MRP IS 90 WHAT WILL BE IT WP?

How many gm of 10 % ointment to be mixed with 18% of 160 gm to get 15% of ointment?
10 % 3Parts
15%
18% 5 Parts
total 8P
5parts = 160 gm, 1 p=160/5=32gm
3P =3x32gm=96 gm
A 12% OINTMENT MIXED WITH 20% OF 240GM TO GET
16% OINTMENT OF X GM. CALCULATE THE VALUE OF X.

12 % 4 Parts (240 gm)

16%
20% 4 Parts (240 gm )
total = 8P
• 4parts = 240 gm , 1Parts= 240/4=60 gm
• 8parts = 8x60=480 gm
HOW MANY PARTS OF 10% OINTMENT MIXED
WITH 2 PARTS OF 15% TO GET 12% OF
OINTMENT?
10 % 3 Parts
12%
15% 2 Parts
total = 5P
HOW MANY MG OF HYDROCORTISONE OINTMENT SHOULD
BE USED IN COMPOUNDING HYDROCORTISONE 1/8 % AND
HYDROPHILIC OINT. 10 GM

Ans
1/8 1/8
10 gm x 1/8 %= 10gm x ……….. =10 x1000 mg x ………. =100 x. 1/8 =12.5 mg
100 100
EXPRESS THE 0.5 MG TO MCG.

1 gm =1000000 mcg
1mg = 1000 mcg
0.5mg = 1000 x0.5 = 500 mcg
IN A 100ML SOLUTION CONTAINS 0.25 MG.
EXPRESS IT INTO PPM.
• 250 ppm
1 gm in 1000000 ml i.e. 1 PPM.
1mg in 1000ml i.e 1 PPM 10x 0.25 mg in 100ml x10 2.5 mg in 1000ml 2.5 PPM
1mcg in 1 ml i.e 1 PPM
IN 20 GM OF OINTMENT MIXTURE CONTAIN 2MG
OF API. EXPRESS IT INTO PPM.
• 1gm in 1000000mg 1 ppm
• 1mg in 1000 mg 1 PPM 2mg in 20 gm 2mg in 20x 1000 2/20 in 20/20 x1000mg
• 0.1mg in 1000mg ie 0.1 PPM

• 1mcg in 1mg 1 PPM

•WP and RP calculation
•
• R.P.

•Wholeshelor Price =−−−−−−−−− (if margin is 16%)

• 1.16

•Retail Price= W.P.x 1.16 (if margin is 16%)

• R.P.

•Wholeshelor Price =−−−−−−−−− (if margin is 20%)

• 1.20
• Retail Price= W.P.x 1.20 (if margin is 20%)
 IN A PARACETAMOL INFUSION CONTAINS 1000MG/100ML.
RATE OF INFUSION IS 2000MG/HRS, EACH ML CONTAINS 20
DROPS. WHAT IS THE RATE OF INFUSION DROPS/MIN ?

• Rate of infusion =2000mg /hrs = 2000mg / 60min =33.34mg /min =67drops /min
• 1000mg = 100ml
• 1mg =100 /1000ml convert ml to drops
• 33.34mg = 100x33.34 /1000ml =3334 /1000ml =3.334ml
• 3.334x20 =66.68drops = 67drops
A SOLUTION CONTAINS 1.25 MG OF DRUGS PER ML.AT
WHAT RARE SHOULD BE INFUSED (DROPS/MIN)IF THE
DRUG IS TO BE ADMINISTER AT THE RATE OF 80 MG /HR ?
(1ML =30 DROPS )
• Rate of infusion = 80mg /hr =80mg /60 min =8mg /6min =4/3 = 1.34mg /min 32drops /min
• 1.34mg convert into ml ,1.25mg =1ml
• 1mg =1 /1.25 ml
• 1.34mg =1x1.34 /1.25 ml =1.072ml
• 1ml =30 drops
• 1.072ml =30x1.07drops
• =32drops
IF A RECOMMENDED DOSE OF AMOXICILLIN IS
30MG/KG/DAY IN 3 DIVIDED DOSE. CALCULATE THE
DOSE FOR 20 KG CHILD.
• Amoxicillin Dose =30mg /kg/day
• Child wt. =20 kg, In 3 divided dose
• Dose for 20 kg child =30mg x20 /day =600mg /3 =200mg
 CLAVAM CONC….5GM /30ML, 5 YRS

• Child Dose
• Age in Years
• AGE 1 to 12, CD= ………………………………x A.D.
• Age in Years +12
• WT wt in Kg (pound)
• CD= ………………………………x A.D.
• 70 (150)
• BSA
MEGA CV 66.6GM /60 ML 2YRS WT 8KG

• 2
• AGE 1 to 12, CD= ………………………………x 625mg. = 89.286 mg
• 2+12
WHAT IS THE W.- AN ITEM WHICH IS BEING SOLD
ON RP AT RS 33.06 (MARGIN 16%)
 BSA
C.D = ………………………………X A.D.
1.73
HOW MANY MILLIGRAMS OF THE PENICILLIN ARE NEEDED TO
PREPARE 120 G OF A PENICILLIN OINTMENT CONTAINING 1000
UNITS PER GRAM (1 UNIT=0.6MCG)?
• 1 unit=0.6mcg
• 1000units =0.6mcg x 1000 =600mcg =0.6 mg ( 1000mcg = 1 mg)
• 1gm PE Oint. =1000 Units = 0.6 mg
• so 120 gm = 0.6mg x 120 =72 mg
CALCULATE THE VALUE OF X AND Y.

Name of excipents Master Formula Working Formula for 20 ml

For 100 ml
Calamine 15 gm 3gm
ZnO 5 gm 1gm

Bentonite 3 gm Xgm

Glycerin Yml 1 ml

Aqua ad 100ml 20ml

• For Value of X,
• Master Formula 15 gm
• for this type of calculation we need the factor = ……………………………=……….
• Working Formula 3 gm
• =5 3
• For X value, x=……..=0.6 gm
• 5
• Similarly, Value of Y = 5x 1ml =5 ml

• N1= 15 gm
CALCULATE THE HALF LIFE OF DRUG IF
ELIMINATION RATE CONSTANT IS 0.087PER HR.
• 0.693 0.693
• Half life =……………….,ke = …………….
• Ke t½
• = 0.693/0.087
• 7.965 hr
PURIFIED TALK IS USED AS

• Lubricants
• Antiadhisive
• Filler
• Glident
AMOUNT OF NACL IN 540 ML 0.9% WT /VL

• 540ml x 0.9%
• =540 x 0.9/100
• = 540x 0.009
• 4.86 gm
HOW MANY GM OF ANHYDROUS DEXTROSE IS
NEEDED TO PREPARED 50 ML OF ISOTONIC SOL OF
AMITHOCANE 0.5%? (NACL EQU OF AMITHOCANE
IS 0.19) NACL EQ TO DEXTROSE IS 0.18
• 0.5% in 50 ml =50x0.5/100=0.25gm
• Nacl equ to Amithocic 0.19, 50ml x0.19=9.5 gm
• Nacl eq to Dex 0.18, 50 x0.18 =9gm
• 9.5 gm –(9gm +0.25 gm) =0.25 gm
CALCULATE THE AMOUNT OF 98% W/V AND 12%
W/V SOL SUCROSE REQUIRED TO 10 L OF 35% W/V
SUCROSE SOL.

• Alligation Method
98% 23 P x 0.116L= 2.668 L
35%
12% 63 P x 0.116L =7.308 L

T= 86 P =10 L, 1 P=10/86=0.116L,
WHAT WT OF 5%W/W SOL CAN BE PREPARED FROM 2
GM OF API ?
Wt of Solution is X gm.
From Question, X x 5% w/w = 2 gm
X x 5/100 =2 gm
X = 2x100/5 gm
= 2x 20 gm
=40 gm
CALCULATE THE NO OF BOTTLE TO BE
DISPENSE OF CLOXA DS CONTAINING 50 ML PER
BOTTLE
 A DRUG A INFUSION RATE IS 45MG/HR, IF SOLUTION
CONTAINS 0.5MG/ML. CALCULATE THE RATE OF
INFUSION IN DROP/MIN.
IN THIS CASE EACH ML CONTAINS 20 DROPS.
a. 20drops /min
b. 30drops /min
c. 45drops /min
d. 60drops /min
• Rate of infusion 45mg /hr
• 45mg/60min
• 0.75mg/min =1.5ml /min =1.5x20 drops /min=30 drops per min
• o.5mg per ml
• 1mg in 1/0.5 ml
• 0.75mg in 1x0.75/0.5
• 1.5ml
DRUG INTERACTION
BIBEK GAUTAM
 DEFINITION

• The modification of Action of one Drug by the another substance when they
are used concurrently or simultaneously is known as Drug Interaction.
• The modification of action means either increase or decrease the
pharmacological action.
• Pharmacological Action means Pd or PK Action.
• Another substance means they may be drug/ food/electrolyte/chemicals
OBJECTIVES

• Review the mechanisms of drug interactions

• Discuss the most common medications involved in drug
interactions
• Discuss other predispositions for drug interaction potential
(prediction of DI)
• Review strategies to assist in minimizing drug interactions
PATIENT HARM FROM DRUG INTERACTIONS
CAN BE REDUCED BY

 Using a personal formulary(Drug Individualization) – using

few drugs and knowing them well
Recognizing drugs that are major perpetrators (violators) of
interactions
Recognizing narrow therapeutic index drugs as vulnerable to
interactions
Applying clinical pharmacology principles
RISK FACTORS FOR DRUG INTERACTIONS

Narrow OTC
Therapeutic Medications • Polypharmacy
Index Drugs

Genetic Multiple
Disposition Prescribers

Morbidity
 EVIDENCE:

• Goldberg et al- Analyzed drug-drug and drug-disease interactions in the

ER setting, both teaching facility and community hospital
– 205 patients analyzed
– 3 or more medications in patients over the age of 50
– 47% potential interactions identified
– 21% confirmed drug interactions
– Risk of interactions rose from 13% for patients taking 3 meds to 82% for patients taking
7 or more medications
 TYPES OF DRUG INTERACTION

A. Pharmacokinetic Drug Interaction

1. Drug-Drug Interaction
2. Drug-Food interaction
B. Pharmacodynamic Drug Interaction
1. Drug-Drug Interaction
2. Drug-Food interaction
C. Pharmaceutical Drug Interaction
 PHARMACOKINETIC DRUG INTERACTION
 Pharmacokinetic Drug Interaction Means interaction in absorption, distribution, metabolism and Excretion.
 Pharmacokinetic drug-drug interactions occur when a drug alters the disposition (absorption, distribution,
elimination) of a co-administered agent.
 Pharmacokinetic interactions may result in the increase or the decrease of plasma drug concentrations. These
modifications are variable in intensity but can lead to contraindications of the association.
 The mechanisms of pharmacokinetic interactions involve drug metabolizing enzymes and drug transporters.
 The increase of drug plasma concentrations is generally related to the inhibition of enzymes and/or drug
transport.
 The decrease of drug concentrations reflects the activation by inducers that lead to the increase of the expression
of enzymes and drug transporters.
 They can cause the decrease and the increase of the exposure of the combined agent depending on the duration of
the association.
DRUG INTERACTION IN ABSORPTION

• Factor that interaction in absorption are :

 PH
Microbial Flora/ Bacterial Flora/GI flora
Gastrointestinal Motility
Complex formation or chelation
Concentration at the site of Absorption
PH

• Acidic Drugs are more absorb in Acidic medium

WHY?
• Basic Drugs are more absorb in Basic medium
• Because of Acidic Drug in Acidic Medium they becomes Unionized similarly basic drugs in
basic medium becomes unionized.
• Acidic drug in Basic medium and Basic Drugs in Acidic medium becomes Ionization
• Ionization form is more water soluble form than Unionization.
• Unionized form is more Lipid soluble form.
• Our cell membrane made up of Lipid bilayer.
• Hence Acidic drug in Acidic medium and basic drug in basic medium better Absorption

So called as Like Dissolve Like

When two drugs alter the GI PH then alter the Absorption through GI System.

Acidic Drugs are absorb from stomach and Basic Drugs are absorb in Intestine
WHAT HAPPEN WHEN KETOCONAZOLE AND
ANTACID ARE USED CONCURRENTLY?
• Ketoconazole absorbed the best in an acidic
environment.
• take ketoconazole at least 2 hours before or 1 hour
after taking the antacid, otherwise ketoconazole
may not be absorbed into the body.
WHAT HAPPENS WHEN BASIC DRUG AND
ANTACID ARE USED CONCURRENTLY?
• Basic Drug are absorb in Basic environment.
• So increase the Bioavaibility of Basic Drug .
(Absorption )
 MICROBIAL FLORA/ BACTERIAL FLORA/GI FLORA

• What happens when Antibiotics such as Amoxicillin and

Digoxin are used concurrently?
• When at normal condition Digoxin are metabolize the 40% by
gastrointestinal flora. (pre systemic metabolism)
• When use with Amoxicillin, it kills the GI flora that means the
concentration of GI flora may decrease.
• So increase the concentration of Digoxin at the site of Digoxin
absorption and increase the Bioavaibility of Digoxin.
WHAT HAPPEN WHEN KETOCONAZOLE AND
ANTACID ARE USED CONCURRENTLY ?

• a) Increase the bioavailability of ketoconazole

• b) Decrease the bioavailability of ketoconazole
• c) No change
• d) nullified
• K is better absorb in acidic medium.
• Antacid decrease the acidic environment in stomo….
WHAT HAPPEN WHEN CIPROFLOXACIN AND
ANTACID CONTAINING ALUMINUM AND
CALCIUM ARE USED CONCURRENTLY ?

• a) Increase the bioavailability of Ciprofloxacin

• b) Decrease the bioavailability of Ciprofloxacin
• c) No change
• d) nullified
• Al and CA ion and ciprofloxacin to becomes complex or complex formation.
• Increase the particle size = 1/Absorption ()
 WHAT HAPPENS WHEN SODIUM VALPROATE
AND PHENYTOIN ARE USED CONCURRENTLY?
• displacing phenytoin from plasma protein binding sites due to high sodium
valproate affinity.
PHy Pharmacological
D Activity
SV
D
P P bound P P free
WHAT HAPPENS WHEN WARFARIN AND
PHENYTOIN ARE USED CONCURRENTLY?
• Warfarin is thought to inhibit the metabolism of phenytoin.(decrease the metabolism
of phenytoin)
• Using warfarin together with phenytoin may cause you to bleed more easily. It may also
increase phenytoin levels. Phenytoin levels and prothrombin time or International
Normalized Ratio (INR) should be monitored whenever the dosage is changed or
discontinued.
• phenytoin toxicity.
 WHICH DRUG INCREASES THE BIOAVAILABILITY OF DIGOXIN
BY INHIBITING THE P-GLYCOPROTEIN EFFLUX TRANSPORTER?

• a) Dabigatran
• b) Hypericin
• c) Rifampicin
• d) Clarithromycin
• e) Morphine
• cyclosporine, erythromycin, clarithromycin, propafenone, itraconazole, amiodarone,
verapamil, and diltiazem increase digoxin plasma concentrations by induced inhibition of P-
gp in the intestine, as well as at sites of digoxin elimination
LIST OUT THE DRUGS WHICH ARE ENZYME
INHIBITOR AND ENZYME INDUCER ?
Inducer Inhibitor
Rifampicin Cimetidine ciprofloxacin metronidazole
Phenytoin Clarithromycin,Allopurinol, lansoprazole
Ritonavir montelukast
Alcohol
Carbamazepine.
Anticonvulsant.
Sodium Valproate.
Rifampicin.
Metabolism.
Enzyme.
Phenytoin.
Phenobarbital.
WHAT HAPPENS GRISEOFULVIN AND FAT ARE
USED CONCURRENTLY ?

• Increase the absorption of Griseofulvin due to fat soluble.

WHAT HAPPENS WHEN RIFAMPICIN AND
WARFARIN ARE USED CONCURRENTLY?
• Rifampicin is enzyme inducer so induce the
microsomal enzymes and, thus, the metabolism of
warfarin is increase. Increase the excretion of warfarin .
• Decrease conc n in blood (Warfarin )
• Decrease the therapeutic activity of warfarin.
LIST OUT THE ENZYME INDUCER AND ENZYME
INHIBITOR DRUGS.
WHAT HAPPEN WHEN RIFAMPICIN AND OCP ARE
USED CONCURRENTLY?
• Rifampicin is enzyme inducer so increase the metabolism of
OCP.
• Increase the excretion rate .
• Blood con n decrease, therapeutic activity
• The consequences of OCP activity is decrease and unplan
pregnancy may occur.
WHAT HAPPEN WHEN ALKALIZER AND BASIC
METABOLIZED ARE INTERACT IN FLOW OF
URINE ?
• Common alkalizers are potassium citrate, sodium
citrate, and sodium bicarbonate.
• Urinary alkalizers are medications that reduce the
acidity of urine.
• Basic metabolites and basic urine PH
Reabsorption
 WHAT HAPPEN WHEN AMOXYCILLIN AND
PROBENECID ARE USED CONCURRENTLY?

• Competitively inhibit renal tubular secretion and causes higher, prolonged serum level of
Amoxycillin.

A
R2

R1 R

B
WHAT HAPPEN WHEN AMOXYCILLIN AND
ALLOPURINOL ARE USED CONCURRENTLY?
LIST OUT THE DRUG WHICH HAVING THE
TENDENCY TO INHIBIT THE METABOLISM
ENZYME AND ENHANCE THE METABOLISM
ENZYME.
CO-ADMINISTER OF SULPHAMETHAXAZOLE
AND TRIMETHOPRIM IS AN EXAMPLE OF……

• A. Addition Interaction
• B. Potentiation Interaction
• C. Synergistic Interaction
• D. Non of the above
WHAT HAPPEN WHEN AMPICILLIN AND
DEXTRAN ARE USED CONCURRENTLY AS
INFUSION ?
WHAT HAPPEN WHEN DIAZEPAM AND
METOCLOPRAMIDE ARE CO- ADMINISTER?
RESULT OF CO-ADMINISTRATION OF LEVODOPA
AND ANTI-CHOLINERGIC DRUG…
THE ANTIHYPERTENSIVE EFFECT OF ACE INHIBITORS CAN BE
SPECIFICALLY REDUCED BY INHIBITION OF RENAL PROSTAGLANDIN
SYNTHESIS. WHICH OF THE FOLLOWING DRUGS INTERACTS IN THIS
PROCESS?

a) Low-dose ASA (Acetyl Salicylic Acid or Asprin )

b) Hydrochlorothiazide
c) Verapamil
d) Diclofenac
e) Morphine
• NSAD inhibit either irreversibly (aspirin) or reversibly the cyclooxygenase enzymes
which convert arachidonic acid to the prostaglandin endoperoxides
WHICH OF THE FOLLOWING ANTICONVULSANT DRUG IS
USE TO THOSE WOMEN WHO USED REGULAR OCP?

a. phenobarbital,
b. Phenytoin,
c. carbamazepine
d. Valproic acid
• A number of anticonvulsants (phenobarbital, Phenytoin,
carbamazepine) are enzyme inducing agents and thereby
increase the clearance of the oral contraceptive steroids.
• Valproic acid has no enzyme-inducing properties, and thus
women on this anticonvulsant can rely on their low dose oral
contraceptive steroids for contraceptive protection.
IF A DRUG HALF LIFE IS 8HR, ADMINISTER AT A
SINGLE DOSE AS 200MG.
WHAT AMOUNT OF DRUG IS REMAIN AFTER 32 HRS?

200mg
8hr
100mg
8 hr
50mg
8 hr
25mg
8 hr
12.5 mg
WHAT IS THE KEL IF HALF IS 8 HRS?

• 0.693
• Kel ========
• t½
• 0.08