CH 15 Flashcards

Question

Bacteriostatic Water for Injection USP

Answer 1

distillation and reverse osmosis pyrogen free YES Sterile yes MUTIPLE DOSE- preservative or contains antimicrobial agents no more than 5 mL of preservative for IV injection NOT FOR NEONATES had benzyl alcohol can be poisoning

Answer 2

distillation and reverse osmosis Pyrogen free yes Sterile free yes greater than 1 liter and labeled "not for injection," wide mouth ONE TIME USE NO preservative -single dose used for clearing, not for IV injection

Answer 3

sterile and isotonic single dose, no antimicrobial or preservative can be used a vehicle for suspensions or solutions

Answer 4

Multiple dose, contains preservative or has antimicrobial agents no more than 5 mL of preservative for IV injection

Answer 5

-Sterile -single dose - nacl, kcl, and, cacl2 similar to our physiological fluids) -can be used alone as a electrolytes replenisher of K and CL and plasma volume expander

Answer 6

has NaCl,KCl, CaCl2, and lactate used as a fluid and electrolyte replenisher and systemic alkalizer

Answer 7

contains preservative and is less than or is 5mL (small volume) ex. 500ml is single dose-no preservative if more than 5ml we use STERILE WATER FOR INJECTION USP rather than bacteriostatic water for injection USP

Answer 8

most for subcutaneous or IM oleaginous injections is NOT IV Aqueous vehicle are preferred but we can use nonaqeous FIXED OILS: USP restrictions: -MUST be of vegetable origin, must be a liquid at room temperature or when cooled to 10 C (50F) (unsaturated), acids free (we know there is acid when muscles irritated), corn oil cottonseed oil, peanut oil, sesame oil. the oils cannot contain paraffin or mineral oil as these are not absorbed into body when drug cannot dissolve very well we use a co-solvent system with small amount alcohol or PPG. **Water is miscible substance (nonaqeous solvents) -fixed oils, glycerin, polythelene glycols, propylene glycol, alcohol.- do not affect therapeutic efficacy

Answer 9

depends on the amount of unsaturated fatty acids (oleic acid) to saturated fatty acids (saturated)

Answer 10

corn oil, cottonseed oil, peanut oil, sesame oil, caster oil, olive oil on occasion

Answer 11

1. control isotonicity (osmotic pressure): NaCl and dextrose. NaCl produce 2 ions more dextrose produce 1 more, and we know NaCl osmotic pressure is less than dextrose. 2. Antioxidants: is the stability of drug. example. sodium bisulfite, (aq) and ascorbic acid (aq.) 3. Buffer reagent: for parental we have suspension, solns, and powder dosage form. if it is a powder we need to dissolve and so there is no problem with using buffer. **antibiotics require suitable solvent but does not need buffer reagent cause it is NOT a soln (powder) ** antibacterial, preservatives, buffers, solubilizes , antioxidants. agents employed for just coloring effect are NOT ALLOWED in a parenteral product. 3. parenteral preservative (antimicrobial) needs to be less than 5mL (multiple dose). parenteral injection have less preservative compared to oral solns which is (0.1%). examples: thimersol, benzyl alcohol benzyl alcohol: is not good for neonate cannot metabolize in liver and kidneys

Answer 12

the maximum limit is 0.01%

Answer 13

1. hydrolysis 2. photolysis 3. oxidation we put nitrogen in vial, so we have less oxygen in vial to avoid problems with stability

Answer 14

1. sterility: is the absences of life (100% removal) 2. sterilization: complete destruction of all viable organism and their spores (cure them all) 100% removal 3. disinfectant: a substances used to inanimate objects to render them noninfectious. IT does not kill just used reduce the microorganisms activity. ex. alcohol. Does not cure. 4. Antiseptic: reduced in introduced the microorganism in the patient. used to prevent sepsis. 5.pyrogen : fever producing substances

Answer 15

verifications: quality assurance 1. application of an adequate sterilization treatment (spores added to a carrier strip like filter paper and packaged to maintain physical integrity while allowing sterilization. 2. verification that the materials are sterile. 3 protection of sterile material 4. delivery, opening, and use of sterile material without entrance of contamination

Answer 16

specific type of microorganism resistant to sterility

Answer 17

steam dry heat sterilization by filteration gas ionizing radation

Answer 18

is in an also know as autocave and employs steam under pressure, the moist heat is in the form of saturated steam most reliable method and first choice if a product can withstand it, can be used on all forms of microorganisms. Mechanism of degradation: is protein coagulation/denaturation in the cell. (bacteria because it contains a large percentage of water is easier to kill than spores which contain less water ) it is the heated moisture that permits relatively low temperature compared to dry heat. **121.5 C (250 F) for 20 mins, 15 psi (ib) 115.5C for 30 min, 10psi 126.5 for 15 mins, 20 psi small pressure= when boiling pt is low and there is more time . (temp, time, pressure) the penetration time of moist heat into a load will vary with the nature of the load and the exposure time must be adjusted to account for this time period. a combination of air and steam will yield lower temperature rather than just steam alone under pressure. use on: ampuls, because it is a solution that has moisture in a sealed container. sealed empty containers with small amount of water can as well. we can use on glassware, bulk solutions, surgical dressings, instruments. ** we cannot use moist heat and steam sterilization on oils and powders because the moisture cannot penetrate them "water for injection" becomes "sterile water for injection." BENCH Top(small) AUTOCLAVIN- in dentists office/ lab setting manufacturing autoclavin is larger

Answer 19

in ovens less effective then moist heat/steam so we need higher temperatures and more time for exposures mechanism: dehydration and slow oxidation of the cell used: fixed oils, dry glassware, petroleum jelly, mineral oils, talcum powder, some dry powders, glycerin, zinc oxide powders, paraffin. dry chemical, instruments or containers and nonaqeous solns 150-170C not less than 2hrs if the chemical agents melts at 170c AND DOESNT melt or denature at 140c then we use the 140c so there is more time needed not all drug stable at this temperature

Answer 20

ONLY SOLUTIONS NOT POWDER example is used for eye solutions we used this when a solution cannot be heated, or heat sensitive solutions MECHANISM: reverse osmosis of smaller pore size and distallation mechanism reverse osmosis removal by adsorption in a filter medium and virtue of interlacing bacteria pores or particles becoming entrapped in these pore and removed MILLEX Filter unit cell is 7um bacterial pores: 0.22 um polioviruses: 0.025um it is used on a small scale in hospitals and not for manufacturing purpose advantages: speed in filtering small quantities, sterilizing thermoliable materials, inexpensive equipment , complete removal of living and dead microorganisms, and particulate matter.we properly assembled the sterilized filter paper can have high flow rate disadvantages: the membrane is fragile so if it is not properly assembled the membrane can rupture. more time is required for larger volume and viscous (high concentration) solutions. current evience show litte to no adsorption takes place with mebrane filters. small doses do not bond to filter paper (less than 5mg) aphoterican B to ensures it passage the filter needs to be more than 1um. we can use " water for injection" by using small pore size of the filter membrane and remove large molecule of the pyrogen the seridose membrane is fragile or membrane is fragile, high pressure when we push the needle the filter can break, the circumference can leak at high pressure filter membranes: cellulose acetate or cellulose nitrate

Answer 21

gas sterilization: destruction of all living microorganism with a chemical in a gaseous or vapor state at room temperature can generate oil or powder without dissolving them. no heat involved. and we used gas vapor to kill microorganism (**example. ethylene oxide and proplyene glycol) use on: oil, heat sensitive or oil compound, moisture sensitive compound and powders. when we use a plastic syringe, surgical supplies, or plastics that are heat sensitive we use gas sterilization

Answer 22

1. UV light (thermometers) 2. gamma radiation disadvantages: limited because it has specific equipment and effects of irradiation on product and containers. vital components of the cell structure are destroyed like chromosomal nucleoproteins, not reversible.

Answer 23

moist sterilization

Answer 24

-cause febrile reactions -gram negative bacteria - metabolizes the (endotoxins, lipolyssacharide) -gram positive bacteria (endotoxins) - they can be destroyed at 250C for 4 hrs - this is different from microorganism it is a organic compound. compounds need higher heat to get rid of pyrogen we are doing a chemical rxn (compound) to remove the organic compounds of fever to speed it up we put in the solution: potassium permanganate and barium hydroxide filter( oxidizing agents) other methods of removal: distillation and hydrolization pyrogen test: USP rabbit test. after water for injection, is it pyrogen free or not.after we perform sterilization and reverse osmosis, does it contain pyrogen. because pyrogen are organic we remove them by oxidation and use oxidizing agents. inject 10ml of water for injection not increase more than 0.5C it is pyrogen free. endotoxin test is faster and efficient than the pyrogen tests: limiulus polyphemus and horseshoe crab.

Answer 25

are water soluble, pass through 0.2um filters are not destroyed by autoclaving, and are insoluble in organic solvents

Answer 26

1. formulation : solvents, and additives 2. preparations: pyrogens and sterilization 3.packing: type of dosing, type of packing 4. special packing : Mix-O-vial and ADD vantage

Answer 27

mix o vial: powder or liquid at the bottom and and liquid at the top . it offer stability of the product until it is used and avoids touch contamination. small volume single dose no preservative. ADD vantage: UV plastic bag and a glass vial of powder or liquid drug, avoid contamination and hospital can reduce drug waste and helps to conserve labor and reduce material costs. single dose, no preservative.

Answer 28

type of dosing: single or multiple dose containers types of packaging: -ampuls -vials -pre-fill syringes

Answer 29

the oldest type of parenteral product containers and made entirely of glass. ampul sealing (use heat the top of ampul and seals) single dose or single use ONLY -opened by breaking the glass at the score link on the neck product must be sterile filtered before administration (filter needle) (because has glass) because the glass particles may become dislodged during the ampul opening

Answer 30

undergoes photolysis

Answer 31

can be glass or plastic and close with a rubber stopper and sealed with aluminium crip multiple dosage form (preservative or bacteriostatic agent) advantage over the ampul: easier to remove the product eliminate the risk of glass particle during opening disadvantage: the stopper may become cored and multiple withdrawals can result in microbial contamination

Answer 32

type I (borosilicate): MOST chemically resistant, low thermal coefficient of expansion. we use this for iv injection type II: soda lime treated glass. -lower concentration of migratory oxides than type III. treated with sulfur oxide to dealkanize the internal surface, pH is less than 7 acidic. type III: soda lime glass. -good for anhydrous and dry substances (no interaction with the glass). we get under the hood. plastic containers: plastic polymers made up of PVC: polyvinyl chloride (soft flexible and no rigid) and polyloefin (semi-rigid and can be stored upright) helps to hold it. advantage of plastic: is it unbreakable, easier to store, reduced weight, and improved safety. BUT if we have interaction between soln and container we cannot use plastic then use glass. NS solution is the soft plastic container

Answer 33

-emergency (epinephrine and atropine are immediate injection) -designed for maximum conivence -improved sterility and accuracy -metal or plastic cartilage holder -prefilled with a needle attached -premixed and remeasured TUBEX

Answer 34

infusion solutions: for intermittent and continuous infusions of fluids or drugs small volume: SVP volume less than 100mL and has preservative large volume: LVP volume more than 100ml has no preservative and is for single dose.

Answer 35

if label says 0.5 ml and we have a excess of mobile liquid of 0.1 giving us total of 0.6 we calculated based on 0.5 not the 0.6 and have excess viscous liquid would be more than excess mobile so it would be 0.12 a very small amount of excess solution may be added as overfill to ensure that the stated dose volume will be fully extractable from the vial.

Answer 36

required from USP. used to prepare a parental admixture in a laminar flow hood high efficiency particulate air (hepa) filters we perform under FEDERAL CLASS 100: no more than 100 particles sized 0.5 um or larger per cubic foot of air. types: vertical laminar flow hood is for toxic compounds or chemoreagants horizitional: no hazard drug or chemoreagants

Answer 37

free of pyrogens(small amount) and microorganisms, and no particles (limited)

Answer 38

sterile products should be prepared in a class 100 environment and sized 0.5um or larger per CUBIC FOOT good of air hospital setting horizational- draw containmaed through a prefliter and pressurized 99.9% 0.3 um are removed Nothing must interrupt the flow of air between the HEPA and the sterile object. if there is a foreign object can cause containments in the sterile object . nothing should pass behind a sterile object in a horiztional hood or above a sterile object in a vertical hood try to stay in deeper into hood without adjusting air flow don't let your hands block air flow

Answer 39

1. the name of preparation 2.for a liquid preparation, the percentage content of drug or the amount of drug in a specified volume. 3. for a dry preparation, the amount of active ingredient present and the volume of liquid added to prepare a solution or suspension 4. the route of administration (IM, IV, ETC). 5. a statement of storage conditions an expiration date 6. the name of manufactures and distributor 7. an identifying a lot number capable of yielding the complete manufacturing history of the specific package including all manufacturing, filling, and sterilizing and labeling operations. (5 is about the type of container it is in the temperature and the expiration and stability of the api.) in hospital setting (labeling): patient name, which hospital and, which room

Answer 40

is before the drug can be released these things are needs to ensure it is properly manufactured. 1. Sterility Tests: 2. Pyrogen Tests: 3. Clarity Tests: size range, number of particles, methods to monitor- coulter counter (small amount allowed as long as it is smaller than RBC 7um) 4. Leaker Test: (ONLY AMPULS) put the ampuls in a color dye and to check if the seal is on there or not 5. USP official test for parenteral

Answer 41

Injections : 1. clarity tests 2. definition 3. vehicles 4. added substances 5. containers 6. volume in containers /9overfill) 7. labeling 8. packaging and storage (expiration date) sterilization: methods 1. biological indicators: a specific microorganism resistant to sterility 2. antimicrobial agents effectiveness 3. pyrogen test 4. container specifications: -light transmission -chemical resistance (glass) -biological test (plastic) -physiochemical tests (plastic) -permeation because we have a lot of tests to perform for the sterile form of injection it is more expensive compared to non sterile injection

Answer 42

The objective of this chapter is to provide guidance (both environmental and practice) to prevent harm, including death, to patients that could result from nonsterility, excessive bacterial endotoxins, variations in intended strength, unintended chemical and physical contaminants, and ingredients of inappropriate quality. This chapter dis- cusses responsibilities and training/evaluation of all personnel as well as facility and equipment requirements, quality control, risk levels, verification, standard operating procedures, finished preparation release checks and tests, storage and beyond-use dating, and many other topics. Pharma compounding for sterile products (CSP) published in fall 2003 and went into effect January 1 2004 addresses the compounding, preparations, labeling of sterile drug preparations applies to all orgs that compounds sterile preparations like healthcare institutions, home infusion pharmacists, and other facilitates.

Answer 43

it is prepared based on the Rx of each patient.

Answer 44

-use of cleaner facilities -specific training and testing of compounding personnel in principles and practices of aseptic manipulations -evaluation and maintenance of air quality in the compounding area - sound knowledge of sterilization - principle and practice of solution stability

Answer 45

to determine this it is based on 90% (next day expire) of the content remained in the product. we determine based on 75% of API remaining in the dosage form.

Answer 46

the status of the components incorporated in the preparation ( we can use a non-sterile drug but needs to undergo sterilization) the process utilized in preparing the preparation the performance of the personnel involved in the preparation environmental conditions under which the process is performed

Answer 47

primary engineering control : laminar flow hoods - horizontal flow clean benches -vertical flow clean benches -biological safety cabinets (similar to the vertical) secondary engineering controls: is the storage - provide a buffer zone or a buffer system room as a core for the location of the workbenches or isolators . -have the cleanest work surfaces (horizontal or vertical work benches) and biological safety cabinets or isolators

Answer 48

allow the manipulation of sterile products without contamination of microorganism pyrogens or particles -dusts, smoke, bacteria -sterile area should be cleaned daily -avoid introduction of cardboard into the clean environment should be avoided -traffic flow should be minimized -special treatment and filter system for air -UV radiation -sticky mats for shoes particulate matter -positive room air pressure to reduce contamination and the air blows out of this room

Answer 49

-must provide at least the ISO Class 5 quality of air to which sterile ingredients and Components are exposed ISO Class 5 quality air means the number of particles having a particle size of 0.5 um and larger contained in the environment does not exceed 3520 particles per CUBIC METER similar to the federal class 100 but: this is 100 particles and is 0.5 um per CUBIC FOOT but are the SAME THINGS SAME VALUES.

Answer 50

- CSP Def - ISO CLASS 5

Answer 51

USP 797 requires personnel to be proficient in performing the following duties: 1. perform antiseptic hand cleansing and disinfection of non sterile compounding surfaces 2. select and appropriately on protective gloves, goggles gowns, masks, and hair and shoe covers. 3. use laminar flow clean air hoods , barrier isolators and other contamination control devices 4. identify, weigh, and, measure ingredients 5. manipulate sterile products aseptically and label and quality inspect compounded sterile preparations

Answer 52

1.solid or liquid of the compounding personal and objects (person with jewelry) yes u are allowed to use non sterile api (when we don't have a sterile api of it) 2. non sterile components employed and incorporated before terminal sterilization (we need to remove microorganism before use in the patient) 3. innapprioate conditions within the compounding area ( yes, hospital can give a flu shot) 4. prolonged pre-sterilization procedures with aqueous preparations (longer time can cause contaminates from the environment increases) 5. non sterile dosage forms used in compounding (if we use a nonsterile dosage how can be preform it has microrg free, particle free, and pyrogen free

Answer 53

( under laminar flow hood) no concern about pyrogen or microorganisms here 1.compounded with aseptic manipulation under ISO class 5 or better quality environment. ONLY sterile ingredients, products, and components and devices. 2. ONLY transfer, measure, and mix manipulations with closed or sealed packaging system. (powder into he solvents in sterile products) 3.manipulations are limited to aseptically opening ampuls, penetrating sterile stoppers on vials with sterile needles and syringes and transferring sterile liquids into sterile syringes to sterile admin. devices and packages of other sterile products

Answer 54

SINGLE TRANSFER: OF STERILE dosage forms from containers like ampuls, bottles, bags, and vials, using a STERILE needle AND STERILE syringe SINGLE transfer of sterile dosage form from other admin device and other sterile containers (IV infusion devices) SINGLE transfer of sterile dosage forms from ampules and the contents of ampules require STERILE FILTRATION to remove any glass particles. manually measuring and mixing NO MORE THAN 3 manufactured products to compound drug admixtures and nutritional solutions. (NO MORE THAN 3 SINGLE TRANSFERS OF DRUG A, B, C )

Answer 55

*(still ISO class 5 and laminar flow hood) -MUTIPLE TRANSFER -has preservative it is multiple doses (preservative) or small doses of sterile products are combined or pooled to prepare a compounded sterile preparation that will be administrated either to multiple patients or to one patient on multiple occasions compounding process included complex aseptic manipulations other than the single volume transfers. Compounding process usually LONG duration, such as required to complete dissolution or homogeneous mixing (problem with solubility of the drug) compounded STERILE preparations DO NOT contain a broad spectrum bacteriostatic substance and they are administrated over several days (internally worn or implanted infusion device).- (the catheter cannot be on there more than 72 hours ) DRUG, D5W, NSS- IV SOLUTION

Answer 56

compounding of TPN fluids using manual or automated devices during which there are MULTIPLE INJECTIONS , detachments, attachments of nutrient source products to device or machine to deliver all nutritional components to the final sterile container filling reservoirs of injections and infusion devices WITH MULTIPLE STERILE DRUGS products and evacuation of air from those reservoirs before the filled device is dispensed. filling reservoirs of injections and infusion devices WITH volumes of sterile drug solutions that will be admin. over SEVERAL DAYS at ambient temp (25-40c). (no preservative and increase contamination) Transfer (MORE THAN 3, SO 4) of volumes from multiple ampuls or vials into a single final sterile container or product.

Answer 57

not for IV usually a spray or eyes., ears no a sterile environment In ISO CLASS 5 hospital setting- low volumes of flue shot or vaccine is high risk but the volume introduced in the human is little.

Answer 58

all sterile ingredients, device, and compenets, abut expose to air quality a below ISO CLASS 5, storage below ISO CLASS 5, used or opened packages of sterile that lack antimicrobial preservative. measure, mix sterile ingredients in NON STERILE device before we do terminal sterilization, packages of bulk ingredients contain at least 95% by weight of their active chemical moiety and hav not been contaminated between uses

Answer 59

-small volume parenteral are solution and suspensions and solids -insulin preparations

Answer 60

1.Insulin Lispro: onset 0.25H (15 min), peak 0.5-1.0 ( 30 min-1hr), 3 hrs duration (YES) compatible Ultralente and NPH 2. Insulin Aspart: onset: 0.25H (15 min) duration: 0.5-1.0 (30min-1hr) 3 Hrs duration NONE compatible

Answer 61

1. regular insulin onset 0.5H (30min) peak 2-5H duration 5-8H **YES compatible: ALL

Answer 62

1. Isophane (NPH) Insulin onset 1-2 H peak 6-10 H duration 16-20H YES compatible : Regular 2. Insulin Zinc (lente) 1-2 H 6-12H 18-24H YES compatible : regular, semilente

Answer 63

1. Insulin zinc extended (Ultralente) 4-6 10-18 24-28 yes compatible: REGULAR, SEMILENTE 2. Insulin glargine ONSET 2 peak NONE duration 24+H NONE compatiable

Answer 64

Isophane/ regular insulin 70/30 and 50/50 ONSET 7-12Hrs 16-24 HRS NO DURATION NPH/lispro mix 75/25 onset 5 min 7-12 hr 1-24hr

Answer 65

2 types of glass for large volume one with air tube and one without air tube Maintenance therapy: electrolyte requirement: cations(Na, K, Ca, Mg) anions(Cl, Phosphate, Acetate) caloric requirement: 5% dextrose to reduce the caloric deficit that usually occurs in patients undergoing maintenance or replacement therapy. The use of dextrose also minimizes ketosis and the breakdown of protein. replacement therapy: patient has undergone a heavy loss of water and electrolytes, as in severe diarrhea or vomiting, greater than usual amounts of these materials may be initially admin and then maintenance therapy provided. Patients with Crohn disease, AIDS, burns, or trauma are candidates for replacement therapy. water requirement (25 to 40 mL/kg) parenteral hyper alimentation enteral nutrition: Enteral nutrition products may be administered orally, via nasogastric tube, via feeding gastrostomy, or via needle-catheter jejunostomy. These products are formulated to contain a variety of vitamins, minerals, carbohydrates, proteins, fats, and caloric require ments to meet the specific needs of patients. intravenous infusion devices

Answer 66

amino acid injection: nutrition dextrose Injection: (2.5, 5, 10) nutrition dextrose and sodium chloride injection: nutrition and electrolyte mannitol injection: diagnostic kidney filter (renal) and nutrition ringer injection : na, k, cl, ca. electrolyte (contains Ca so not for tetracycline bc it will for kelade) - physiological fluid-electrolytes lactated ringer injection: ca, k, na, lactate. alkalizer and electrolyte Sodium chloride injection : nacl 0.9% - electrolyte and isotonic vehicle

Answer 67

sterile products and have same standards as IV prep. NOT FOR INFUSION INTO IV types: 1. topical admin: pour bottle, irrigating wounds, dressing, cleaning instruments in surgeries 2.infusion of irrigating solutions: surgical patients. perfuse tissues, remove blood, provide clear view . reduce risk of infection (antibiotic prep: Neosporin irrigant) 3. dialysis solutions: patients with renal failure, poisoning, electrolyte disturbance. remove waste, serum electrolytes, toxic products in body. **ex. peritoneal and hemodialysis

Answer 68

blood is filtered outside body and then returned to body when cleansed patients blood is transfused through a dialyzing membrane unit that removes the harmful substances from the patients vascular system after passing the dialyzer the blood reenters the body by the vein

Answer 69

a hypertonic dialyaste is infused directly into the peritoneal cavity by a surgical implanted catheter contains dextrose and electrolytes, removes harmful things by osmosis and diffusion. after a dwell period the solution is drained antibiotics and heparin may be added to dialysate

Answer 70

has a plastic cap and most are not guaranteed sterility pray and swab all vials with 70% alcohol swabbing in one direction removes particles alcohol- disinfect to prevent core formation needs to penetrated with the tip and heal Vital- glass container with rubber cap held together by aluminum cover- Aluminum cover does not guarantee sterility and therefore rubber cap must be wiped with alcohol swap before use. To prevent core formation, the needle should penetrate the rubber closer at the same point with both the tip and heel of the bevel Since vials are enclosed containers, to prevent a vacuum, the same amount of air as fluid required should be released into the vial before uptake of fluid

Answer 71

one open is a open system higher ring is the point to where finger should be to avoid getting cut. cleans with alcohol swab . ampul is tilted horizontal and surface tension keeps the solution from spilling out bevel of needle corner space near opening. you need a filter needle 5um to rid of glass particles. Amples- completely made up of glass, becomes open system when used- Not necessary to release air into amples- Ample ring can tell you where to place your fingers or where the head will break Ample is broken with alcohol swab around the neck and a quick firm snapping motion Do not break the ampul toward the HEPA filter or other objects in hood To uptake drug from ampul, it should be tiled and the bezel of the needed placed on the opening of the ampul PVC bags used for IV fluid. Easier storage, less breakage, no need to vent container Injection portal should be placed toward HEPA filter 2 diaphragms need to be pierced for drug to enter IV bag; therefore a needle longer than ⅜ inch should be used Sterilization of ridge IV container portal and cap is not necessary

Answer 72

prevent water loss injection portal is upright and disinfected, insert needle into portal. 2 injection parts so we need a needle longer than 3/8 inch no protective cap needed on the polflin rigid iv bag.

Answer 73

stored at room temp admin within 28 hrs of prep stored in refrigerator for 7 or less, not exceed 24hrs 30 days or less before, not to exceed 24 hrs.

Answer 74

products beyond 7 days under refrig. stored beyond 30 days frozen , admin beyond 28 hrs after prep

Answer 75

nonsterile ingredients or compounded with nonsterile compenet.