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1. NAPLEX Prep > Chapter 7: IV medication Principles > Flashcards

Chapter 7: IV medication Principles Flashcards

1
Q

Peripheral venous catheters

A

Inserted into smaller veins away from the bodys central compartment. Common veins used for peripheral venous catheters are the cephalic vein in the arm and the saphenous vein near the ankle.

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2
Q

Phlebitis

A

Vein irritation

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3
Q

Venous thrombosis

A

Clots

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4
Q

Fluid extravasation

A

when the catheter becomes dislodged from the vein and the infusion contents enter surrounding tissue

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5
Q

Administering drugs into smaller veins can cause

A

Phlebitis, venous thrombosis, and fluid extravasation

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6
Q

Central lines are required in the administration of

A

Highly concentrated drugs (KCl >20mEq/100mL)
Long term antibiotics (example to treat osteomyelitis)
Toxic drugs that would cause severe phlebitis (eg chemotherapy, especially with vesicants)
Drugs with a pH or osmolality that is not close to blood pH or osmolality (parenteral nutrition)

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7
Q

Central Line Placement

A

The catheter tip must be located in a large vessel (superior vena cava, right atrium, or inferior vena cava).

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8
Q

Peripherally inserted central catheters (PICC)

A

Inserted by placing the line into a peripheral vein and advancing (pushing) the catheter through the vein until the tip ends in the superior vena cava. PICC lines are more simple to insert than central lines and can be inserted at the bedside and checked with a quick xray.

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9
Q

Vesicants

A

Drugs that will cause severe tissue damage if the catheter tip comes out of the vein, allowing the drug to seep into the surrounding tissues (extravasate). Vesicants are safer through a central line.

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10
Q

Vesicants examples

A

Vasopressors (dopamine, NE), anthracyclines (doxorubicin), vinca alkaloids (vincristine, vinblastine), digoxin, foscarnet, nafcillin, mannitol, mitomycin, and promethazine

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11
Q

Promethazine can cause

A

Severe tissue injury.
Some hospitals removed it from formulary due to risk.
Not to be given intra-arterial or SC; IM is preferred but still has risk.
Do NOT give to children <2yo, dilute the drug, limit the dose and concentration and be careful

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12
Q

Primary resources for incompatible drugs

A

Handbook on Injectable Drugs (commonly called Trissel’s), the King Guide to Parenteral Admixtures (King’s), and the drugs package insert

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13
Q

Chemical Incompatibility

A

Causes drug degradation or toxicity due to a hydrolysis, oxidation, or decomposition reaction.

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14
Q

Physical incompatibility

A

Occurs between a drug and one of the following:
The container
The diluent
Another drug

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15
Q

DEHP from the container

A

The majority of PVC containers use DEHP as a “plasticizer” to make the plastic bag more flexible. DEHP can leach from the container and into the solution. DEHP is toxic and can harm the liver and testes.

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16
Q

Container absoprtion/adsorption

A

Absorption occurs when drug moves into the PVC container
Adsorption occurs when the drug adheres to the container
Both reduce drug concentration

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17
Q

Alternate (Non-PVC) Containers

A

Drugs that have leaching or absorption/adsorption issues with PVC containers can be placed in polyolefin, polypropylene or glass containers

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18
Q

Insulin and PVC containers

A

Insulin adsorbs to PVC. Clinicians adjust the rate of insulin infusions to obtain blood glucose control, regardless of the type of IV container and tubing used. It might be useful to know that insulin does adsorb to PVC for testing purposes.

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19
Q

Drugs with leaching/adsorption/absorption issues with PVC containers

A

Leach Absorbs To Take In Nutrients
Lorazepam
Amiodarone
Tacrolimus
Taxanes (Paclitaxel-albimin bound can be placed into PVC)
Insulin
Nitroglycerin

Other: Carmustine, Cyclosporine, Ixabepilone, Sufentanil, Temsirolimus

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20
Q

Saline (no dextrose) diluent drugs

A

A DIAbetic Can’t Eat Pie
Ampicillin
Daptomycin
Infliximab
Ampicillin/Sulbactam
Caspofungin
Ertapenem
Phenytoin

Other: Abatacept, Azacitidine, Belimumab, Bevacizumab, Idarucizumab, Iron sucrose, sodium ferric gluconate complex, Natalizumab, trastuzumab

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21
Q

Dextrose (no saline) diluent drugs

A

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

Others: Carfilzomib, Mycophenolate, Pentamidine

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22
Q

Y-site administration

A

Drugs mix together briefly in the common portion of the IV tubing. Drugs and solutions must be compatible.

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23
Q

Additive Compatibility

A

Needs to be confirmed when putting multiple drugs together in the same container or syringe. Additive compatibilities and Y site compatibilities are separate on Trissel’s

24
Q

High-risk incompatibilities- Ceftriaxone and calcium

A

Ceftriaxone and Calcium
Risk of precipitates
Lactated ringers contains calcium and cannot be mixed with ceftriaxone
Avoid in all age groups

25
Q

High risk incompatibilities- Calcium and phosphate

A

Can form deadly precipitate in IV fluids

26
Q

High risk incompatibilities- Amphotericin B and sodium bicarbonate

A

Incompatible iwth the majority of IV drugs and any type of IV administration

27
Q

Precipitates

A

Risk of precipitates–> Emboli–> Fatality
Calcium and ceftriaxone
Calcium and phosphate

28
Q

Most drugs use what filter?

A

0.22 micron filter

29
Q

Lipids use what filter?

A

1.2 microns

30
Q

Parenteral nutrition uses what filter?

A

0.22 micron

31
Q

What drugs must not be filtered?

A

Large molecules, including many liposomal formulations of chemotherapy drugs.
Must not be filtered due to size of the drug particle.

32
Q

Common drugs with filter requirements

A

GAL PLAT
Golimumab
Amiodarone
Lorazepam- if by CIVI
Phenytoin- if by CIVI
Lipids- 1.2 microns
Amphotericin B- liposomal requries 5 micron filter
Taxanes, except docetaxel

33
Q

Time in solution

A

The likelihood of a chemical reaction that would degrade the drug increases with time. This is important to consider with Pip/Tazo longer infusion times.

34
Q

Do not refrigerate drugs

A

Dear Sweet Pharmacists, Freezing Makes Me Edgy
Dexmedetomidine
Sulfamethoxazole/Trimethoprim
Phenytoin-crystallizes
Furosemide- crystallizes
Metronidazole
Moxifloxacin
Enoxaparin

Others- Acetaminophen, Acyclovir (crystallizes), deferoxamine (precipitates), levetiracetam, pentamidine (cystallizes), valproate

35
Q

Light exposure causes

A

Photo-degradation, which destroys some rugs, and in some cases, increases a drugs toxicity (nitroprusside)

36
Q

Protect from light during administration drugs

A

Protect Every Necessary Med from Daylight
Phytonadione
Esoprostenol
Nitroprusside
Micafungin
Doxycycline

37
Q

Do not shake/agitate

A

Agitation destroys some drugs, including hormones and other proteins. Drugs that are easily destroyed/damaged should not be shaken.
Protein/blood products- albumin, immune globulins, monoclonal antibodies, insulins
Products that foam- alteplase, etanercept, rasburicase, Synercid, or caspofungin. Only swirl when reconstituting, do not shake.
Vaccines that have been reconstituted
Emulsions such as propofol and injectable lipid emulsions.

38
Q

Check solutions for color changes

A

In most cases, discoloration indicates oxidation or another type of decomposition

39
Q

Anthracyclines (doxorubicin) color

A

Red
Discolors sweat and urine

40
Q

Rifampin color

A

Red
Discolors body fluids and teeth

41
Q

Mitoxantrone color

A

Blue
Discolors skin, eyes, urine

42
Q

Methotrexate color

A

Yellow
Does not discolor secretions or skin

43
Q

Multivitamins for infusion color

A

Yellow
Does not discolor secretions or skin

44
Q

Tigecycline color

A

Yellow/Orange
Teeth discoloration if used during teeth development

45
Q

IV iron, various color

A

Brown
Urine discoloration

46
Q

Chlorpromazine color

A

Slight yellow
Do not use if darkens

47
Q

Dascarbazine color

A

Do not use if pink

48
Q

Dobutamine color

A

Oxidation turns the solution slightly pink, but potency is not lost

49
Q

Dopamine color

A

Slight yellow
Do not use if darkens

50
Q

Epinephrine color

A

Do not use if pink or brown

51
Q

Isoproterenol color

A

Damaged by air, light, heat
Do not use if pink or darker

52
Q

Morphine color

A

Do not use if dark colored

53
Q

Nitroprusside color

A

Blue indicates nearly complete dissociation to cyanide.
Orange–> Brown-> Blue

54
Q

Norepinephrine color

A

Normal color: yellow/orange
Do not use if brown or any discoloration

55
Q

Tigecycline color

A

Do not use if green/black

1. NAPLEX Prep (15 decks)

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