7. IV Med Principles Flashcards
Common veins used for peripheral venous catheters are the ____ in the arm and the saphenous vein near the ankle
cephalic vein
Administering drugs into smaller veins can cause ___
phlebitis (vein irritation), venous thrombosis (clots) and interstitial fluid extravasation (catheter gets dislodged from vein and the infusion contents enter surrounding tissue)
Central lines provide secure, long-term vascular access and are required for administration of ____
Highly concentrated drugs (e.g. poassium chloride > 20 mEq/100mL)
Long-term abx (e.g. to treat osteomyelitis)
Toxic drugs that would cause severe phlebitis or tissue damage (e.g. chemo therapy, esp with vesicants)
Drugs with pH or osmolality that is not close to blood pH or osmolality (e.g. parenteral nutrition)
To be considered a central venous catheter (aka central line), the catheter tip must be located in a large vessel such as ___
superior vena cava, or inferior vena cava
Peripherally inserted central catheters (PICC) are inserted by placing the line into a ___ and pushing the catheter through the vein until the tip ends in the ____
peripheral vein
superior vena cava
Why are vesicants safer with a central line?
Line is less likely to become dislodged from the vein
What are some examples of vesicants
vasopressors (e.g. dopamine, NE), anthracyclines (e.g. doxorubicin), vinca alkaloids (e.g. vincristine, vinblastine), digoxin, foscarnet, nafcillin, mannitol, mitomycin, and promethazine
Some hospitals have removed ____ from formulary d/t risk of severe tissue injury. IM is preferred but this also has risk for tissue injury; intra-arterial or SC routes should not be used. Do NOT give to children <2 yo.
Promethazine
If using IV: dilute drug, limit dose and monitor
Chemical incompatibility causes drug degradation or toxicity d/t ____ reactions
hydrolysis, oxidation, or decomposition
Physical incompatibility occur between a drug and on of the following: _____
container (e.g. PVC container)
Diluent (e.g. dextrose, saline)
Another drug
The majority of polyvinyl chloride (PVC) containers us ____ as a “plasticizer” to make the plastic bag more flexible. This can leach from the container into the solution, which is toxic and can harm the liver and testes.
Diethylhexyl phthalate (DEHP)
What are non-PVC containers that can be used for drugs that are not compatible with PVC?
Polyolefin
Polypropylene
Glass (although heavy and can break)
Concern with insulin and PVC containers
Insulin adsorbs to PVC
Clinicians adjust rate of insulin infusions to obtain BG control, regardless of type of IV container and tubing used.
Drugs with leaching/adsorption/absorption issues with PVC containers
Leach Absorbs To Take In Nutrients
Lorazepam
Amiodarone
Tacrolimus
Taxanes (exception: Paclitaxel-albumin bound (Abraxane))
Insulin
Nitroglycerin
Common drugs that must be in saline (no dextrose)
A DIAbetic Can’t Eat Pie
Ampicillin
Daptomycin (Cubicin)
Infliximab (Remicade)
Ampicillin/Sulbactam (Unasyn)
Caspofungin (Cancidas)
Ertapenem (Invaz)
Phenytoin (Dilantin)
Common drugs that must be in dextrose (no saline)
Outrageous Bakers Avoid Salt
Oxaliplatin
Bactrim
Amphotericin B (all)
Synercid - Quinupristin/Dalfopristin
Which 2 drugs cannot be mixed with calcium (precipitation)?
Ceftriaxone and phosphate
Note: When calcium and phosphate are mixed into parenteral nutrition, methods must be used
Concern with mixing ceftriaxone and lactated ringers
Lactated Ringers contains calcium
Ceftriaxone cannot mix with calcium d/t precipitation
What are primary resources that you can use for drug compatibility?
ASHP injectable Drug Information
Trissel’s 2 clinical pharmaceutics database
King Guide to Parenteral Admixtures
Drug package inserts
Most drugs that require filters use 0.22 micron filter; another common filter size is ___ micron, which is used for ____ and ____. Large molecule drugs, including many liposomal formulations of chemotherapy drugs, must NOT be filtered d/t size of drug particle.
1.2 micron
Parenteral nutrition to catch calcium-phosphate particulates
Injectable lipid emulsions (e.g. Intralipid)
Common drugs with filter requirements
My GAL isPAT who has a MaP
Golimumab
Amphotericin B (lipid formulations)
Lipids-1.2 micron
Isavuconazonium
Phenytoin (only required for cont IV, not for push)
Amiodarone
Taxanes (cabazitaxel, paclitaxel)
Mannitol ≥20%
Parenteral nutrition -1.2 micron
IV drugs that should NOT be refrigerated
Dear Sweet, Pharmacist, Freezing Makes Me Edgy!
Dexmedetomidine*
SMX/TMP
Phenytoin - crystallizes
Furosemide - crystallize*
Metronidazole
Moxifloxacin
Enoxaparin
*optional: diluted dexmedetomidine and furosemide can be kept cold
IV drugs that need protection from light during administration
Protect Every Necessary Med from Daylight
Phytonadione (Vit K)
Epoprostenol
Nitroprusside
Micafungin
Doxycycline
Drugs that should not be shaken/agitated
Albumin, immune globulins, monoclonal antibodies, insulins
Alteplase, etanercept (Enbrel), rasburicase, quinupristin/dalfopristin (Synercid) or caspofungin; must be swirled when reconstituting
Vaccines that have been reconstituted (Varicella)
Emulsions, such as propofol and injectable lipid emulsions
Do not use with color change: Nitroprusside
Orange»_space; brown»_space; blue
Blue = nearly complete dissociation to cyanide
Pharmacist notices dobutamine IV solution has a pink tinge. Is this safe to use?
Oxidation turns solution slightly pink, but potency not lost
What color is anthracyclines (e.g. doxorubicin) IV solution?
Red (can discolor sweat and urine)
What color is rifampin IV solution?
Red (can discolor saliva, urine, sweat, and tears)
What color is methotrexate IV solution?
Yellow
What color is mitoxantrone IV solution?
Blue (can discolor skin, eyes, urine)
What color is Multivitamins for IV solution?
Yellow
What color is tigecycline IV solution?
yellow/orange (can discolor teeth if used during teeth development)
What color is iron IV solution?
Brown (can discolor urine)
