DOSAGE CALCULATIONS (TOTAL 14)

1. What is the quantity of Mannitol present in 60ml of 20% Mannitol?

1% solution is 1g in 100mL
Therefore 20% solution will be 20g in 100mL
100mL contains 20g
Therefore 60mL contains 60 X 20/100 = 12g of Mannitol

2. How many µg of Adrenaline is present in a 30mL vial of 2% Xylocaine with

adrenaline?

Adrenaline available as 1:200000

1:200000 means 1g in 2,00,000 mL
Conversion of 1gm to µg [1g =1000 mg ; 1mg =1000 µg]
1g =1000 X 1000 µg
2, 00,000 ml contains 1g of adrenaline
Alternatively 2,00,000 ml contains 1000 x 1000 of adrenaline .
Therefore 30 ml contains
1000 x 1000 x 30 = 150 µg of
2,00,000 Adrenaline is present
in 30mL of 2% Xylocaine

3. How many mmol of sodium bicarbonate are there in 100ml of an 8.4%

solution?

Mol. Wt of sodium bicarbonate is 84

84g = 1mole , So 8.4g = 100 mmol
1molar soln is 84g in 1litre, so 8.4g in 100ml
8.4% is 8.4g in 100 ml
Hence 100mmol of sodium bicarbonate in 100 ml of 8.4% solution
4. A person with 50Kg body weight is to be given IV Thiopentone sodium in a
dose of 3mg/Kg body weight. The strength of the solution is 2.5%. What is the
volume of the drug used?

Dose required= 3 x 50 =150 mg

2.5% i.e 2.5 g in 100ml
2500 mg in 100ml
150mg in = 100 x 150 = 6mL
2500

5. A 30 year old man weighing 50Kg develops hypotension after myocardial

infarction. He was prescribed Inj. Dopamine 8µg/min/Kg. Calculate the rate of
infusion in drops per minute if strength of Dopamine ampoule(1mL) = 200mg

Dose required = 8 x 50 = 400 µg/min

Dissolve the Dopamine ampoule in 500 mL NS
200mg (200000µg) is present in 500 mL
400µg is present in
= 500 x 400
200000
= 1mL per minute
= 15 or 20 drops per minute (depending on drop factor of IV Set)

6. For a 6 month old infant with moderate dehydration, 150ml of Ringer Lactate
I.V. for 2 hours followed by 150ml sodium chloride I.V. for 3 hours is to be given.
The I.V. set yields 20 drops/ml. Calculate the drops per min. of both solutions.

Drops per minute = Drop factor X Volume to 60

be infused per hour
Calculation
Drop factor = number of drops to make 1mL= 20 drops

a) 150ml of R.L. to be given I.V. in 2 hrs

Hourly volume of R.L.: 150/2 = 75ml/hour
Drop factor of the given IV set: 20 drops = 1ml
Drops per minute to be administered:
20/60 x 75 = 25 drops / min

b) 150ml of NaCl to be given I.V. in 3 hrs

Hourly volume of NaCl: 150ml/3hr = 50ml/hr.
Drop factor of the given IV set: 20 drops = 1ml
Drops per minute to be administered: 20/60 x 50 = 16.60 = 17 drops/m

7. A 22 year old lady with advanced pregnancy with anaemic, with a

haemoglobin (Hb) deficit of 7gm%. Calculate the parenteral iron dosage for this
patient. Body weight of the patient is 50kg.

Calculation
Dose of parenteral iron to administered
= Body Weight X Hb% deficit X 4.4
= 50 X 7 X 4.4 .
= 1540 mg of Iron

8. Calculate the Paediatric dose of INH and Rifampicin for a 10 year old child
using Dilling’s formula.

[ Adult dose of INH - 300mg OD and Rifampicin - 600mg OD]

Calculation
Dilling’s Formula to calculate child dose
= Age of the Child /20 x Adult dose

Dose of INH for the child of 10 years

= 10/20 x 300
= 150mg OD
Dose of Rifampicin for the child of 10 years
= 10/20 x 600
= 300mg
9. Using Young’s Formula Calculate the dose of Paracetamol and Metronidazole
for a 3 year old child.

[ Adult dose of Paracetamol is 500mg TID and Metronidazole is 400mg TID.]

Calculation
Young’s Formula to calculate child dose: = Age/(Age +12) X Adult Dose
Child dose of Paracetamol
= 3/3+12 X 500
= 100mg TID
Child dose of Metronidazole
= 3/3+12 X 400
= 80mg TID

10. The adult dose of Gentamicin is 80mg/BD. How much Gentamicin should a 1
year old child weighing 12kg receive?

Weight of the child = 12 kg

Clark’s formula =(Adult dose X Body weight ) / 70
= (80X 12) / 70
= 13.7mg

11. A 35 yr old male diagnosed to have acute maniac episode & was put on tab.
Lithium 600mg/day. On day 7, the symptoms still persisted and the plasma
concentration of lithium was found to be 0.6 mEq/L. Calculate the revised
dosage regimen for this patient. Desired plasma concentration is 1.0 mEq/L.

Revised Dose Rate

= Previous dose rate x Target Cpss
measured Cpss
Measured Cpss = 600 x 1.0
0.6
= 1000 mg/day.
12. Calculate the Creatinine Clearance with the following data; Age:60 years,
Weight: 54 Kg, Normal serum creatinine= 0.6-1.2 mg/dL

Creatinine Clearance Estimate by Cockcroft-Gault Equation

Creatinine clearance using Cockcroft Gault equation
= (140-age) X Weight in Kg
72 x Serum Creatinine
= (140-60) x 54
72 x 1.2
= 50 mL/ min

Note: In females the equation has to be multiplied by 0.85

13. Calculate the creatinine clearance of a drug whose IV dose is 240mg and
plasma conc. Is 6mg/ lt, t1/2 of the drug is 4hrs

t½ = 0.693x Vd /Cl
Cl = 0.693x Vd/ t1/2
Vd = Total dose administered/ Plasma conc.
= 240/ 6 = 40 lts
So, Cl = 0.693x 40/4 = 6.93ml/min
14. A 40 yr old male patient ( body wt 70kgs) has a serum creatine of 4mg/dl. He
has proteus mirabilis induced UTI, sensitive to Gentamicin. Calculate the
Gentamicin dose which should be administered to this patient. Gentamicin dose
in a patient with normal renal function is5mg/ kg once a day. Renal clearance of
Gentamicin is 78ml/min in a normal renal function patient according to
literature

a) Calculate the creatinine clearance in this patient using Cockcroft Gault equation
- (140 – Age) x body wt / Serum creatine x 72
- (140 – 40)x 70 / 4 x 72 = 24.3ml/min

b) Dose of Gentamicin
In normal renal clearance i.e 78ml/min, it is5mg/ kg
For 24.3 ml /min clearance – 5x 24.3/78
= 1.56mg/kg
ORS (Oral rehydration solution)
1. A 15 month old child weighing 12 kg with vomiting and diarrhea, is
moderately dehydrated based on physical examination, vitals and clinical signs.
How will you plan Oral Rehydration Therapy?

PH Oral rehydration solution Marks

2.2
1 Describes the causes and clinical assessment of 1
dehydration
2 Enumerate the different types of ORS along with their 2
composition with actions of each ingredient
3 Choose the appropriate type of ORS for a given 1
condition/patient
4 Calculate the quantity of ORS required to correct / prevent 1
dehydration
5 Demonstrate preparation of ORS from sachet 4
6 Enumerate non-diarrheal uses of ORS 1
Total 10

1. Describes the causes and clinical assessment of dehydration

CAUSES FOR DEHYDRATION:

Diarrhea is the major cause for dehydration

Other causes includes
Vomiting
Fever
Excessive sweating
Increased urination
certain drugs like diuretics, laxatives, antihistamines, chemotherapeutic drugs

Clinical assessment of dehydration

Levels of dehydration:
No dehydration
Some dehydration
Severe dehydration

1. NO DEHYDRATION:
No signs of dehydration are present

2. SOME DEHYDRATION:
If 2 or more signs are present:
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back slowly
Arms & legs are cool to touch
Rapid heartbeat
Muscle cramps
Lightheadedness( relieved by lying down)

3. SEVERE DEHYDRATION
If 2 or more signs are present:
Lethargic or unconscious
Sunken eyes
Not able to drink or drinking poorly
Skin pinch goes back very slowly
Rapid breathing, weak pulse
Cold, clammy skin or hot dry skin
Little or no urination for 12 or more hours

2. Enumerate the different types of ORS along with their composition with
actions of each ingredient

TYPES OF ORS

1. HIGH OSMOLARITY ORS

2. Low osmolarity ORS
 3. Citrate based ORS
4. Rice based ORS
5. Home available ORS
6. SUPER ORS
7. ORS with nutrients-Zinc, Magnesium, selenium, vitamin A

1. HIGH OSMOLARITY ORS

Composition:
Sodium Chloride-3.5g
Trisodium citrate-2.9g
Glucsee anhydrous-20g
Potassium chloride-1.5g

Osmolarity:
Sodium-90 mM
Chloride-80mM
Potassium-20mM
Citrate-10mM
Glucose-111mM
Total-311mOsm/L

2. Low osmolarity ORS

WHO formula- Composition (FOR 1 LITRE ORS)

Most commonly used

Sodium chloride- 2.6gm (3.5gm)
Potassium chloride- 1.5gm
Trisodium citrate- 2.9gm
Glucose anhydrous- 13.5gm (20gm)
Total weight- 20.5gm

Osmolarity:
Sodium-75mN
Citrate-10mM
Potassium-20mM,
Glucose-75mM
Chloride-65mM
Total osmolarity-254mOsm/L (311mOsm/L)

3. Citrate based ORS

Previous Bicarbonate based ORS is replaced with citrate
As citrate based ORS is more stable compared to bicarbonate, no discoloration &
shelf life 2-3 years
Reduces the stool output in high output diarrhea
Trisodium citrate increases the absorption of sodium & water

4. Rice based ORS

Addition of the rice powder (50gm/L) instead of glucose in premixed powder
Starch other than rice including wheat flour & maize have also been shown to
decrease stool volume

5. Home available ORS

Composition: 1 litre water, 6 teaspoons of sugar(30gm approx), Half teaspoon of
common salt

6. SUPER ORS
It is a type of ORS where instead of monosugars more complex sugars are added.
They may be food based (as rice based) or starch free with amino acids (glycine/
alanine based or glucose polymer based)
Amino sugars help in sodium & water absorption

7. ORS with nutrients- Zinc, magnesium, selenium, vitamin A

Super super ORS: Addition of zinc to super ORS

Advantages:
Improved absorption of water & electrolyte by intestine
Faster regeneration of gut epithelium
Increased level of enterocyte brush border enzymes
Enhanced immune response leading to increased clearance of the pathogens

3. Choose the appropriate type of ORS for a given condition/patient

Low osmolarity ORS(WHO)

4. Calculate the quantity of ORS required to correct / prevent dehydration

Volume of the fluid to administered = BW X % Loss

= 12kg x 100ml
=1200ml
Time duration of infusion = 4hrs
1200ml to be infused over 4hours
Therefore 300ml /hr for next 4hours→ 15ml every 3min for next 4 hrs

5. Demonstrate preparation of ORS from sachet.

• Preparation of Oral rehydration solution from ORS packet

• Readymade ORS packet may be available for 1000ml or 200ml.

• Take ORS packet as per requirement of patient & storage facility

• For ORS packet of 1L, take 1 L of boiled & cooled filtered water & add all
the contents of the packet
• Mix well till ORS powder gets dissolved completely

• Use within 24 hours

6. Enumerate non-diarrheal uses of ORS

Electral ORS is commonly used for the diagnosis or treatment of Acidity, low
sodium levels, kidney stones, electrolyte imbalance, fluid depletion
 2. A child wt 20kg, has vomiting and diarrhea, is moderately dehydrated based
on physical exam, vital, clinical signs. Calculate the oral hydration therapy and
rate of administartion

PH Oral rehydration solution Marks

2.2
1 Describes the causes and clinical assessment of 1
dehydration
2 Enumerate the different types of ORS along with their 2
composition with actions of each ingredient
3 Choose the appropriate type of ORS for a given 1
condition/patient
4 Calculate the quantity of ORS required to correct / prevent 1
dehydration
5 Demonstrate preparation of ORS from sachet 4
6 Enumerate non-diarrheal uses of ORS 1
Total 10

[Link] the causes and clinical assessment of dehydration

CAUSES FOR DEHYDRATION:

Diarrhea is the major cause for dehydration

Other causes includes
Vomiting
Fever
Excessive sweating
Increased urination
certain drugs like diuretics, laxatives, antihistamines, chemotherapeutic drugs

Clinical assessment of dehydration

Levels of dehydration:
No dehydration
Some dehydration
Severe dehydration

1. NO DEHYDRATION:
No signs of dehydration are present

2. SOME DEHYDRATION:
If 2 or more signs are present:
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back slowly
Arms & legs are cool to touch
Rapid heartbeat
Muscle cramps
Lightheadedness( relieved by lying down)

3. SEVERE DEHYDRATION
If 2 or more signs are present:
Lethargic or unconscious
Sunken eyes
Not able to drink or drinking poorly
Skin pinch goes back very slowly
Rapid breathing, weak pulse
Cold, clammy skin or hot dry skin
Little or no urination for 12 or more hours

2. Enumerate the different types of ORS along with their composition with
actions of each ingredient

TYPES OF ORS

1. HIGH OSMOLARITY ORS

2. Low osmolarity ORS
3. Citrate based ORS
4. Rice based ORS
5. Home available ORS
 6. SUPER ORS
7. ORS with nutrients-Zinc, Magnesium, selenium, vitamin A

1. HIGH OSMOLARITY ORS

Composition:
Sodium Chloride-3.5g
Trisodium citrate-2.9g
Glucsee anhydrous-20g
Potassium chloride-1.5g

Osmolarity:
Sodium-90 mM
Chloride-80mM
Potassium-20mM
Citrate-10mM
Glucose-111mM
Total-311mOsm/L

2. Low osmolarity ORS

WHO formula- Composition (FOR 1 LITRE ORS)

Most commonly used

Sodium chloride- 2.6gm (3.5gm)
Potassium chloride- 1.5gm
Trisodium citrate- 2.9gm
Glucose anhydrous- 13.5gm (20gm)
Total weight- 20.5gm

Osmolarity:

Sodium-75mN
Citrate-10mM
Potassium-20mM,
Glucose-75mM
Chloride-65mM
Total osmolarity-254mOsm/L (311mOsm/L)

3. Citrate based ORS

Previous Bicarbonate based ORS is replaced with citrate
As citrate based ORS is more stable compared to bicarbonate, no discoloration &
shelf life 2-3 years
Reduces the stool output in high output diarrhea
Trisodium citrate increases the absorption of sodium & water

4. Rice based ORS

Addition of the rice powder (50gm/L) instead of glucose in premixed powder
Starch other than rice including wheat flour & maize have also been shown to
decrease stool volume

5. Home available ORS

Composition: 1 litre water, 6 teaspoons of sugar(30gm approx), Half teaspoon of
common salt

6. SUPER ORS
It is a type of ORS where instead of monosugars more complex sugars are added.
They may be food based (as rice based) or starch free with amino acids (glycine/
alanine based or glucose polymer based)
Amino sugars help in sodium & water absorption

7. ORS with nutrients- Zinc, magnesium, selenium, vitamin A

Super super ORS: Addition of zinc to super ORS

Advantages:
Improved absorption of water & electrolyte by intestine
Faster regeneration of gut epithelium
Increased level of enterocyte brush border enzymes
Enhanced immune response leading to increased clearance of the pathogens
3. Choose the appropriate type of ORS for a given condition/patient
Low osmolarity ORS (WHO)

4. Calculate the quantity of ORS required to correct / prevent dehydration

Volume of the fluid to administered = BW X % Loss

= 20kg x 100ml
=2000ml
Time duration of infusion = 4hrs
2000ml to be infused over 4hours
Therefore 500ml /hr for next 4hours→ 25ml every 3min for next 4 hrs

5. Demonstrate preparation of ORS from sachet.

• Preparation of Oral rehydration solution from ORS packet

• Readymade ORS packet may be available for 1000ml or 200ml.

• Take ORS packet as per requirement of patient & storage facility

• For ORS packet of 1L, take 1 L of boiled & cooled filtered water & add all
the contents of the packet

• Mix well till ORS powder gets dissolved completely

• Use within 24 hours

6. Enumerate non-diarrheal uses of ORS

Electral ORS is commonly used for the diagnosis or treatment of Acidity, low
sodium levels, kidney stones, electrolyte imbalance, fluid depletion
ADVERSE DRUG REACTIONS (ADR)
1. Carbimazole ADRs
2. Cotrimoxazole ADRs
3. Tinidazole ADRs
 Adverse drug reactions (ADR)

1. Carbimazole ADRs
1. Describes the drug therapy of the given case and explains the rationality of
prescription
Tab. Carbimazole 10mg → inhibition of peroxidases (inhibits the synthesis )
Radioiodine 3-6 m curie → destruction of thyroid cells by beta particle

2. Recognise an adverse drug reaction (ADR) in the given case

Carbimazole induced agranulocytosis

3. Perform causality assessment of the identified ADR using WHO & Naranjo's
Scale
Questions Yes No Don’t
know
Are the previous conclusive reports on this reaction +1 0 0
Did the adverse event appear after suspected drug was +2 -1 0
administered ?
Did the adverse reaction improve when the drug was +1 0 0
discontinued or a specific antagonist was administered
Did the adverse reaction appear when the drug was re- +2 -1 0
administered
 Are there alternative causes (other than drug) that could -1 +2 0
have solely caused the reaction
Did the reaction reappear when placebo was given -1 +1 0
Was the drug detected in the blood (or the other fluids)in a +1 0 0
concentration known to be toxic
Was the reaction more sever when the dose was increased, +1 0 0
or less sever when the dose was decreased
Did the patient have a similar reaction to the same or similar +1 0 0
drugs in any previous exposure
Was the adverse event confirmed by objective evidence +1 0 0

Narango scale Score – 6 – Probable

WHO – Probable

4. Fill the ADR reporting form (CDSCO from)

FILLED

5. Explain the management of the ADR

Replacement of drug due to adverse effect of carbimazole (carbimazole induced

agranulocytosis )

6. Explain the methods to prevent the occurrence of the ADR

1. Avoid all inappropriate use of drugs in the context of patient’s clinical
condition.
2. Use appropriate dose, route and frequency of drug administration based on
patient’s specific variables.
3. Elicit and take into consideration previous history of drug reactions.
4. Elicit history of allergic diseases and exercise caution (drug allergy is more
common in patients with allergic diseases).
5. Carry out appropriate laboratory monitoring (e.g. prothrombin time with
warfarin, serum drug levels with lithium).

7. Report the ADR to the pharmacovigilance centre

8. Describe the Importance of reporting ADRs and pharmacovigilance
1. To create a nation-wide system for patient safety reporting
2. To identify and analyze the new signal (ADR) from the reported cases
3. To analyze the benefit - risk ratio of marketed medications
4. To generate the evidence-based information on safety of medicines
5. To support regulatory agencies in the decision- making process on use of
medications
6. To communicate the safety information on use of medicines to various
stakeholders to minimize the risk
7. To emerge as a national centre of excellence for pharmacovigilance activities
8. To collaborate with other national centers for the exchange of information and
data management
9. To provide training and consultancy support to other national
pharmacovigilance centers located across globe.
2. Cotrimoxazole ADRs
1. Describes the drug therapy of the given case and explains the rationality of
prescription

Tab Bactrim DS . BD X 10Day → Protein synthesis inhibition

Syp. Citralka → Alkalization of urine

2. Recognise an adverse drug reaction (ADR) in the given case

Cotrimoxazole induced Steven johnson syndrome

3. Perform causality assessment of the identified ADR using WHO & Naranjo's
Scale
Questions Yes No Don’t
know
Are the previous conclusive reports on this reaction +1 0 0
Did the adverse event appear after suspected drug was +2 -1 0
administered ?
Did the adverse reaction improve when the drug was +1 0 0
discontinued or a specific antagonist was administered
Did the adverse reaction appear when the drug was re- +2 -1 0
administered
Are there alternative causes (other than drug) that could -1 +2 0
have solely caused the reaction
Did the reaction reappear when placebo was given -1 +1 0
Was the drug detected in the blood (or the other fluids)in a +1 0 0
concentration known to be toxic
Was the reaction more sever when the dose was increased, +1 0 0
or less sever when the dose was decreased
Did the patient have a similar reaction to the same or similar +1 0 0
drugs in any previous exposure
Was the adverse event confirmed by objective evidence +1 0 0

Naranjo scale Score – 7 – Probable

WHO – Probable

4. Fill the ADR reporting form (CDSCO from)

Filled

5. Explain the management of the ADR

Withdrawal of bactrim DS
Administration of IV Dexamethasone 10mg 6 hourly
Tab. Norfloxacin 400mg 7days
Tab. Cetrizine 10mg 3days
Betamethasone cream

6. Explain the methods to prevent the occurrence of the ADR

1. Avoid all inappropriate use of drugs in the context of patient’s clinical

condition.
2. Use appropriate dose, route and frequency of drug administration based on
patient’s specific variables.
3. Elicit and take into consideration previous history of drug reactions.
4. Elicit history of allergic diseases and exercise caution (drug allergy is more
common in patients with allergic diseases).
5. Carry out appropriate laboratory monitoring (e.g. prothrombin time with
warfarin, serum drug levels with lithium).

7. Report the ADR to the pharmacovigilance centre

8. Describe the Importance of reporting ADRs and pharmacovigilance

• To create a nation-wide system for patient safety reporting

• To identify and analyze the new signal (ADR) from the reported cases
• To analyze the benefit - risk ratio of marketed medications
• To generate the evidence-based information on safety of medicines
• To support regulatory agencies in the decision- making process on use of
medications
• To communicate the safety information on use of medicines to various
stakeholders to minimize the risk
• To emerge as a national centre of excellence for pharmacovigilance
activities
• To collaborate with other national centers for the exchange of information
and data management
• To provide training and consultancy support to other national
pharmacovigilance centers located across globe.
3. Tinidazole ADRs
1. Describes the drug therapy of the given case and explains the rationality of
prescription
Ta. Tinidazole 400mg BD , 7days → Antiamoebic drug

2. Recognise an adverse drug reaction (ADR) in the given case

Tinidazole induced fixed drug eruption

3. Perform causality assessment of the identified ADR using WHO & Naranjo's
Scale
Questions Yes No Don’t
know
Are the previous conclusive reports on this reaction +1 0 0
Did the adverse event appear after suspected drug was +2 -1 0
administered ?
Did the adverse reaction improve when the drug was +1 0 0
discontinued or a specific antagonist was administered
Did the adverse reaction appear when the drug was re- +2 -1 0
administered
Are there alternative causes (other than drug) that could -1 +2 0
have solely caused the reaction
 Did the reaction reappear when placebo was given -1 +1 0
Was the drug detected in the blood (or the other fluids)in a +1 0 0
concentration known to be toxic
Was the reaction more sever when the dose was increased, +1 0 0
or less sever when the dose was decreased
Did the patient have a similar reaction to the same or similar +1 0 0
drugs in any previous exposure
Was the adverse event confirmed by objective evidence +1 0 0

Naranjo's Score – 6 – Probable

WHO - Probable

4. Fill the ADR reporting form (CDSCO from)

FILLED

5. Explain the management of the ADR

Stop the drug tinidazole
Tab. Deflazacort 12mg x 3day
Tab. Cetrizine 10mg hs 7days

6. Explain the methods to prevent the occurrence of the ADR

1. Avoid all inappropriate use of drugs in the context of patient’s clinical
condition.
2. Use appropriate dose, route and frequency of drug administration based on
patient’s specific variables.
3. Elicit and take into consideration previous history of drug reactions.
4. Elicit history of allergic diseases and exercise caution (drug allergy is more
common in patients with allergic diseases).
5. Carry out appropriate laboratory monitoring (e.g. prothrombin time with
warfarin, serum drug levels with lithium).

7. Report the ADR to the pharmacovigilance centre

FILLED
8. Describe the Importance of reporting ADRs and pharmacovigilance
• To create a nation-wide system for patient safety reporting
• To identify and analyze the new signal (ADR) from the reported cases
• To analyze the benefit - risk ratio of marketed medications
• To generate the evidence-based information on safety of medicines
• To support regulatory agencies in the decision- making process on use of
medications
• To communicate the safety information on use of medicines to various
stakeholders to minimize the risk
• To emerge as a national centre of excellence for pharmacovigilance
activities
• To collaborate with other national centers for the exchange of information
and data management
• To provide training and consultancy support to other national
pharmacovigilance centers located across globe.
Prescription Writing –List of prescriptions(Total-05)
1. Hook worm infestation with anemia
2. Migrane
3. HTN with Diabetes
4. UTI
5. Typhoid
 PRESCRIPTION WRITING

1. A) boy 12 yr of age coming from lower socioeconomic status presents with

fatigue, generalized weakness and dyspnoea on exertion. On examination he
was pale and had Hb of 9gm%. On history he did have any loss of blood and had
good appetite. He was diagnosed to be a case of iron deficiency anaemia due to
hook worm infection. Write a prescription for above case.

B) What else would you add if the boy had dimorphic blood picture on
peripheral smear?
Prescription:

Date:04/10/2016
Mr. Raghu Dr. Sam
Age : 12 yrs Address: RIMS
Sex : Male
Address: Alur Phone no:
Phone no:

Diagnosis: Iron deficiency anaemia

Rx:
Tab ALBENDAZOLE 400mg HS stat
Cap. FERROUS SULPHATE 200mg 0-1-0 – -------30

Dispense 1 tablet of albendazole

Dispense 30 capsules of Ferrous sulphate

Take Tab Albendazole 400mg stat along with fatty meal.

Take Cap. Ferrous sulphate once a day, half an hour before taking food for one
month. Review after 30 days.

Signature
Reg no.
B) Tab. Folic acid 5mg OD , inj hydroxycobalamin 1mg on alternate dates for 2
weeks followed by 1mg inj every 2-3 months for maintananceX 30day

2. A) A young women, 21yrs of age presents with sever throbbing headache, it

is pulsating in nature and unilateral. It it accompanied by nausea and vomiting
and hypersensitivity to light and sound. Prescribe medication to relieve the
acute attack.

B) Modify your prescription if she comes with repeated attacks of migraine.

Prescription:

Date:04/10/2016
[Link] Dr. Sam
Age : 21 yrs Address: RIMS
Sex :Female
Address: Alur Phone no:6788898
Phone no: 56678888

Diagnosis: Acute attack of migraine

Rx:
Tab. SUMATRIPTAN 50mg OD X 1day
Tab. DOMPERIDONE 10mg BD X 3days

Dispense 1 [Link] 50mg, 6 Tab. DOMPERIDONE 10mg

Take 1 SUMATRIPTAN 50mg in morning for 1 day , & 1 tab. DOMPERIDONE 10mg
for 3days after food.

Signature
Reg no.

B) Tab. Propranalol 40mg BD X 30 days

Dispense 60 tablets of Propranalol 40mg
3. A) Middle aged obese person who is hypertensive is recently diagnosed with
type 2 Diabetes mellitus. Prescribe for the clinical condition

B). He report back with dry cough not subsiding with cough suppressants,
after few of above treatment and his blood sugars were still high. How would
you modify you your prescription now in view of the present symptoms?

Prescription:

Date:04/10/2016

Mr. Raghu Dr. Sam

Age : 35 yrs Address: RIMS
Sex : Male
Address: Alur Phone no:
Phone no:
Diagnosis: Type 2 DM with Hypertension

Rx: [Link] 5mg OD X 15days

Tab. METFORMIN 500mg OD X 15 days

Dispense 15 [Link] 5mg and Tab. Metformin 500mg

Take 1 [Link] 5mg and 1 Tab. Metformin 500mg daily

Revisit after 2 weeks for FBS ,PPBS

Signature
Reg no.

B.
Replace [Link] 5mg by Tab. TELMISARTAN 40MG OD X 15Days
Also add glimeperide 1mg OD to metformin 500mg X 2weeks
4. A) Prescribe for a pregnant female of 28weeks of gestation. Complaining of
burning micturition, frequent urination and fever with chills. Urine routine
shows significant number of pus cells. Prescribe empirically for this patient,.

B) Urine culture showed E. coli and proteus. Do you want to modify your
prescription now? If so why?

Prescription:
Date:04/10/2016

Ms. reshma Dr. Sam

Age : 28 yrs Address: RIMS
Sex : female
Address: Alur Phone no:
Phone no:

Diagnosis: Urinary tract infection

Rx: Tab. AMOXICILLIN 500mg TID X 5days

Tab,PARACETAMOL 500mg TID X 3Days

Dispense 15 Tab. Amoxicillin 500mg & 9 Tab,PARACETAMOL 500mg

Take 1 Tab Amoxicillin 500mg thrice a day for 5days , & Tab,PARACETAMOL
500mg thrice a day

Signature
Reg no.

B) Replace . AMOXICILLIN 500mg by Tab. AMOXICILLINE 500mg + CLAVULANIC

ACID 125 mg BD for 05 days.

Culture revealed the presence of [Link] and Proteus which are gram negative
bacteria producing extended spectrum betalactamase (ESBL) rendering the
Amoxicilline ineffective hence Lactamase inhibitor like clavulanic acid are
combined and admistered
5. 8year child with high grade fever since 7days was treated with PCT but fever
did not subside. Now child has vomiting and abdominal pain. On investigation
widal test showed significant titers .prescribe appropriately for the above
clinical condition.

Prescription:
Mr. Raghu Dr. Sam
Age : 08 yrs Address: RIMS
Sex : Male
Address: Alur Phone no:
Phone no:
Diagnosis: Typhoid Fever

Rx: Tab. CIPROFLOXACIN 250mg BD x 10 days

Tab. PARACETAMOL 500 mg , half tablet BD x 5 days

Signature

Reg no.

Dispense: 20 Tab. Ciprofloxacin 250mg & 5 Tab. Paracetamol 500 mg

Take 1 Tab Ciprofloxacin 250mg twice a day for 10 days ,& tab . Paracetamol 500
mg , half table twice a day for 5 days after food
 GRAPHS (Total-04)
1. Potentiation of Ach by Anticholinesterase
2. Effect of Ephedrine on Nor-Epinephrine response
3. Effect of alpha blocker (vasomotor reversal dale
phenomenon)
4. Effect of beta blockers on dog blood pressure
 GRAPHS

1. Potentiation of Ach by Anticholinesterase

1. Describe the graph (observation)
Effect of carbachol , pilocarpine , acetyl choline on dog
BP before and after administration of physostigmine
A & B are response of carbachol & pilocarpine with a
doses of0.5 mcg/kg and 0.5mcg /kg respectively .
C & D are the response of acetylcholine with doses of 1
and 2 mcg on dog BP
After administration of physostigmine there is no change
in response of carbachol and pilocarpine but there is
potentiation of action of acetylcholine

2. Interpret the graph (pharmacological actions,

receptors, any phenomenon etc)
Potentiation of action of acetylcholine by physostimine is
due to inhibition of acetylcholine esterase enzyme which
terminates the action of acetyl choline

3. Describe the inference drawn from graph

Carbachol and pilocarpine are cholinomimetic and are

not degraded by acetyl choline esterase enzyme

4. What are Implications of the graph?

To know the drugs which are inhibited by acetyl choline
esterase enzyme and which are not.
(Potentiation)
2. Effect of Ephedrine on Nor-Epinephrine response
1. Describe the graph (observation)
The graph demonstrates the effect of nor-epinehrine
before and after administration of ephedrine on dog BP
A – explains the effect of nor-epinephrine in the dose of
2 mcg/kg and there is rise in dog BP
B – Explains effect of ephedrine on dose 0.2 mg/kg and
there is sustained and prolonged rise in dog BP.

2. Interpret the graph (pharmacological actions,

receptors, any phenomenon etc)

• Effect of nor-epinehrine :- rise in BP due to α-1

mediated vasoconstriction
• Ephedrine is mixed acting sympathomimetic, it
directly acts on post- synaptic adrenergic receptors
and also indirectly by releasing nor-epinephrine from
sympathetic nerve terminals – Prolonged rise in BP.

3. Describe the inference drawn from graph

Ephedrine is a mixed acting sympathomimetic drug –

leads to potentiation of nor-epinephrine effect.
3. Effect of alpha blocker (vasomotor reversal dale
phenomenon)
1. Describe the graph (observation)
The graph demonstrates the effect of epinephrine, nor-
epinephrine and isoprenaline before and after
administration of unknown drug.
A – Explains the effect of epinephrine and there is
biphasic response on dog BP (initial rise later fall in BP).
B – Explains the effect of nor-epinephrine, there is rise in
BP.
C – Explains the effect of isoprenaline on dog BP, there is
initial rise in BP but later there a marked fall in BP.

AFTER ADDING UNKOWN DRUG

α - mediated vasoconstriction of adrenaline, nor-
adrenaline is blocked and fall in BP is seen.
There is no change in isoprenaline‘s action.

2. Interpret the graph (pharmacological actions,

receptors, any phenomenon etc)
Adrenaline –
o α1Vasoconstriction of blood vessels
o β1 heart (ionotropic, chronotropic)
o β2 Vasodilatation of blood vessel of skeletal muscle
o So mean arterial pressure is increased
Noradrenaline –
• α1Vasoconstriction of blood vessels
• β1 heart (ionotropic, chronotropic)
• no β2 action
• So mean arterial pressure is increased
Isoprenaline -
• no α action
• β1 heart (ionotropic, chronotropic)
• β2 mediated vasodilatation causes decrease in BP
• β3 weak
• So mean arterial pressure is decreased .

EFFECTS AFTER ADDING UNKNOWN DRUG

α - mediated vasoconstriction of adrenaline , nor-
adrenaline is blocked and fall in BP is seen. But
isoprenaline ‘s β actions are not altered.

3. Describe the inference drawn from graph

EFFECTS AFTER ADDING UNKNOWN DRUG

α - mediated vasoconstriction of adrenaline , nor-
adrenaline is blocked and fall in BP is seen. But
isoprenaline ‘s β actions are not altered. So the given
unknown drug is a α BLOCKER.
4. What are Implications of the graph?

Selective receptor antagonism

4. Effect of beta blockers on dog blood pressure

1. Describe the graph (observation)

The graph demonstrates the effect of epinephrine, nor-
epinephrine and isoprenaline before and after
administration of unknown drug.
A – Explains the effect of epinephrine and there is
biphasic response on dog BP (initial rise later fall in BP).
B – Explains the effect of nor-epinephrine, there is rise in
BP.
C – Explains the effect of isoprenaline on dog BP, there is
initial rise in BP but later there a marked fall in BP.

AFTER ADDING UNKNOWN DRUG

Increase in BP when isoprenaline is given.
but α- mediated vasoconstriction due to epinephrine and
nor-epinephrine is not altered.

2. Interpret the graph (pharmacological actions,

receptors, any phenomenon etc)
Adrenaline –
o α1Vasoconstriction of blood vessels
o β1 heart (ionotropic, chronotropic)
o β2 Vasodilatation of blood vessel of skeletal muscle
o So mean arterial pressure is increased
Noradrenaline –
• α1Vasoconstriction of blood vessels
• β1 heart (ionotropic, chronotropic)
• no β2 action
• So mean arterial pressure is increased
Isoprenaline -
• no α action
• β1 heart (ionotropic, chronotropic)
• β2 mediated vasodilatation causes decrease in BP
• β3 weak
• So mean arterial pressure is decreased .

EFFECTS AFTER ADDING UNKNOWN DRUG

after adding unknown drug there is blockade of β2
induced vasodilator effect and rise in BP due to β1
mediated cardiac stimulation with isoprenaline. but
α- mediated vasoconstriction due to epinephrine
and nor-epinephrine is not altered.
3. Describe the inference drawn from graph
after adding unknown drug there is blockade of β2
induced vasodilator effect and rise in BP due to β1
mediated cardiac stimulation with isoprenaline. but α-
mediated vasoconstriction due to epinephrine and nor-
epinephrine is not altered. So the given drug is a β
BLOCKER.

4. What are Implications of the graph?

RECEPTOR ANTAGONISM
 DOSAGE FORMS LIST-(Total-05)
1. Inhalational Dosage form
2. Subcutaneous Dosage form
3. Intramuscular Dosage form
4. Transdermal Dosage form
5. Liquid Dosage form
 DOSAGE FORMS-1
1. A 45 year old male patient with chronic bronchial asthma suddenly developed
severe acute asthma. He needs to be given salbutamol, ipratropium and
hydrocortisone.

1) Choose the appropriate dosage form for given clinical scenario

• -Inhalational Dosage form

2) Describes the reason for choosing the particular dosage form

• Aerosols are formed as drug solution or micro-ionised drug powder is
converted into mist/ dust respectively.
• Action is either on bronchial tree or system due to absorption through
lungs- Targeteed drug delivery system.

3) Provides the appropriate instructions to be followed for administering the

chosen dosage form
• Cough up as much sputum as possible
• Shake the inhaler before use.
• Hold the inhaler as indicated in instructions
• Fully exhale
• Place the lips tightly around the mouth piece
• Tilt the head backwards slightly
• Breathe in deeply and activate the inhaler (press the metallic bottle)
keeping the tongue down co-ordination between activating the inhaler and
breathing is critical for effective delivery
• The aerosolized medicine is drawn into the lungs by continuing to inhale
deeply before holding the breath for 10 seconds to allow absorption into
the bronchial wall
• Hold the breath for 10-15 seconds
• Breathe out through the nose
• Rinse the mouth with warm water
4) Describes the merits and demerits of the given dosage form

Merits-
• Systemic effect including toxicity is less
• Targeted delivery of drug
• Easy to use
• Less amount of drug is needed
• Onset- fast
Demerits-
• Reflex bronchospasm
• Candida growth in oral cavity
• Patient has to learn the technique

5) Explains the components of the commercial label

Generic name (brand name ),dose, dosage form, route, quantity in numbers,
implication, caution, storage instruction, manufacturing date and expiry date, cost
HOW TO USE-
• Cough up as much sputum as possible
• Shake the inhaler before use.
• Hold the inhaler as indicated in instructions
• Fully exhale
• Place the lips tightly around the mouth piece
• Tilt the head backwards slightly
• Breathe in deeply and activate the inhaler (press the metallic bottle)
keeping the tongue down co-ordination between activating the inhaler
and breathing is critical for effective delivery
• The aerosolized medicine is drawn into the lungs by continuing to inhale
deeply before holding the breath for 10 seconds to allow absorption into
the bronchial wall
• Hold the breath for 10-15 seconds
• Breathe out through the nose
• Rinse the mouth with warm water
 DOSAGE FORMS-2
2. A 40year old type I diabetic female patient needs human
insulin injection daily

1) Choose the appropriate dosage form for given clinical scenario

- Subcutaneous Dosage form

2) Describes the reason for choosing the particular dosage form

• Subcutaneous injections are highly effective in administering such
medications as insulin.
• Hyaluronidase can breaks down intracellular matrix which increases the
absorption.

3) Provides the appropriate instructions to be followed for administering the

chosen dosage form
Requirements-
• Syringe with the drug to be administered (without air), needle 25G, liquid
dis-infectant, cotton wool, adhesive tape.
Procedure-
1. Wash hands with soap and water
2. Reassure the patient and explain the procedure
3. Uncover the to be injected
4. Disinfect skin
5. Pinch fold the skin
6.
Insert needle in the base of the skin fold ta an angel of 20 0-300
7. Release skin
8. Aspirate briefly , if blood appears withdraw the needle
9. Inject slowly ( 0.5 – 2 minutes)
10. Withdraw needle quickly
11. Press sterile cotton wool on to the opening
12. Check the patients reaction and give additional re-assuranc eif necessary
13. Clean up and dispose off waste safely and wash hands.

4) Describes the merits and demerits of the given dosage form

Merits-
• Self administration possible
• Drugs in oil or implants can be given
• Action on the drug is sustained and uniform
Demerits-
• Painful
• Onset of action is slow
• Only non-irritant substances can be injected

5) Explains the components of the commercial label

Generic name (brand name ),dose, dosage form, route, quantity in numbers,
implication, caution, storage instruction, manufacturing date and expiry date, cost
HOW TO USE-
1. Wash hands with soap and water
2. Reassure the patient and explain the procedure
3. Uncover the area to be injected
4. Disinfect skin
5. Pinch fold the skin
6.
Insert needle in the base of the skin fold ta an angel of 20 0-300
7. Release skin
8. Aspirate briefly , if blood appears withdraw the needle
9. Inject slowly ( 0.5 – 2 minutes)
10. Withdraw needle quickly
11. Press sterile cotton wool on to the opening
12. Check the patients reaction and give additional re-assuranc eif necessary
13. Clean up and dispose off waste safely and wash hands.
 DOSAGE FORMS-3

3. A 14 year boy fell down while playing on the road and

sustained abrasions over his knees. He needs to be given
tetanus toxoid

1) Choose the appropriate dosage form for given clinical scenario

- Intramuscular Dosage form

2) Describes the reason for choosing the particular dosage form

• Drug is injected in one of the large skeletal muscle of the body.
• Skeletal muscle is highly vascular and its capillaries contain small pores
which enable substance of small molecular weight to pass through into the
blood stream- influence the rate of drug absorption.
• Can be injected with the quantities of upto several milli-litre
• Without inducing discomfort to the patient

3) Provides the appropriate instructions to be followed for administering the

chosen dosage form
1. Wash hands with soap and water
2. Reassure the patient and explain the procedure
3. Uncover the area to be injected
4. Disinfect skin
5. Insert the needle swiftly at the angel of 900
6. Aspirate briefly, if blood appears withdraw needle, replace it
7. Inject slowly using Z technique
8. Withdraw needle swiftly
9. Press sterile cotton wool on to the opening
10. Check the patients reaction and give additional re-assurance if necessary
11. Clean up and dispose off waste safely and wash hands.

4) Describes the merits and demerits of the given dosage form

Merits-
• Rate of absorption is reasonably uniform
• Less painful
• Onset of action - fairly rapid
• Depot preparation can be given
• In addition to soluble substance, mild irritants, suspension, colloids can be
injected by this route.
Demerits-
• Aseptic precautions are mandatory
• Danger of injecting into blood stream
• Volume of injection should not be more than 10ml
• Pain at the site of injection, irritation , abscess formation or tissue and
nerve damage may occur.
• Rapid absorption may cause even death

5) Explains the components of the commercial label

Generic name (brand name ),dose, dosage form, route, quantity in numbers,
implication, caution, storage instruction, manufacturing date and expiry date, cost
HOW TO USE-
1. Wash hands with soap and water
2. Reassure the patient and explain the procedure
3. Uncover the area to be injected
4. Disinfect skin
5. Insert the needle (22G) swiftly at the angel of 900
6. Aspirate briefly, if blood appears withdraw needle, replace it
7. Inject slowly using Z technique
8. Withdraw needle swiftly
9. Press sterile cotton wool on to the opening
10. Check the patients reaction and give additional re-assurance if necessary
11. Clean up and dispose off waste safely and wash hands.
 DOSAGE FORMS-4

4. A 20 year old sales man has to travel frequently to hilly

areas. He has motion sickness and needs scopolamine for
prophylaxis.

1) Choose the appropriate dosage form for given clinical scenario

-Transdermal Dosage form

2) Describes the reason for choosing the particular dosage form

Transdermal Dosage form avoids problem s such as gastrointestinal irritation,

metabolism, variation in delivery rate, and interference due to the presence of food.

3) Provides the appropriate instructions to be followed for administering the

chosen dosage form
• Do not apply over bruised / damaged skin
• Do not wear over skin fold/ under tight clothing and change spots regularly
• Apply with clean, dry hands.
• Clean and dry the area of application completely
• Remove patch form package, do not touch drug side
• Place on skin and press firmly. Rub the edges to seal.
• Remove and replace according to instruction

4) Describes the merits and demerits of the given dosage form

Merits:
• Bypass first pass metabolism
• Maintains constant plasma levels for a longer periods
• Less side effects
• Easy to discontinue if toxic appears
• No GIT side effect
• Convenient to use, compliance improves
Demerits:
• Local irritation, erythema
• Onset of action – slow
• Cannot achieve high concentration in plasma
• Cannot deliver drugs in a pulsatile manner
• expansive

5) Explains the components of the commercial label

Generic name (brand name ),dose, dosage form, route, quantity in numbers,
implication, caution, storage instruction, manufacturing date and expiry date, cost
HOW TO USE-
Peel off the clear backing from the patch and apply it on a clean, dry, hairless area
of skin behind the ear
 DOSAGE FORMS-5

5. Mother of a 9months old infant complaints of 3episodes of

vomiting since 2days for which syrup ondensetron was
prescribed.

1) Choose the appropriate dosage form for given clinical scenario

-Liquid Dosage form

2) Describes the reason for choosing the particular dosage form

• They are sweet in taste sp masking the bad taste of drugs , especially
suitable for children
• Quicker effect than tablet

3) Provides the appropriate instructions to be followed for administering the

chosen dosage form
• Shake well before use
• Close the bottle cap properly after use.
• Keep it away from sunlight.

4) Describes the merits and demerits of the given dosage form

Merits:
• They are sweet in taste sp masking the bad taste of drugs , especially
suitable for children
• Quicker effect than tablet
• Certain chemical substances can cause gastric irritation if taken in the form
of powder / tablet

Demerits:
• Maintenance not easy
• Costlier than tablet
5) Explains the components of the commercial label
Generic name (brand name ),dose, dosage form, route, quantity in numbers,
implication, caution, storage instruction, manufacturing date and expiry date, cost
HOW TO USE-
• Shake well before use
• Close the bottle cap properly after use.
• Keep it away from sunlight.