOPERAMIDE 2MG 2 QQH 192
• METFORMIN500MG 1 TDS 81
• TRAZODONE 50MG 2 OD 30
• METHOTREXATE 2.5mg TAKE 5 tablets at once 25
• (to make up total 12.5mg) MDU

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SYNCHRONISE A PRESCRIPTION- 2

You are working in a community pharmacy and one of the patients complained to you that she runs out of one of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE ALENDRONIC ACID TABLETS

• DRUG & STRENGTH DOSE REMAINDER STOCK
• CO-CARELDOPA 12.5mg 1 QDS 328
• ALENDRONIC 70MG 1 WEEKLY 6
• RAMIPRIL 2.5MG 1 OD 22
• LANSOPRAZOLE 15MG 1 BD 122
• Co-codamol 30/500 1 - 2 QDS 640
• Metformin 500MG 2 TDS 474
• SITAGLIPTIN 50MG 1 OD 14
• CREON 25000 8 PER DAY 632

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• LONDON PHARMACIST NETWORK INTENSIVE CALCULATIONS

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-3 - SYNCHRONISE A PRESCRIPTION-

You are working in a community pharmacy and one of the patients complained to you that she runs out of two of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE risedronate tablets.

• DRUG & STRENGTH DOSE REMAINDER tablets
• METHOTREXATE 2.5MG 4 WEEKLY 12
• CO-CARELDOPA 12.5mg 1 QDS 300
• LISINOPRIL 2.5MG 1 OD 16
• LEVOTHYROXINE 100MCG 1 OD 22
• RISEDRONATE 35MG 1 PER WEEK 8
• Paracetamol tablets 500MG 1- 2 QDS 160
• LEVOTHYROXINE 25MCG ONE ON ALTERNATE DAYS 42
• CARBOCEISTEINE 375 2 TDS 96

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SYNCHRONISE A PRESCRIPTION- 4

You are working in a community pharmacy and one of the patients complained to you that she runs out of one of her medicines rather quickly. She would like you to mention it to her practice pharmacist during your next surgery run. See details of her medication below . SYNCHRONISE CODEINE TABLETS

• DRUG & STRENGTH DOSE REMAINDER STOCK tabs
• METHOTREXATE 2.5MG 4 WEEKLY 16
• CO-CARELDOPA 12.5mg 1 QDS 324
• RAMIPRIL 2.5MG 1 OD 16
• LANSOPRAZOLE 15MG 1 BD 122
• CODEINE TABS 15MG 3 BD 60
• METFORMIN 500MG 2 TDS 480
• SITAGLIPTIN 50MG 1 OD 14
• CARBOCEISTEINE 375 2 TDS 96

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• THE END