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By A. Stejnar. University of California, Los Angeles.

Question 6 In this case one millimole of calcium chloride will give one millimole of calcium and two millimoles of chloride order sulfasalazine 500mg with visa. So the amount (in milligrams) for one millimole of calcium chloride will give one millimole of calcium and two millimoles of chloride order sulfasalazine 500mg on line. So 147mg (one millimole) of calcium chloride will give one millimole of calcium and two millimoles of chloride. Now calculate how much calcium chloride in the 10mL ampoule containing calcium chloride 10%. If using the formula: percentage strength (% w/v) mmol = × 10 × volume (mL) mg of substance cconntaining 1mmol For calcium: percentage strength (% w/v) = 10 mg of substance containing 1mmol = 147 volume (mL) = 10 Substituting the numbers into the formula: 10 × 10 × 10 = 6. Answer: There are approximaetly 7 millimoles of calcium and 14 millimoles of chloride in a 10 mL ampoule of calcium chloride 10%. To convert this to a molar concentration, you need to calculate the equivalent number of moles per litre (1,000mL). Alternatively, a formula can be used: weight (g) × 1,000 concentration (mol/L or M)= molecular weight × final volumev (mL) In this case: weight (g) = 8. Alternatively, a formula can be used: concentration (mol/L or M)× molecular weight×× final volume (mL) weight (g) = 1,000 In this case: desired concentration (mol/L or M) = 0. Chapter 8 Infusion rate calculations 201 Chapter 8 Infusion rate calculations Question 1 First convert the volume to a number of drops. To do this, multiply the volume of the infusion by the number of drops per mL for the standard giving set: 500 × 20 = 10,000 drops Next convert hours to minutes by multiplying the number of hours the infusion is to be given by 60. The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: Dose = 10mcg/min = 10 × 60 = 600mcg/hour Convert mcg to mg by dividing by 1,000: 600 = 0. As the dose is being given as a total dose (not on a weight basis), the following formula can be used: volume to be infused dose 60 mL/hour = amount of drug ×1,0001 where: total volume to be infused = 500mL total amount of drug (mg) = 50mg dose = 10mcg/min 60 converts minutes to hours Substitute the numbers in the formula: 500 10 60 = 6mL/hour 50×1 000, Answer: The rate required is 6mL/hour. The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: dose = 2mg/min = 2 × 60 = 120mg/hour Calculate the volume for 1mg of drug. As the dose is being given as a total dose (not on a weight basis), the following formula can be used: volume to be infused dose 60 mL/hour = amount of drug where: total volume to be infused = 500mL total amount of drug (mg) = 1,000mg dose = 2mg/min 60 converts minutes to hours Substituting the numbers into the formula: 500××2 60 = 60mL/hour 1 000, Answer: The rate required is 60mL/hour. Question 6 First calculate the dose required: Dose required = patient’s weight × dose prescribed = 80 × 3 = 240mcg/min Dose = 240mcg/min. The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: dose = 240 × 60 = 14,400mcg/hour Convert mcg to mg by dividing by 1,000: 14,400 = 14. The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: 150 × 60 = 9,000mcg/hour Convert mcg to mg by dividing by 1,000: 9,000 = 9mg/hour 1 000, The next step is to calculate the volume for the dose required. Calculate the volume for 1mg of drug: You have: 50mg in 50mL: 50 1mg= =1mL 50 Thus for the dose of 9mg, the volume is equal to: 9 × 1 = 9mL/hour Answer: The rate required is 9mL/hour. As the dose is being given as a total dose (not on a weight basis), the following formula can be used: volume to be infused dose 60 mL/hour = amount of drug where: total volume to be infused = 50mL total amount of drug (mg) = 50mg dose = 150mcg/min 1,000 converts mcg to mg 60 converts minutes to hours Substitute the numbers in the formula: 50 150 60 = 9mL/hour 50×1 000, Answer: The rate required is 9mL/hour. The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: 450 × 60 = 27,000mcg/hour Convert mcg to mg by dividing by 1,000: 27,000 = 27mg/hour 1 000, The next step is to calculate the volume for the dose required. Alternatively, using the formula: volume to be infused dose weight 60 mL/hour = amount off drug ×1,000 In this case: total volume to be infused = 50mL total amount of drug (mg) = 250mg dose = 6mcg/kg/min patient’s weight = 75kg 60 converts minutes to hours 1,000 converts mcg to mg Substituting the numbers into the formula: 5 0××6 7 5 ×6 0 = 5. Question 11 (i) You need a final concentration of 5mg/mL which is the same as: 1 1mg= mL 5 Chapter 8 Infusion rate calculations 207 A dose of 1g = 1,000mg would need: 1 × 1,000 = 200mL 5 Nearest commercial bag size is 250mL. As the pump needs to be set at a rate per hour, we need to calculate the volume to be given over 60 minutes: 250 1 minute = mL 100 250 So over 60 minutes: × 60 = 150mL/hour 100 Answer: 150mL/hour Question 12 (i) First calculate the dose required: dose required = patient’s weight × dose prescribed = 73 × 5 = 365mcg/min Answer: 365mcg/min (ii) You have 250mg in 500mL. The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: 365 × 60 = 21,900mcg/hour Convert mcg to mg by dividing by 1,000: 21900, = 21. You have 50mg in 500mL: 500 Therefore 1mg = = 10mL 50 Thus 2mg/hour = 10 × 2 = 20mL/hour Answer: The rate is 20mL/hour. Chapter 8 Infusion rate calculations 209 Using the formula: rate (mL/hour) amount of drug 1,000 mcg/kg/min = weight (kkg) volume (mL) 60 where, in this case: rate = 4mL/hour amount of drug (mg) = 200mg weight (kg) = 89kg volume (mL) = 50mL 60 converts minutes to hours 1,000 converts mg to mcg Substituting the numbers into the formula: 4 200 1 000, = 2. First calculate the dose required: dose required = patient’s weight × dose prescribed = 64 × 6 = 384mcg/min The final answer is in terms of hours, so multiply by 60 to convert minutes into hours: 384 × 60 = 23,040mcg/hour Convert mcg to mg by dividing by 1,000: 23 040. A formula can be used: volume to be infused dose weight 60 mL/hour = amount off drug ×1,000 In this case: total volume to be infused = 50mL total amount of drug (mg) = 250mg dose = 6mcg/kg/min patient’s weight = 64kg 60 converts minutes to hours 1,000 converts mcg to mg Substituting the numbers into the formula: 50××6 64×60 = 4. Using the formula: 212 Answers rate (mL/hour) amount of drug 1,000 mcg/kg/min = weight (kkg) volume (mL) 60 where in this case: rate = 28mL/hour amount of drug (mg) = 50mg weight (kg) = 78kg volume (mL) = 50mL 60 converts minutes to hours 1,000 converts mg to mcg Substituting the numbers into the formula: 28 50 1 000, = 5. Question 17 First, convert the volume to drops by multiplying the volume of the infusion by the number of drops/mL for the giving set: 500 × 20 = 10,000 drops Next, calculate how many minutes it will take for 1 drop: 42 drops per minute 1 1 drop will take min 42 Calculate how many minutes it will take to infuse the total number of drops: 1 10,000 drops will take × 10,000 = 238min 42 Convert minutes to hours by dividing by 60: 238 238min = = 3. Using the formula: Chapter 8 Infusion rate calculations 213 number of hours the infusion is to run = volume of the infusion × drip rate of giving set rate (drops/min)×60 where, in this case: volume of the infusion = 500mL rate (drops/min) = 42 drops/min drip rate of giving set = 20 drops/mL Substituting the numbers into the formula: 500×20 = 3. Question 18 Divide the volume by the rate to give you the time over which the infusion is to run: calculated rate = 83mL/hour volume = 1,000mL 1 000, = 12.

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The underlying physiology is likely related to over- -)(11#$ 0 stimulation of dopamine receptors in the part of the brain responsible for instant gratification generic sulfasalazine 500 mg on-line. Dopamine Agonist Started Stopped 2% 2% The Parkinson’s Outcomes Project is the largest clinical study of Parkinson’s in the world order sulfasalazine 500 mg with mastercard. This chart shows the percentage of people using and not using dopamine Used 38% agonists at each of the more than 19,000 visits tracked Not Used in the study as of May 2015. Frequency surveys have shown that these abnormal behaviors are more common with dopamine agonists but can also be seen with carbidopa/levodopa. Those at greatest risk include patients with a family history of gambling and those who are younger, unmarried, and/or cigarette smokers. Additional study will likely provide more insight into the true risk associated with the addition of these dopaminergic medications, as the newer questionnaire may be more likely to pick up such behaviors. Remember also that the people suffering from impulse control issues may not have insight into the behavioral problems, and this lack of insight underscores the importance of involving caregivers in any proactive monitoring plan. Neither of these dopamine agonists is ergot- derived, nor have they been associated with abnormalities of the heart valves. The side effects are similar, with the addition of usually mild local skin irritation under the patch in up to 40% of patients. Fewer than 5% of those studied in the clinical trials discontinued its use due to skin irritation. The initial formulation of the patch was removed from the market worldwide in 2008 because of technical problems with the delivery system. The original patches had a tendency to show a crystallized substance on their surface after they were stored in pharmacies and in patient medicine cabinets for weeks. Neupro® was redesigned and returned in 2012 with dosing available in 1, 2, 3, 4, 6 and 8 mg daily. Its short half-life (average 40 minutes) and chemical structure make it difficult, if not impossible, to take by mouth. In the person affected by severe “off” reactions, during which disabling bradykinesia and rigidity interfere with function, a self-injected dose of Apokyn® can reverse the “off” period within minutes and bridge the gap of one to two hours until the next dose of levodopa takes effect. An anti-nausea medication (usually trimethobenzamide or Tigan®) is required prior to injection in the early phase of treatment but can be discontinued after the first week or two. Selegiline was shown to delay the need for levodopa by nine months, suggesting neuroprotection, but this benefit may simply have been from the antiparkinson symptom effect of selegiline. Selegiline is available in two formulations: standard oral (Eldepryl®, l-deprenyl) and orally- disintegrating (Zelapar®). Standard oral selegiline is converted to an amphetamine like by-product which may contribute to side effects of jitteriness and confusion. Conversely, Zelapar® is dissolved in the mouth and absorbed directly into the bloodstream (no byproduct) without these side effects. Because of Zelapar®’s absorption in the mouth, it may be preferred for convenience or out of necessity for the person who has difficulty swallowing. Clinical trials of Azilect® as monotherapy or adjunctive therapy showed mild but definite efficacy, and there was also an unproven hint of slowing disease progression. A worldwide, multi-institutional clinical trial of rasagiline’s potential for neuroprotection was published in 2008 and follow-up data from the original studies has also been examined closely. A study was published in 2011 that fortunately found no cases of dangerous blood pressure shifts in 18 Parkinson’s Disease: Medications over 2000 patients taking rasagiline in combination with many of the anti-depressant medications on the market today. Additional side effects include confusion, hallucinations, discoloration of urine (reddish-brown or rust-colored) and diarrhea. Entacapone is prescribed with each dose of levodopa, whereas tolcapone is taken three times a day, no matter how many doses of levodopa are prescribed. Tolcapone was removed from the American market in the early 2000s because of a few instances of liver toxicity in people who used it. Tolcapone is currently available with the condition that blood tests of liver function be conducted every two to four weeks for the first six months after beginning treatment, then periodically thereafter. It works by providing relief for the motor symptoms as well as reducing “off” time. By combining the two drugs into one tablet, the manufacturer has made pill-taking a little more convenient compared with carbidopa/ levodopa + entacapone taken separately. In addition, there are more dosing options (see table) to better tailor the medication needs to an individual patient. Its mechanisms of action are not fully known, but it is likely that it interacts with multiple receptors at various sites in the brain to achieve its positive effect. Amantadine is cleared from the body by the kidneys, so a person with kidney problems may require a lower dose. Amantadine is most commonly available as a 100 mg capsule, although liquid and tablet forms can also be obtained.