Professional Documents
Culture Documents
Bolus Dosing
OBJECTIVES
For an IV one compartment model plasma and urine:
1. Given patient drug and/or metabolite concentration, amount, and/or rate vs. time
profiles, the student will calculate (III) the relevant pharmacokinetic parameters
available from IV plasma, urine or other excreta data: e.g.
V d, K, k m, k r, AUC, AUMC, CL, MRT, t 1 ⁄ 2
2. The student will provide professional communication regarding the pharmacoki-
netic parameters obtained to patients and other health professionals.
3. The student will be able to utilize computer programs for simulations and data
analysis.
4.1.1 PLASMA
Valid equations: ln C p = – K ⋅ t + ln C p 0 (EQ 4-1)
(Obtained from the
LaPlace transforms
ln X = – K ⋅ t + ln X0 (EQ 4-2)
derived from the
appropriate models
– Kt
derived from the C p = C p0 e (EQ 4-3)
pharmacokinetic
descriptions of the drug)
D-
C p 0 = ----- (EQ 4-4)
Vd
t ½ = 0.693
------------- (EQ 4-5)
K
( ∞)
( Cp n + Cp n + 1 ) Cp last
AUC = ∫ Cp dt = Σ ------------------------------------- ⋅ ∆t + -------------- (EQ 4-6)
2 K
0
( ∞) t
( t n ⋅ Cp n ) + ( t n + 1 ⋅ Cp n + 1 ) Cp l ast ( t l ast ⋅ Cp last )
AUMC = ∫ t ⋅ C p dt = ∑ -------------------------------------------------------------------
2
- ⋅ ∆t + --------------- + ----------------------------------
K
2 K
(EQ 4-7)
0 0
MRT = AUMC
------------------ (EQ 4-8)
AUC
Cl = K ⋅ Vd (EQ 4-9)
Utilization:
Can you determine the • You should be able to plot a data set Concentration vs. time on semilog yielding a straight line
slope and intercept from with slope = – K and an intercept of C p0 .
a graph? Plot the data
in table 4 -1.on semi-log
graph paper. Extrapo-
late the line back to time TABLE 4-1 Nifedipine 25 mg IV bolus
= 0 to get Cp0. Find the
Cp
half life. Calculate the Time (hr) (mcg/L)
elimination rate con-
2 139
stant.
4 65.6
6 31.1
8 14.6
FIGURE 4-1.
Does your Graph look FIGURE 4-1 Nifedipine IV Bolus (25 mg IV Bolus)
like this?
100 10 3
Concentration (mic/L)
Cp0 = 295 mic/L
-K1 = -0.375 hr -1
Concentration (ng/mL)
10 2
50 1.85 hr
10 1
0 2 4 6 8
Time (hr)
Time (hours)
• You should be able to determine K. A plot of the data in TABLE 4-1 results in FIGURE 4-1
dy
Remember from high school algebra, the slope of any straight line is the rise over the run, ------ ,
dx
In the case of semi-log graphs dy is the difference in the logarithms of the concentrations. Thus,
using the rules of logarithms, when two logs are subtracted, the numbers themselves are
divided. i.e. ln ( C1 ) – ln ( C2 ) = ln ------- . Thus if we are judicious in the concentrations that we
C1
C2
take, we can set the rise to a constant number. So, if we take any two concentrations such that
one concentration is half of the other (In FIGURE 4-1 above, we took 100 and 50), the time it
takes for the concentration to halve is the half life (in the graph above, 1.85 hr). Then
0.693 0.693 –1
K = ------------- = ---------------- = 0.375 hr
t½ 1.85hr
• You should be able to determine V d :. To do this, extrapolate the line to t = 0 . The value of Cp
mic
when t = 0 is C p0 (in the graph above, C p0 = 295 --------- which is equal to D ⁄ V d for an IV bolus
L
dose only.
Dose 25mg ⋅ 1000mic
Thus, Cp 0 = ------------- , V d = Dose
------------- = ------------------ --------------------- = 85L
Vd Cp 0 295mic mg
------------------
L
The volume of distribution is a mathematical construct. It is merely the proportionality constant
between two knowns - the C p0 which results from a given D 0 . It is, however, useful because it
is patient specific and therefore can be used to predict how the patient will treat a subsequent
dose of the same drug. You should be able to obtain the volume of distribution from graphical
analysis of the data. Pay attention to the units! Make sure that they are consistent on both sides
of the equation. NOTE: the volume of distribution is not necessarily any physiological space.
For example the approximate volume of distribution of digoxin is about 600 L If that were a
physiological space and I were all water, that would mean that I would weigh about 1320
pounds. I’m a little overweight (I prefer to think that I’m underheight), but REALLY!
• Given any three of the variables of the IV bolus equation, either by direct information (the vol-
ume of distribution is such and such) or by graphical data analysis, you should be able to find
the fourth.
• You should be able to calculate Area Under the Curve (AUC) from IV Bolus data (Time vs. Cp).
From the above data in TABLE 4-1 the AUC is calculated using (EQ 4-6):
(∞)
Cpn + Cp n + 1 Cp
AUC = ∫ Cp dt = Σ --------------------------------- + --------l which in this case is:
∆t K
0
295 + 139 139 + 65.6 65.6 + 31.1 31.1 + 14.6 14.6 mcg
Σ ------------------------ ⋅ 2 + ------------------------- ⋅ 2 + --------------------------- ⋅ 2 + --------------------------- ⋅ 2 + ------------- ---------- hr or
2 2 2 2 0.375 L
mcg mcg
Σ { 434 + 204.6 + 96.7 + 45.7 + 38.9 } ---------- hr = 819.9 ---------- hr . In tabular format, the AUC calculation
L L
is shown in TABLE 4-2.
t t
AUC AUC
TIME Cp t–1 0
0 295
2 139 434.0 434.0
4 65.6 204.6 638.6
6 31.1 96.7 735.3
8 14.6 45.7 781.0
∞ 0 38.9 819.9
The AUC of a plot of plasma concentration vs. time, in linear pharmacokinetics, is a number
which is proportional to the dose of the drug which gets into systemic circulation. The propor-
tionality constant, as before, is the volume of distribution. It is useful as a tool to compare the
amount of drug obtained by the body from different routes of administration or from the same
route of administration by dosage forms made by different manufacturers (calculate bioavail-
ability in subsequent discussions).
The AUC of a plot of Rate of Excretion of a drug vs. time, in linear pharmacokinetics, is the
mass of drug excreted into the urine, directly.
• You should be able to calculate the AUMC from IV Bolus data (Time vs. Cp). The equation for
AUMC is equation 4-7:
( ∞) t
( t n ⋅ Cp n ) + ( t n + 1 ⋅ Cp n + 1 ) Cp l ast ( t l ast ⋅ Cp last )
AUMC = ∫ t ⋅ C p dt = ∑ -------------------------------------------------------------------
2
- ⋅ ∆t + --------------- + ----------------------------------
K
2 K
which in the
0 0
data given in TABLE 4-1 is:
T0 ⋅ C po + T1 ⋅ C p1 T1 ⋅ C p1 + T2 ⋅ C p2 T 2 ⋅ C p 2 + T3 ⋅ C p3
Σ ----------------------------------------------- ⋅ ∆t 1 + ----------------------------------------------- ⋅ ∆t 2 + ----------------------------------------------- ⋅ ∆t 3 +
2 2 2
mcg 2
Σ { 278 + 540.4 + 449 + 303.4 + 311.47 + 103.82 } = 1986.1 ---------- hr
L
Thus in tabular format the AUMC for data given in TABLE 4-1 is TABLE 4-3 below.
t
AUMC t AUMC
TIME Cp Cp*T 0
0 295 0
2 139 278 278.0 278.0
4 65.6 262.4 540.4 818.4
6 31.1 186.6 449.0 1267.4
8 14.6 116.8 303.4 1570.8
∞ 0 0 415.3 1986.1
The AUMC is the Area Under the first Moment Curve. A plot of T*Cp vs. T is the first
moment curve. The time function buried in this plot, the Mean Residence Time (MRT), can be
extracted using equation 4-8 below.
It is the geometric mean time that the molecules of drug stay in the body. It has utility in the fact
that, as drug moves from the dosage form into solution in the gut, from solution in the gut into
the body, and from the body out, each process is cumulatively additive. That means if we can
physically separate each of these processes in turn, we can calculate the MRT of each process.
The MRT of each process is the the inverse of the rate constant for that process.
• You should be able to calculate MRT from IV Bolus data (Time vs. Cp) using equation 4-8
AUMC 1986.1
MRT = ------------------ = ---------------- = 2.42
AUC 819.9
Since there is only the process of elimination (no release of the drug from the dosage form, no
absorption), the MRT is the inverse of the elimination rate constant, K. Thus MRT = 1/K.
K
X
MRT(IV) = 1/K
Suppose the drug were given in a solution. Then the drug would have to be absorbed and then
eliminated. Since the MRTs are additive, the MRT of the oral solution would be made up of the
MRTs of the two processes, thus:
Ka K
Xa X
MRT(os) = MAT(os)+MRT(IV)
MRT(os) = 1/Ka + 1/K
Consequently, if a drug has to be released from a dosage form for the drug to get into solution
which is subsequently absorbed, a tablet for example, the MRT of the tablet will consist of the
MRT(IV) and the MAT(os) and the Mean Dissolution Time (MDT), thus:
Kd Ka K
Xd Xa X
Normally, we don’t have information from the oral solution, just IV and tablet. So in that case
the information obtained about absorption from the tablet is bundled together into an apparent
absorption rate constant consisting of both dissolution and absorption.
It should be apparent that this is a reasonably easily utilized and powerful tool used to obtain
pharmacokinetic parameters.
1
3. MRT = ---- ( estimate ) MRT = AUMC
------------------ equation 4-8
K AUC
Cp ∞
5. Estimate for AUC = AUC = ---------0 which is
K ∫0 Cp dt
(∞)
( Cp n + Cp n + 1 ) Cp last
AUC = ∫ Cp dt = Σ ------------------------------------- ( ∆t ) + --------------
2 K
0
( ∞) t
( t n ⋅ Cp n ) + ( t n + 1 ⋅ Cp n + 1 ) Cp last ( t last ⋅ Cp l ast )
AUMC ∫ Cp dt = ∑ -------------------------------------------------------------------
2
- ⋅ ∆t n + --------------- + ----------------------------------
K
2 K
0 0
7. V d = Dose
------------- from equation 4-4
Cp 0
Cp 0 Dose
8. Cl = K1 ⋅ V d = ------------ ⋅ ------------- = Dose
-------------
AUC Cp 0 AUC
Acyclovir (Problem 4 - 1)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
De Miranda and Burnette, “Metabolic Fate and Pharmacokinetics of the Acyclovir Prodrug Valaciclovir in Cynomolgus Mon-
keys”, Drug Metabolism and Disposition (1994): 55-59.
Acyclovir is an antiviral drug used in the treatment of herpes simplex, varicella zoster, and in suppressive therapy. In
this study, three male cynomolgus monkeys were each given a 10 mg ⁄ kg intravenous dose. The monkeys weighed an
average of 3.35 kg each. Blood samples were collected and the following data was obtained:
PROBLEM TABLE 4 - 1. Acyclovir
Serum concentration
Time (hours) ( µg ⁄ mL )
0.167 26.0
0.300 23.0
0.500 19.0
0.75 16.0
1.0 12.0
1.5 7.0
2.0 5.0
From the data presented in the Preceding table, determine the following:
1. Find the elimination rate constant, k .
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 1) Acyclovir:
2
10
CONCENTRATION (MIC/ML)
1
10
100
0.0 0.5 1.0 1.5 2.0
TIME (HR)
–1
1. k = 0.93hr
2. t½ = 0.75hr .
3. MRT = 1.08hr .
4. ( C p )0 = 30.4ug ⁄ mL .
5. AUC = 32.75ug ⁄ mL ⋅ hr .
2
6. AUMC = 35.2ug ⁄ mL ⋅ hr .
7. Vd = 1.1L
8. Cl = 1.02L ⁄ hr .
Aluminum (Problem 4 - 2)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
Xu, Pai, and Melethil, "Kinetics of Aluminum in Rats. II: Dose-Dependent Urinary and Biliary Excretion", Journal of Pharmaceu-
tical Sciences, Oct 1991, p 946 - 951.
A study by Xu, Pai, and Melethil establishes the pharmacokinetics of Aluminum in Rats. In this study, four rats with an
average weight of 375g, were given an IV bolus dose of aluminum (1 mg/kg). Blood samples were taken at various
intervals and the following data was obtained:
PROBLEM TABLE 4 - 2. Aluminum
ng
Serum concentration, --------
Time (hours) mL
0.4 19000
0.6 18000
1.4 15000
1.6 14500
2.3 12500
3.0 10500
4.0 8500
5.0 6500
6.0 5000
8.0 3250
10.0 2000
12.0 1250
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 2) Aluminum:
5
10
CONCENTRATION (NG/ML)
4
10
3
10
0 2 4 6 8 10 12
TIME (HR)
–1
1. k = 0.234hr
2. t½ = 3hr .
3. MRT = 4.3hr .
4. ( C p )0 = 21000ng ⁄ mL .
5. AUC = 89285ng ⁄ mL ⋅ hr .
2
6. AUMC = 383926ng ⁄ mL ⋅ hr .
7. Vd = 17.86mL
8. Cl = 4.18mL ⁄ hr .
Amgen (Problem 4 - 3)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
Salmonson, Danielson, and Wikstrom, "The pharmacokinetics of recombinant human erythropoetin after intravenous and subcuta-
neous administration to healthy subjects", Br. F. clin. Pharmac. (1990), p 709- 713.
Amgen (r-Epo) is a form of recombinant erythropoetin. Erythropoetin is a hormone that is produced in the kidneys and
used in the production of red blood cells. The kidneys of patients who have end-stage renal failure cannot produce
erythropoetin; therefore, r-Epo is being investigated for use in these patients in order to treat the anemia that results
from the lack of erythropoetin. In a study by Salmonson et al, six healthy volunteers were used to demonstrate that
both IV and subcutaneous administration of erythropoetin have similar effects in the treatment of anemia due to
chronic renal failure. The six volunteers were each given a 50 U/kg intravenous dose of Amgen. The average weight
of the six volunteers was 79 kg. Blood samples were drawn at various times and the data obtained is summarized
below:
PROBLEM TABLE 4 - 3. Amgen
mU
Serum concentration, ---------
Time (hours) mL
2 700
4 600
6 400
8 300
12 150
24 40
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 3) Amgen:
103
CONCENTRATION (MU/ML)
102
Con (mU/mL)
101
0 5 10 15 20 25
TIME (HR)
–1
1. k = 0.134hr
2. t½ = 5.2hr .
3. MRT = 7.46hr .
4. ( C p )0 = 900mU ⁄ mL .
5. AUC = 6945mU ⁄ mL ⋅ hr .
2
6. AUMC = 49600 mU ⁄ mL ⋅ hr .
7. Vd = 4.44L
8. Cl = 0.6L ⁄ hr .
A study by Brier and Harding a dose of 45 ng was given by IV bolus to rats. Samples of blood were taken at various
intervals throughout the length of the study and the following data was obtained:
PROBLEM TABLE 4 - 4. Atrial Naturetic Peptide (ANP)
pg
Serum concentration, --------
Time (minutes) mL
3 380
10 280
20 170
30 130
40 100
50 70
60 50
From the data presented in the preceding table, determine the following:
1. Find the elimination rate constant, k .
3. Find MRT .
4. Find ( C p )0 .
103
Con CONCENTRATION (PG/ML)
102
(pg/mL)
101
0 10 20 30 40 50 60
Time (min)
–1
1. k = 0.0345min
2. t½ = 20.09min .
3. MRT = 28.95min .
4. ( C p )0 = 386.6pg ⁄ mL .
8. Cl = 4.02mL ⁄ min .
Aztreonam (Problem 4 - 5)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
Cuzzolim et al., "Pharmacokinetics and Renal Tolerance of Aztreonam in Premature Infants", Antimicrobial Agents and Chemo-
therapy (Sept. 1991), p. 1726 - 1928.
Aztreonam is a monolactam structure which is active against aerobic, gram-negative bacilli. The pharmacokinetic
parameters of Aztreonam were established in a study presented in by Cuzzolim et al in which Aztreonam (100 mg/ kg)
was administered intravenously to 30 premature infants over 3 minutes every 12 hours. The group of neonates had an
average weight of 1639.6g. The following set of data was obtained:
PROBLEM TABLE 4 - 5. Aztreonam
µg
Serum concentration, --------
Time (minutes) mL
1 40.50
2 34.99
3 29.99
4 23.88
5 22.20
6 19.44
7 16.55
8 14.99
From the data presented in the preceding table, determine the following:
1. Find the elimination rate constant, k .
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 5) Aztreonam:
10 2
CONCENTRATION (UG/ML)
Con (ug/mL)
10 1
0 2 4 6 8
TIME (MIN)
–1
1. k = 0.144min
2. t½ = 4.81min .
3. MRT = 6.94min .
4. ( C p )0 = 45.75ug ⁄ mL .
8. Cl = 0.516L ⁄ min .
Bovine placental lactogen (bPL) is a hormone similar to growth hormone and prolactin. It binds to both prolactin and
growth hormone receptors in the rabbit and stimulates lactogenesis in the rabbit. In a study by Byatt, et. al., four cows
(2 pregnant and 2 nonpregnant) were given IV bolus injections of 4 mg and the following data was obtained:
PROBLEM TABLE 4 - 6. Recombinant Bovine Placental Lactogen
µg
Serum concentration ------
Time (minutes) L
3.8 117
6.8 72
12.0 43
16.0 27
20.0 18
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
(MIC/L)
ConCONCENTRATION
102
(ug/L)
101
0 5 10 15 20
Time (min)
–1
1. k = 0.113min
2. t½ = 6.13min .
3. MRT = 8.85min .
4. ( C p )0 = 167.8ug ⁄ L .
8. Cl = 2.69L ⁄ min .
Caffeine (Problem 4 - 7)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
Dorrbecker et. al., "Caffeine and Paraxanthine Pharmacokinetics in the Rabbit: Concentration and Product Inhibition Effects.",
Journal of Pharmacokinetics and Biopharmaceutics (1987), p.117 - 131.
This study examines the pharmacokinetics of caffeine in the rabbit. In this study type I New Zealand White rabbits
were given an 8 mg intravenous dose of caffeine. Blood samples were taken and the following data was obtained:
PROBLEM TABLE 4 - 7. Caffeine
µg
Serum concentration --------
Time (minutes) mL
12 3.75
40 2.80
65 2.12
90 1.55
125 1.23
173 0.72
243 0.37
From the data presented in the preceding table, determine the following:
1. Find the elimination rate constant, k .
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 7) Caffeine:
CONCENTRATION (MIC/ML)
Caffeine
101
100
10-1
Con (ug/L)
Time (min)
–1
1. k = 0.00997min
2. t½ = 69.51min .
3. MRT = 100.3min .
4. ( C p )0 = 4.105ug ⁄ mL .
8. Cl = 19.44mL ⁄ min .
Ceftazidime (Problem 4 - 8)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
Demotes-Mainard, et. al., "Pharmacokinetics of Intravenous and Intraperitoneal Ceftazidime in Chronic Ambulatory Peritoneal
Dyialysis", Journal of Clinical Pharmacology (1993), p. 475 - 479.
Ceftazidime is a third generation cephalosporin which is administered parenterally. In this study, eight patients with
chronic renal failure were each given 1 g of ceftazidime intravenously. Both blood samples were taken the data
obtained from the study is summarized in the following table:
mg
Serum concentration -------
Time (hours) L
1 50
2 45
4 38
24 21
36 14
48 11
60 8
72 4
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 8) Ceftazidime:
102
CONCENTRATION (MG/L)
101
Con (mg/L)
100
0 20 40 60 80
Time (hours)
–1
1. k = 0.0324hr
2. t½ = 21.39hr .
3. MRT = 30.86hr .
4. ( C p )0 = 47.57mg ⁄ L .
5. AUC = 1468.2mg ⁄ L ⋅ hr .
2
6. AUMC = 45308.6mg ⁄ L ⋅ hr .
7. Vd = 21.02L
8. Cl = 0.681L ⁄ hr .
Ciprofloxacin (Problem 4 - 9)
Problem Submitted By: Maya Lyte AHFS 12:34.56 Antivirals
Problem Reviewed By: Vicki Long GPI: 1234567890 Antivirals
Lettieri, et. al., "Pharmacokinetic Profiles of Ciprofloxacin after Single Intravenous and Oral Doses", Antimicrobial Agents and
Chemotherapy (May 1992), p. 993 -996.
Ciprofloxacin is a fluoroquinolone antibiotic which is used in the treatment of infections of the urinary tract, lower res-
piratory tract, skin, bone, and joint. In this study, twelve healthy, male volunteers were each given 300 mg intravenous
doses of Ciprofloxacin. Blood and urine samples were collected at various times throughout the day and the following
data was collected:
PROBLEM TABLE 4 - 9. Ciprofloxacin
mg
Serum concentration -------
Time (hours) L
2 1.20
3 0.85
4 0.70
6 0.50
8 0.35
10 0.25
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
(Problem 4 - 9) Ciprofloxacin:
101
CONCENTRATION (MG/L)
100
Con (mg/L)
10-1
0 2 4 6 8 10
Time (hours)
–1
1. k = 0.1875hr
2. t½ = 3.7hr .
3. MRT = 5.33hr .
4. ( C p )0 = 1.57mg ⁄ L .
5. AUC = 8.395mg ⁄ L ⋅ hr .
2
6. AUMC = 44.74mg ⁄ L ⋅ hr .
7. Vd = 190.6L
8. Cl = 35.74L ⁄ hr .
Diprophylline is used as a bronchodilator. A study by Nadai et al was designed to determine whether or not coadmin-
istration of Diprophylline with Probenecid affected the pharmacokinetic parameters of Diprophylline. In this study,
male rats (average weight: 300 g) were given 60 mg/kg of Diprophylline intravenously and a 3 mg/kg loading dose of
Probenecid followed by a continuous infusion of 0.217 mg/min/kg of Probenecid. The following set of data was
obtained for Diprophylline (DPP):
µg
Serum concentration --------
Time (minutes) mL
16 40.00
31 27.00
60 13.00
91 6.50
122 3.50
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
102
CONCENTRATION (MIC/ML)
101
Con (ug/mL)
100
0 20 40 60 80 100
Time (min)
–1
1. k = 0.023min
2. t½ = 30.13min .
3. MRT = 43.48min .
4. ( C p )0 = 55.13ug ⁄ mL .
8. Cl = 7.5mL ⁄ min .
Epoetin is recombinant human erythropoetin. Erythropoetin is a hormone that is produced in the kidneys and used in
the production of red blood cells. The kidneys of patients who have end-stage renal failure cannot produce erythropo-
etin; therefore, Epoetin is used in these patients to treat the anemia that results from the lack of erythropoetin. Epoetin
has also been used in the treatment of anemias resulting from AIDS. malignant disease, prematurity, rheumatoid arthri-
tis, sickle-cell anemia, and myelosplastic syndrome. In a study by Macdougall et al, eight patients who were on perito-
neal dialysis (CAPD) were given an IV bolus dose of 120 U/kg which decayed monoexponentially from a peak of 3959
U/L to 558 U/L at 24 hours. The following data was obtained:
PROBLEM TABLE 4 - 11. Epoetin
U
Serum concentration ----
Time (hours) L
0.0 4000
0.5 3800
1.0 3600
2.0 3300
3.0 3000
4.0 2550
5.0 2350
6.0 2150
7.0 1900
From the data presented in the preceding table and assuming that the patient weighs 65 kg, determine the following:
3. Find MRT .
4. Find ( C p )0 .
104
CONCENTRATION (U/L)
Con (U/L)
103
0 1 2 3 4 5 6 7
Time (hours)
–1
1. k = 0.107 hr
2. t½ = 6.5 hr .
3. MRT = 9.38 hr .
4. ( C p )0 = 4023 Units/L .
Units ⋅ hr
5. AUC = 37775 ------------------------ .
L
2
Units ⋅ hr
6. AUMC = 354697 --------------------------- .
L
7. Vd = 1.9 L
L
8. Cl = 0.2065 ----- .
hr
Famotidine is a histamine H2-receptor antagonist. The study by Kraus, et. al., focuses on the kinetics of famotidine in
children. In the study, ten children with normal kidney function and a body weight ranging from 14 - 25 kg, were each
given a single intravenous 0.3 mg/kg dose of famotidine. Blood and urine samples were taken providing the following
data:
PROBLEM TABLE 4 - 12. Famotidine
µg
Serum concentration ------
Time (hours) L
0.33 300
0.50 250
1.00 225
4.00 125
8.00 70
12.00 40
16.00 15
From the data presented in the preceding table, determine the following assuming that the patient weighs 17.2 kg:
3. Find MRT .
4. Find ( C p )0 .
10 3
(MIC/L)
ConCONCENTRATION
10 2
(ug/mL)
10 1
0 5 10 15 20
Time (hours)
–1
1. k = 0.17 hr
2. t½ = 3.9 hr .
3. MRT = 5.7 hr .
µg
4. ( C p )0 = 285 ------ .
L
µg ⋅ hr
5. AUC = 1600 ----------------- .
L
2
µg ⋅ hr
6. AUMC = 9000 ------------------ .
L
7. Vd = 18 L
8. Cl = 3.2L .
Ganciclovir (mw: 255.23) is used against the human herpes viruses, cytomegalovirus retinitis, and cytomegalovirus
infections of the gastrointestinal tract. In this study, twenty-seven newborns with cytomegalovirus disease were given
4 mg/kg of ganciclovir intravenously over one hour. Blood samples were taken and the data obtained is summarized in
the following table:
From the data presented in the preceding table and assuming the patient weighs 3.6 kg, determine the following :
3. Find MRT .
4. Find ( C p )0 .
10
CONCENTRATION (MICMOLE/L)
10
10
0 2 4 6 8
TIME (HR)
–1
1. k = 0.288hr
2. t½ = 2.4hr .
3. MRT = 3.5hr .
µmole
4. ( C p )0 = 23 ---------------- .
mL
µmole ⋅ hr
5. AUC = 80 -------------------------- .
mL
2
µmole ⋅ hr
6. AUMC = 280 ----------------------------- .
mL
mg 1000µg
4 ------- ⋅ 3.6kg ⋅ -------------------
Dose kg mg
7. Vd = ------------- = ------------------------------------------------------------- = 2.45L
Cp 0 µmole µg
23 ---------------- ⋅ 255.23 ----------------
L µmole
L
8. Cl = 0.7 ----- .
hr
Imipenem is a beta-lactam antibiotic which is used in combination with cilastin and is active against a broad spectrum
of bacteria. The pharmacokinetics of Imipenem in pregnant women is established in this study. Twenty women (six of
which were non-pregnant controls) were given a single intravenous dose of 500 mg of imipenem-cilastin (1:1). Blood
samples were taken at various intervals and the data obtained is summarized in the following table:
mg
Serum concentration -------
Time (minutes) L
10 27.00
15 23.50
30 15.50
45 9.50
60 6.50
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
CONCENTRATION (MG/L)
1
10
0
10
0 10 20 30 40 50 60
TIME (MIN)
–1
1. k = 0.029 min
2. t½ = 24 min .
Methylprednisolone is a corticosteriod that has been used in combination chemotherapy for the treatment of hemato-
logical malignancy, myeloma, and acute lymphoblastic leukemia. In a study by Patel et. al., eight patients were given
1.5 gram intravenous doses of methylprednisolone from which the following data was obtained:
µg
Serum concentration --------
Time (hours) mL
0.5 19.29
1.0 17.56
1.8 15.10
4.0 9.98
5.8 7.10
8.0 4.70
12.0 2.21
18.0 0.71
24.0 0.23
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
102
CONCENTRATION (MIC/ML)
101
100
Con (ug/mL)
10-1
0 5 10 15 20 25
Time (hours)
–1
1. k = 0.188 hr
2. t½ = 3.69hr .
3. MRT = 5.3hr .
µg
4. ( C p )0 = 21.2 -------- .
mL
µg ⋅ hr
5. AUC = 112.5 ----------------- .
mL
2
µg ⋅ hr
6. AUMC = 598.4 ------------------ .
mL
7. Vd = 71L
L
8. Cl = 13.3 ----- .
hr
Omeprazole (mw: 345.42) is a gastric proton-pump inhibitor which decreases gastric acid secretion. It is effective in
the treatment of ulcers and esophageal reflux. In normal patients 80% of the omeprazole dose is excreted as metabo-
lites in the urine and the remainder is excreted in the feces. In the study by Anderson, et. al., eight patients with liver
cirrhosis were given 20 mg, IV bolus doses of omeprazole. The patients had a mean body weight of 70 kg. Both blood
were taken at various intervals throughout the study and the following data was obtained:
ρmole
Serum concentration ----------------
Time (hours) mL
0.75 3.49
1.00 3.25
2.00 2.46
3.00 1.86
4.00 1.40
5.00 1.06
6.00 0.80
7.00 0.61
8.00 0.46
10.00 0.26
12.00 0.15
From the data presented in the preceding table, determine the following :
3. Find MRT .
4. Find ( C p )0 .
10 1
(umol/mL) (PICOMOLE/ML)
10 0
ConCONCENTRATION
10-1
0 2 4 6 8 10 12
Time (hours)
–1
1. k = 0.280hr
2. t½ = 2.5hr .
3. MRT = 3.57hr .
ρmole
4. ( C p )0 = 4.3 ---------------- .
mL
ρmole ⋅ hr
5. AUC = 15.4 -------------------------- .
mL
2
ρmole ⋅ hr
6. AUMC = 55 ----------------------------- .
mL
Dose 20mg
7. Vd = ------------- = ------------------------------------------------------------------------------------------------------------ = 13465L
Cp 0 ρmole mmole
4.3 ---------------- ⋅ ------------------------ - ⋅ 345.42mg
------------------------ ⋅ 1000mL
--------------------
mL 10 ρmole mmole 9 L
L
8. Cl = 3.9 ----- .
hr
Pentachlorophenol (PCP) is a general biocide. That is, it is an insecticide, fungicide, bactericide, herbicide, algaecide,
and molluskicide, that is used as a wood preservative. Extensive exposure to PCP can be fatal. In a study by Reigner
et al, six mice (average weight: 27 g) were given 15 mg/kg of PCP by intravenous bolus. Blood samples were taken at
various intervals from which the following data was obtained:
PROBLEM TABLE 4 - 17. Pentachlorophenol
µg
Serum concentration --------
Time (hours) mL
0.083 38.00
4.000 22.00
8.000 14.00
12.000 7.90
24.000 1.30
28.000 0.75
32.000 0.60
36.000 0.40
From the data presented in the preceding table, determine the following :
1. Find the elimination rate constant, k .
3. Find MRT .
4. Find ( C p )0 .
CONCENTRATION (MIC/ML)
102
101
100
Con (ug/mL)
10-1
0 10 20 30 40
Time (hours)
–1
1. k = 0.134 hr
2. t½ = 5.2hr .
3. MRT = 7.5hr .
µg
4. ( C p )0 = 35.6 -------- .
mL
µg ⋅ hr
5. AUC = 281 ----------------- .
mL
2
µg ⋅ hr
6. AUMC = 2100 ------------------- .
mL
7. Vd = 11.4mL
ml
8. Cl = 1.5 ------ .
hr
µg
Serum concentration --------
Time (minutes) mL
2.0 90.3
2.9 83.9
5.6 67.3
8.9 51.5
10.5 45.2
13.5 35.4
15.0 31.3
20.0 20.9
24.0 15.1
59.6 0.9
From the data presented in the preceding table, determine the following. (Assume that the mouse weighs 200g.)
3. Find MRT .
4. Find ( C p )0 .
10 2
ConCONCENTRATION (MIC/ML) 10 1
10 0
(ug/mL)
10 -1
0 10 20 30 40 50 60
Time (min)
–1
1. k = 0.08min
2. t½ = 8.67min .
3. MRT = 12.5min .
µg
4. ( C p )0 = 105 -------- .
mL
µg ⋅ hr
5. AUC = 1300 ----------------- .
mL
2
µg ⋅ hr
6. AUMC = 16250 ------------------- .
mL
7. Vd = 47.6ml
mL
8. Cl = 3.8 --------- .
min
Thioperamide is a histamine (H3) receptor-antagonist. In a study by Sakurai et al, rats were given 10 mg/kg intrave-
nous injections of Thioperamide. The following data was obtained from the study:
PROBLEM TABLE 4 - 19. Thioperamide
µg
Serum concentration --------
Time (minutes) mL
3.7 3.1
7.5 2.8
13 2.4
45 1.1
60 0.74
120 0.16
From the data presented in the preceding table, determine the following:
3. Find MRT .
4. Find ( C p )0 .
101
ConCONCENTRATION (MIC/ML)
100
(ug/mL)
10-1
0 20 40 60 80 100 120
Time (min)
–1
1. k = 0.0254min
2. t½ = 27.3min .
3. MRT = 39.4min .
µg
4. ( C p )0 = 3.39 -------- .
mL
µg ⋅ min
5. AUC = 133.5 --------------------- .
mL
2
µg ⋅ min
6. AUMC = 5256 ----------------------- .
mL
mg
10 -------
Dose kg L
7. Vd = ------------- = -------------------------------------------------------------------- = 2.95 ------
Cp 0 µg mg 1000mL kg
3.39 -------- ⋅ ------------------- ⋅ --------------------
mL 1000µg L
–1 L 1000ml mL
8. Cl = 0.0254min ⋅ 2.95 ------ ⋅ ------------------ = 75 -------------------- .
kg L min ⋅ kg
Khan,vM. et. al. “Determination of pharmacokinetics of cocaine in sheep by liquid chromatography” J. Pharm. Sci. 76:1 (39-43)
Jan 1987
4.1.3 URINE
k ( –K ⋅ t )
Xu = ----u- ⋅ X0 ⋅ ( 1 – e ) (EQ 4-10)
K
k
( Xu )∞ – Xu = ----u- ⋅ X 0 ⋅ e
– Kt
K
(EQ 4-11)
ku
where the amount of drug that shows up in the urine at infinite time, ( X u ) ∞ = ----- ⋅ X 0 .
K
Thus a plot of ( Xu )∞ – X u vs. time on semi-log paper would result in a straight line
with a slope of -K and an intercept of ( X u ) ∞ .. and we can get ku from the intercept
( X u )∞
and the slope. Rearranging the intercept equation, we get k u = K ⋅ -------------- This method
X0
of obtaining pharmacokinetic parameters is known as the Amount Remaining to be
Excreted (ARE) method.
TABLE 4-4 Enalapril urinary excretion data from 5 mg IV Bolus
Cumulative
∞
Enalapril in urine X – X u mg
Time (hr) (mg) u
1 0.41 0.59
2 0.65 0.35
3 0.80 0.20
4 0.88 0.12
6 0.96 0.04
∞ 1.0 ------
0.2
Xu(inf) - Xu
0.1
-1
10
1.3 hr
half life
-2
10
0 1 2 3 4 5 6
Hours
• You should be able to transform a data set containing amount of drug in the urine vs. time into
cumulative amount of drug in the urine vs. time and plot the ARE. (Amount Remaining to be
Excreted -> { ( Xu )∞ – Xu ( cum ) } vs. time on semi-log yielding a straight line with a slope of
–1 ku ⋅ X0
– K = – 0.533 hr and an intercept of ( Xu ) ∞ = --------------- = 1.0 mg
K
• You should be able to determine the elimination rate constant, K1, from cumulative urinary
excretion data. (Calculate the slope of the graph on SL paper.)
• You should be able to determine the excretion rate constant, ku, from cumulation urinary excre-
tion data. (Divide the intercept of the graph by X0 and multiply by K1.
( X u )∞ –1 1.0 mg –1
k u = K ⋅ -------------- = 0.53 hr ⋅ ----------------- = 0.106 hr )
X0 5.0 mg
A second method is to plot the rate at which the drug shows up in the urine over
time. Again, using the LaPlace transforms, we find that:
dX u –K t –K t
--------- = k u ⋅ X0 ⋅ e = R0 ⋅ e (EQ 4-12)
dt
Utilization: Rate of Thus, a plot of the rate of excretion vs. time results in a straight line on semi-log
excretion method paper with a slope of -K1 and an intercept, R0 , of kuX0 . Rearranging the intercept
R
equation yields k u = -----0- . In real data, we don’t have the instantaneous excretion
X0
dX u ∆X
rate , but the average excretion rate, ---------u- , over a much larger interval. What
dt ∆t
that means to our calculations is that over the interval of data collection, the total
amount of drug collected divided by the total time interval is the average rate. In
the beginning of the interval the rate was faster than at the end of the interval. So
the average rate must have occurred in the middle of the interval. Thus equation 4-
12 which is the instantaneous rate can be rewritten to
∆Xu –K t
mid
–K t
mid
---------- = k u ⋅ X 0 ⋅ e = R0 ⋅ e (EQ 4-13)
∆t
TABLE 4-5 Enalapril Urinary Rate Data
Enalapril in ∆X
urine ∆X u ,(mg) ---------u-
Interval (hr) t(mid) ∆t ∆t
0-1 0.5 1 0.41 0.41
1-2 1.5 1 0.24 0.24
2-3 2.5 1 missed sample ?
3-4 3.5 1 0.08 0.08
4-6 5 2 0.08 0.04
• You should be able to transform a data set containing amount of drug in the urine vs. time inter-
∆X
val into Average Rate, ---------u- , vs. t ,(t mid the time of the midpoint of the interval), on semilog
∆t
yielding a straight line with a slope of – K and an intercept of k u ⋅ X 0 . as shown below.
-1
0
10
R0 = 0.53 mg/hr
Urinary Excretion Rate (mg/hr)
-1
-2
10
1.3 hr
half life
-2
10
0 1 2 3 4 5
T (Mid)
• You should be able to determine k u extrapolate the line to t = 0 . The value of Rate (at
t = 0 ), R0, = k r ⋅ X0 = 0.53 ( mg ⁄ hr ) which when divided by X 0 .is kr.
R 0.53mg/hr –1
Thus, -----0- = ------------------------- = 0.106hr
X0 5mg
The rate equation is superior clinically because the ARE method requires collec-
tion of all of the urine which is usually only possible when you have a catheterized
patient while the Rate Method does not. (People don’t urinate on command, and
your data could be in the toilet, literally.)
∞
An additional advantage of the rate equations is that the AUC has the units of
0
mass, which gives the total amount of drug excreted into the urine directly. Thus:
∞ R 0 0.53 mg/hr
AUC = ------ = --------------------------
–1
= 1 mg
0 K 0.53 hr
dX –K t –K t
--------u- = k u ⋅ X 0 ⋅ e = R0 ⋅ e
dt
where ku is the rate constant through which the drug entered the urine and
dX –K t
------- = X 0 ⋅ e is the equation of the previous compartment.
dt
4.2 Metabolite
4.2.1 PLASMA
– ( K l arg e ⋅ t )
km X 0 – ( Ksmall ⋅ t )
C pm = -------------------------------------- ---------- e –e (EQ 4-14)
K l arg e – K small V dm
Utilization: • You should be able to plot a data set of plasma concentration of metabolite vs. time on semi-log
Curve Stripping paper yielding a bi-exponential curve.
–k t –k t
– Kt l arg e small
e → 0 as t → ∞ . And e → 0 faster than e → 0 . So, at some long
–K t –K t –K t
l arg e small l arg e
time, t, e «e . In fact e is small enough to be ignored. Thus at long
time, t, the equation becomes :
km X0 –( Ksmall ⋅ t )
C pm = ----------------------------------
- --------
- e
K l arg e – K small V dm (EQ 4-15)
So that the plot of the terminal portion of the graph would yield a straight line with a slope of
km
---------------------------------- X0
-Ksmall and an intercept of I = - --------
-
K l arg e – K small Vdm
• You should be able to obtain the slope of the terminal portion of the curve, the negative of
which would be the smaller of the two rate constants, K small , (either the summation of all the
ways that the drug is eliminated, K , or the summation of all the ways that the metabolite is
eliminated, K1 ).
• Subtracting the two previous equations yields
km X 0 –( Kbig ⋅ t )
C pm – C pm = ----------------------------------
- --------
- e
K l arg e – K small Vdm (EQ 4-16)
which is a straight line on semi-log paper with a slope of -kbig and an intercept of
km X0
I = ------------------------------------ --------- . Note: we can get the larger of the two rate constants from this
K l arg e – K small V dm
method.
TABLE 4-6
Drug Metabolite
Cp
Time (hr) (mcg/L) Cpm1 (mcg/L) Cpm Cpm – Cpm
0 0 181.2 181.2
0.5 24.7 175 150.3
1 44.4 168.9 124.5
2 139 71.8 157.5 85.7
4 65.6 96.5 136.9 40.4
6 31.1 100 119 19
8 14.6 94.7
12 76.5
24 34
In the above data Cp vs. Time is the plasma profile of the drug from Table 4-1 on page 2 and
Cpm1 vs. Time is the plasma profile of the metabolite. A plot of Cp vs. Time yielded a straight
0.693 –1
line with a slope,(-K) of -0.375 hr-1, K = ---------------------- = 0.375 hr and and intercept of 295 mic/
–1
1.85 hr
L,
10 3
Concentration (mic/L)
100
10 2
Concentration (ng/mL)
50
1.85 hr
10 1
0 2 4 6 8
Time (hours)
Time (hr)
while a plot of Cpm1 vs. Time( Figure 4-3 on page 54) yields a biexponential plot with a termi-
nal slope of 0.07 hr-1 , k small = 0.693
------------- and extrapolating the terminal line back to time = 0
10 hr
yields 181 mic/L.
FIGURE 4-3. Nifedipine Metabolite (column 3 vs. 1 in Table 4-6 on page 53)
)
mic
Cpm0 = 181 ---------
L
Concentration (mic/L)
80
102
40
10 hr
101
0 4 8 12 16 20 24
Time (hours)
• You should be able to feather (curve strip) the other rate constant out of the data by plotting the
difference between the extrapolated (to t = 0 ) terminal line (column 4 vs. 1 in Table 4-6 on
page 53) and the observed data (at early times) (column 3 vs. 1 in Table 4-6 on page 53) yield-
ing a straight line with the slope of the line equal to the negative of the other (larger) rate con-
stant (column 5 vs. 1 in Table 4-6 on page 53).
First you would fill in the Cpm column (column 4 in Table 4-6 on page 53) by computing Cpm
– k small t
for various values of time i.e Cpm = Cpm 0 ⋅ e where – k small is the terminal slope of the
graph. Then Cpm – Cpm (column 5 in Table 4-6 on page 53) would be column 4 - column 3.
Then a plot of Cpm – Cpm vs. time (column 5 vs. 1 in Table 4-6 on page 53) is shown below.
10
3
Intercept
2
Column 5
100
102
50 1.85 hr
Half life
1
10
0 1 2 3 4 5 6
Time (hr)
In this case, the slope of the stripped line line is -0.375 hr-1 and the intercept is 0.181.2 mic/L.
The slope of -0.375 hr-1 should not be surprising as the plot of the data in Figure 4-3 on page 54
resulted in a terminal slope of -.07 hr-1 . Since the data set yielded a bi-exponential plot, sepa-
rating out the exponents could only yield K (0.375 hr-1) or K1 as determined by our Laplace
Transform information. Thus, the terminal slope could be either -K1 or -K. Since it was obvi-
ously not -K, it had to be -K1. Thus the other rate constant obtained by stripping has to be K.
You can determine which slope is which rate constant if you have any data regarding intact drug
(i e. either plasma or urine time profiles of intact drug) as the slope of any of those profiles is
always –K .
• You should be able to determine V dm if you have any urine data regarding intact drug (i.e.
urine time profiles of intact drug) as the intercept of those profiles allow for the solution of k m .
Thus the intercept, I, of the extrapolated line of equation 4-14 could be rearranged to contain
–1 1000 mic
km ⋅ X0 0.375hr ⋅ 25mg ⋅ ----------------------
mg
only one unknown variable, V dm = ----------------------------------------------- = -------------------------------------------------------------------------- = 170 L .
( K l arg e – K small ) ⋅ I –1 mic
( 0.375 – 0.07 ) hr ⋅ 181.2 ---------
L
Utilization: • You should be able to determine the rate constants using MRT calculations.
MRT Calculations In a caternary chain, each compartment contributes its MRT to the overall MRT of the drug,
thus:
K
X
MRT(IV) = 1/K
Suppose the drug were given by IV bolus. Then the drug would have to be metabolized and the
metabolite eliminated. Since the MRTs are additive, the overall MRT of the metabolite would
be made up of the MRTs of the two processes, thus:
km kmu
X Xm
MRT(met) = MRT(elim)+MRT(IV)
MRT(met) = 1/K1 + 1/K
Thus, using the data from Table 4-3 on page 5 the MRT(IV)Trap is
------------------ = 1986.1
MRT = AUMC ---------------- = 2.42 hr or about MRT = AUMC
------------------ = 2100
------------ = 2.67 hr using calculus.
AUC 819.9 AUC 787
And using the data from columns 1 and 3 from Table 4-6 on page 53 the MRT(met) using calcu-
------------------ = 36000
lus is MRT = AUMC --------------- = 17 hr.
AUC 2116
4.2.2 URINE
Valid equations:
By this time, it should be apparent that data which fits the same shape curve
(mono-exponential, bi-exponential, etc.) are treated the same way. When the
curves are evaluated, the slopes and intercepts are obtained in the same manner.
The only difference is what those slopes and intercepts represent. These represen-
tations come from the equations which come from the LaPlace Transforms which
come from our picture of the pharmacokinetic description of the drug. Please
refer back to the section on graphical analysis in the Chapter 1, Math review for a
interpretation of slopes and intercepts of the various graphs.
Temporarily, please refer to exam section 1, chapter 14 for problems for this sec-
tion (until problems can be generated) as well as additional problems for the previ-
ous sections.