21. IV Drug Storage, Compatibility & Administration Flashcards
All of the following drugs are compatible with saline only and cannot be put in dextrose EXCEPT which drug?
A. Infliximab
B. Bactrim
C. Caspofungin
D. Invanz
E. Unasyn
B. Infliximab, caspofungin, Invanz, and Unasyn are all compatible in saline only.
NS only: ampicillin, ampicillin/sulbactam (Unasyn), caspofungin (Cancidas), daptomycin (Cubicin), phenytoin, ertapenem (Invanz), infliximab (Remicade)
Doreen is in the intensive care unit receiving seven intravenous medications, many of which are not compatible with one another. Which of the following statements is correct regarding the use of a central intravenous line?
A. Central lines have a lower risk of causing bleeding, infection, and thromboembolism.
B. Central lines are not difficult to place; any nurse or physician can insert one.
CCentral lines contain multiple lumens allowing for multiple medications to be given at once.
D. Central lines provide no advantage for patients experiencing phlebitis with a peripheral line.
E. Central lines are not used for medication administration.
C. Central intravenous lines allow for multiple medications to be given at once even if they would not be compatible within a single catheter. A peripheral intravenous line is a single catheter inserted into a peripheral vein, usually in the patient’s wrist or arm.
Which of the following medications require a “protect from light” covering while infusing? (Select ALL that apply.)
A. Furosemide
B. Linezolid
C. Imipenem
D. Metronidazole
E. Piperacillin-Tazobactam
A, B, D. Furosemide, linezolid, and metronidazole are light sensitive.
Common light protection drugs during administration: dopamine, doxycycline, epoprostenol (Flolan), linezolid (Zyvox), metronidazole (Flagyl), micafungin (Mycamine), nitroprusside (Nitropress), norepinephrine (Levophed), phytonadione (vitamin K), SMX/TMP (Bactrim), verapamil
What is the definition of incompatibility?
A. When a product fails to meet good manufacturing practices
B. When a product is modified because of storage conditions and loses more than 10% of its potency
C. When one product is combined with another resulting in a product unsuitable for patient use
D. When one product is levigated with another product and a solid material forms
E. When two products come together and form a visible precipitous gel
C. Incompatibility is when one product is mixed or combined with another and changes occur that make the product unsuitable for patient use.
Which of the following drugs are compatible with dextrose only? (Select ALL that apply.)
A. Amphotec
B. Ativan
C. Synercid
D. Unasyn
E. Bactrim
A, B, C, E. Amphotericin B (Amphotec), lorazepam (Ativan), quinupristin/dalfopristin (Synercid), and sulfamethoxazole/ trimethoprim (Bactrim) are all compatible in dextrose solution only.
Drugs known to leach to PVC bags include the following: (Select ALL that apply.)
A. Tacrolimus
B. Meropenem
C. Imipenem
D. Docetaxel
E. Paclitaxel
A, D, E. tacrolimus, temsirolimus, teniposide, cabazitaxel, docetaxel, etopiside, ixabepilone, paclitaxel
“tic, tac, toe, craving delicious, excellent, irresistible pho”
A patient will receive a central line. Which of the following statements are true concerning central lines? (Select ALL that apply.)
A. Central lines are used by dialysis patients.
B. Central lines are used by patients receiving long-term enteral therapy.
C. Central lines are used for long-term antibiotic therapy, and most commonly, a PICC line is used.
D. Central line associated blood stream infections are very rare and not likely if the line is placed properly.
E. A central line is also called a central venous catheter.
A, C, E. Central lines are used by patients receiving long-term parenteral (not enteral) therapy. Enteral therapy is administered by a patient eating, or using a gastric tube (typically via the nose, or NGT), or sometimes through the jejunum (J tube).
Which of the following statements concerning IV medications are correct? (Select ALL that apply.)
A. Furosemide and metronidazole IV bags are not refrigerated.
B. Phenytoin IV requires a filter due to the potential for precipitation.
C. Sulfamethoxazole/trimethoprim and phenytoin IV are diluted with NS only.
D. Phenytoin IV has a maximum infusion rate of 50 mg/min.
E. Metronidazole IV does not require protection from light.
A, B, D.
Sulfamethoxazole/Trimethoprim is compatible with D5W only (not saline). Phenytoin is compatible with saline only (not dextrose).
A patient comes to the emergency department with acute coronary syndrome. Intravenous nitroglycerin therapy is started. Which of the following statements regarding intravenous nitroglycerin is correct? (Select ALL that apply.)
A. This medication will be adsorbed by polyvinyl chloride bags.
B. Intravenous nitroglycerin should not be used in patients with ACS.
C. This medication can be given for a maximum of 18 hours.
D. This medication requires non-polyvinyl chloride tubing sets for administration.
E. Intravenous nitroglycerin must be protected from light.
A, D. Adsorption occurs with soft plastic such as polyvinyl chloride. This can cause the nitroglycerin to leach out and adhere to the plastic. Non-polyvinyl chloride bags and tubing sets are recommended with the use of intravenous nitroglycerin.
Which of the following medications require protection from light during administration?
A. Adenosine
B. Sodium nitroprusside
C. Milrinone
D. Dexmedetomidine
E. Nitroglycerin
B. Sodium nitroprusside should be wrapped in aluminum foil or placed in an opaque bag while it is being infused.
Common light protection drugs during administration: dopamine, doxycycline, epoprostenol (Flolan), linezolid (Zyvox), metronidazole (Flagyl), micafungin (Mycamine), nitroprusside (Nitropress), norepinephrine (Levophed), phytonadione (vitamin K), SMX/TMP (Bactrim), verapamil
Which of the following is an example of a physical incompatibility that can occur with a drug? (Select ALL that apply.)
A. Drug degradation due to hydrolysis
B. Drug toxicity due to oxidation
C. Drug decomposition
D. Drug that cannot be placed into PVC container
E. Drug incompatible with NS
D, E. Physical incompatibility can occur with the containers that drugs are placed into (e.g., PVC container) or the solutions (e.g., diluent, such as NS). The other choices are examples of chemical incompatibilities.
Which of the following drugs require filtration? (Select ALL that apply.)
A. Lorazepam
B. Cefazolin
C. Golimumab
D. Aztreonam
E. Doxycycline
A, C. Lorazepam and golimumab both require filtration.
Filtration required during administration: albumin, amiodarone, amphotericin B liposomal (AmBisome), golimumab (Simponi), lorazepam (Ativan), phenytoin (Dilantin), parenteral nutrition
A patient is receiving a furosemide infusion. The total daily dose the patient received of intravenous furosemide is 40 mg. What would be the oral equivalent dose of furosemide for this patient?
A. 20 mg
B. 40 mg
C. 80 mg
D. 120 mg
E. 200 mg
A. Furosemide has an intravenous to oral ratio of 1:2.
All of the following drugs require light protection during administration EXCEPT?
A. Phytonadione
B. Linezolid
C. Heparin
D. Sulfamethoxazole/Trimethoprim
E. Verapamil
C. Phytonadione, linezolid, sulfamethoxazole/trimethoprim, and verapamil all require protection from light.
Common light protection drugs during administration: dopamine, doxycycline, epoprostenol (Flolan), linezolid (Zyvox), metronidazole (Flagyl), micafungin (Mycamine), nitroprusside (Nitropress), norepinephrine (Levophed), phytonadione (vitamin K), SMX/TMP (Bactrim), verapamil
A nurse calls the pharmacy to see if she can infuse diltiazem via Y-site into the same line with heparin. What is a reputable resource for this compatibility information?
A. Critical Care Handbook
B. The ICU Book
C. The Drug Information Handbook
D. Harrison’s Principles of Internal Medicine
E. Trissel’s Handbook on Injectable Drugs
E. Trissel’s Handbook on Injectable Drugs is a well-known resource for intravenous compatibility information. It comes in print and electronic versions. King’s Guide is another reputable source for this information.
