7. IV Med Principles

Question 1

Common veins used for peripheral venous catheters are the ____ in the arm and the saphenous vein near the ankle

Answer 1

cephalic vein

Question 2

Administering drugs into smaller veins can cause ___

Answer 2

phlebitis (vein irritation), venous thrombosis (clots) and interstitial fluid extravasation (catheter gets dislodged from vein and the infusion contents enter surrounding tissue)

Question 3

Central lines provide secure, long-term vascular access and are required for administration of ____

Answer 3

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)

Question 4

To be considered a central venous catheter (aka central line), the catheter tip must be located in a large vessel such as ___

Answer 4

superior vena cava, or inferior vena cava

Question 5

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 ____

Answer 5

peripheral vein
superior vena cava

Question 6

Why are vesicants safer with a central line?

Answer 6

Line is less likely to become dislodged from the vein

Question 7

What are some examples of vesicants

Answer 7

vasopressors (e.g. dopamine, NE), anthracyclines (e.g. doxorubicin), vinca alkaloids (e.g. vincristine, vinblastine), digoxin, foscarnet, nafcillin, mannitol, mitomycin, and promethazine

Question 8

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.

Answer 8

Promethazine

If using IV: dilute drug, limit dose and monitor

Question 9

Chemical incompatibility causes drug degradation or toxicity d/t ____ reactions

Answer 9

hydrolysis, oxidation, or decomposition

Question 10

Physical incompatibility occur between a drug and on of the following: _____

Answer 10

container (e.g. PVC container)
Diluent (e.g. dextrose, saline)
Another drug

Question 11

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.

Answer 11

Diethylhexyl phthalate (DEHP)

Question 12

What are non-PVC containers that can be used for drugs that are not compatible with PVC?

Answer 12

Polyolefin
Polypropylene
Glass (although heavy and can break)

Question 13

Concern with insulin and PVC containers

Answer 13

Insulin adsorbs to PVC
Clinicians adjust rate of insulin infusions to obtain BG control, regardless of type of IV container and tubing used.

Question 14

Drugs with leaching/adsorption/absorption issues with PVC containers

Answer 14

Leach Absorbs To Take In Nutrients

Lorazepam
Amiodarone
Tacrolimus
Taxanes (exception: Paclitaxel-albumin bound (Abraxane))
Insulin
Nitroglycerin

Question 15

Common drugs that must be in saline (no dextrose)

Answer 15

A DIAbetic Can’t Eat Pie
Ampicillin
Daptomycin (Cubicin)
Infliximab (Remicade)
Ampicillin/Sulbactam (Unasyn)
Caspofungin (Cancidas)
Ertapenem (Invaz)
Phenytoin (Dilantin)

Question 16

Common drugs that must be in dextrose (no saline)

Answer 16

Outrageous Bakers Avoid Salt
Oxaliplatin
Bactrim
Amphotericin B (all)
Synercid - Quinupristin/Dalfopristin

Question 17

Which 2 drugs cannot be mixed with calcium (precipitation)?

Answer 17

Ceftriaxone and phosphate

Note: When calcium and phosphate are mixed into parenteral nutrition, methods must be used

Question 18

Concern with mixing ceftriaxone and lactated ringers

Answer 18

Lactated Ringers contains calcium
Ceftriaxone cannot mix with calcium d/t precipitation

Question 19

What are primary resources that you can use for drug compatibility?

Answer 19

ASHP injectable Drug Information
Trissel’s 2 clinical pharmaceutics database
King Guide to Parenteral Admixtures
Drug package inserts

Question 20

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.

Answer 20

1.2 micron
Parenteral nutrition to catch calcium-phosphate particulates
Injectable lipid emulsions (e.g. Intralipid)

Question 21

Common drugs with filter requirements

Answer 21

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

Question 22

IV drugs that should NOT be refrigerated

Answer 22

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

Question 23

IV drugs that need protection from light during administration

Answer 23

Protect Every Necessary Med from Daylight
Phytonadione (Vit K)
Epoprostenol
Nitroprusside
Micafungin
Doxycycline

Question 24

Drugs that should not be shaken/agitated

Answer 24

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

Question 25

Do not use with color change: Nitroprusside

Answer 25

Orange&raquo_space; brown&raquo_space; blue
Blue = nearly complete dissociation to cyanide

Question 26

Pharmacist notices dobutamine IV solution has a pink tinge. Is this safe to use?

Answer 26

Oxidation turns solution slightly pink, but potency not lost

Question 27

What color is anthracyclines (e.g. doxorubicin) IV solution?

Answer 27

Red (can discolor sweat and urine)

Question 28

What color is rifampin IV solution?

Answer 28

Red (can discolor saliva, urine, sweat, and tears)

Question 29

What color is methotrexate IV solution?

Answer 29

Yellow

Question 30

What color is mitoxantrone IV solution?

Answer 30

Blue (can discolor skin, eyes, urine)

Question 31

What color is Multivitamins for IV solution?

Answer 31

Yellow

Question 32

What color is tigecycline IV solution?

Answer 32

yellow/orange (can discolor teeth if used during teeth development)

Question 33

What color is iron IV solution?

Answer 33

Brown (can discolor urine)