Chapter 7: IV Medication Principles

Question 1

hypertonic saline

Answer 1

• 3% and 23.4%
• can be fatal if given peripherally: cause water to move out of RBC to dilute the saline

Question 2

venous catheter

Answer 2

• catheter in vein used for fluid and drug delivery (IV acess)
• two groups: peripheral and central lines

Question 3

peripheral lines limitations

Answer 3

• phleitis: vein irritation
• venous thrombosis (clot)
• fluid extravasation: catheter becomes dislodged and IV contents end up in surrounding tissue

Question 4

when are central lines required

Answer 4

• for highly concetrated drugs
• for long term ABX
• for veissicants (drug that can cause tissue damage)
• drugs wth a pH not close to blood pH
• drugs with high osmolarity (parenteral nutrition)

Question 5

PICC line

Answer 5

peripherally inserted central catheter

Question 6

vessicant examples

Answer 6

• vasopressers
• anthracyclines (doxorubicin)
• vinca alkaloids (vincristine)
• digoxin
• promethazine - IM preferred, IV can cause severe tissue injury, limit dose and monitor pt

Question 7

chemical incompatibility for IV drugs

Answer 7

causes drug degradation or tox dt hydrolysis, osidation or decomposition

Question 8

physical incompatibility of IV drugs

Answer 8

physical incompatibilty between a drug and the container, diluent, or another drug

Question 9

DEHP problems

DEHP is a “plasticizer” used in most PVC bags to make them flexible

Answer 9

• DEHP can leach from the container and end up in the solution
• DEHP is toxxic and can harm the liver

drugs taht require non-PVC containers: Leach Absorbs To Take In Nutrients
- lorazepam
- amiodarone
- tacrolimus
- taxanes
- insulin - adsorbs to the PVC
- nitroglycerin

Question 10

Alternative to PVC contaienrs

Answer 10

• polyolefin
• polypropylene
• glass

Question 11

drugs that should be mixed in saline only

Answer 11

A DIAbetic Can’t Eat Pie
- ampicillin (because it has a much shorter stability in dextrose)
- daptomycin
- infliximab
- amp/sul
- caspofungin
- ertapenem
- phenytoin

Question 12

drugs to mix in dextrose only

Answer 12

Only Sugar Always
- oxaliplatin
- SMX/TMP
- amphotericin B

Question 13

IV CTX canNOT be mixed with _

Answer 13

calcium containing soln dt risk of precipitate

LR contains Ca

Question 14

Phosphate canNOT be mixed with _

Answer 14

Ca, it can form a deadly precipitate in the I Vfluid

Question 15

Primary resources for IV compatibility

Answer 15

• ASHP Injectale Drug Information
• Trissel’s 2 Lcinical Pharmacetuics Database
• King Guide to Parenteral admixture
• Drug inserts

Question 16

what size filter is typically used for drugs that require filters

Answer 16

0.22 micron filter

Question 17

Common drugs with filter requirements

Answer 17

my GAL Is PAT who has a MaP
- golimumab
- amphotericin B (lipid formulations)
- lipids (need 1.2 microns)
- isavuconazonium
- phenytoin (only for IV continuous, not IV push)
- amiodarone
- taxanes
- mannitol > 20%
- parenteral nutrition (1.2 microns)

also: abatacept, certain albumins, antithymocyte globulin, inflixmab

Question 17

what filter is required for pernteral nutrition

Answer 17

1.2 microns

Question 18

IV drugs to NOT refrigerate

Answer 18

Dear Sweet Pharmacist, Freezing Makes Me Edgy
- Dexmedetomidine (if diluted can be kept cold)
- SMX/TMP
- phenytoin - crystallizes
- furosemide - crystallizes (if diluted can be kept cold)
- metronidazole
- moxifloxacin
- enoxaparin

also: APAP, acyclovir, deferoxamine, keppra, pentamidine, valproate

Question 19

examples of drugs that should be shaken/agitated

Answer 19

• protein/blood rpoducts: albumin, Ig, mAb, inuslins
• products that foam: alteplase, etanercept, raburicase - swirl, don’t shake
• vaccines that have already been reconstituted

Question 20

Drugs to protect from light

Answer 20

Protect Every Necessary Med from Daylight
- phytonadione (vit K)
- epoprostenol
- nitroprusside
- micafungin
- doxycycline

also: amp B, deoxycholate, anthracyclines, decarbazine, pentamidine

Question 21

don’t use chlopromazine if it looks _

Answer 21

darker than slightly yello

if it is only slightly yellow, it is ok to use

Question 22

don’t use dacarbazine if it looks _

Answer 22

pink

Question 23

dobutamine turns _ if it has been oxidated

Answer 23

pink but it is still ok to use

Question 24

don’t use dopamine if it looks _

Answer 24

darker than slightly yello

still ok to use if slightly yello

Question 25

don’t use epinephrine if it looks _

Answer 25

pink then brown

Question 26

don’t use isoproterenol if it looks _

Answer 26

pink or darker, it has been damaged by air, light, heat

Question 27

don’t use morphine if it looks _

Answer 27

dark

Question 28

don’t use nitroprusside if it looks _

Answer 28

orange then brown then blue

if it is blue then it is almost completely dissociated into cyanide

Question 29

don’t use tigecycline if it looks _

Answer 29

green or black (it’s normal color is yellow or orange)

Question 29

don’t use NE if it looks _

Answer 29

pink or darker

Question 30

anthracyclines (doxorubicin) IV fluids can discolor _

Answer 30

sweat and urine to red

Question 31

rifampin IV fluids can discolor _

Answer 31

saliva, urine, sweat, tears to red

Question 32

mitoxantrone IV fluids can discolor _

Answer 32

skin, eyes, urine to blue