Chapter 7: Learning IV Medications

Question 1

Another name for a venous catheter

Answer 1

Line

Question 2

Where is a common vein where a peripheral catheter can be inserted?

Answer 2

cephalic vein in the arm

Question 3

What is a limitation of administering drugs into smaller veins?

Answer 3

Phlebitis (vein irritation), venous thrombosis and fluid extravasation

Question 4

Where does a central line empty into?

Answer 4

larger veins

Question 5

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

Answer 5

• highly concentrated drugs
• long term antibiotics
• toxic drugs that can cause phlebitis (e.g. chemo)
• drugs with a pH or osmolality that is not close to blood pH or osmolality (e.g. parenteral nutrition)

Question 6

Where can central lines be placed?

Answer 6

• Into a large vessel like the superior vena cava
• Into a smaller vein and advancing the catheter through the vein until the tip ends in the superior vena cava (called a PICC - peripherally inserted central catheter)

Question 7

What are examples of common vesicants

Answer 7

• Vasopressors (dopamine, NE)
• Anthracyclines (e.g. doxorubicin)
• Vinca alkaloids (e.g. vincristine)
• Promethazine

Question 8

Name 3 primary compatibility and stability sources for parenteral medications

Answer 8

• Trissel’s Handbook on Injectable Drugs
• King guide to Parenteral Admixtures
• Package insert

Question 9

Drugs that have leaching or adsorption/absorption issues with PCV containers can be placed in:

Answer 9

Polyolefin, polypropylene or glass containers (these are known as non-PVC containers)

Question 10

Key drugs with leaching/adsorption/absorption issues with PVC containers

Answer 10

• Lorazepam
• Amiodarone
• Tacrolimus
• Taxanes
• Insulin
• Nitroglycerin

Remember: Leach Absorbs To Take In Nutrients

Question 11

What are key drugs that cannot be put into dextrose & can only be used with saline?

Answer 11

• Ampicillin
• Daptomycin (cubicin)
• Infliximab (Remicade)
• Ampicillin/sulbactam (Unasyn)
• Caspofungin (Cancidas)
• Ertapenem (Invanz)
• Phenytoin (Dilantin)

Remember: A DIAbetic Cant Eat Pie

Question 12

What are key drugs that cannot be put into saline & can only be used with dextrose?

Answer 12

• Bactrim
• Oxaliplatin
• Amphotericin B
• Synercid (Quinupristin/Dalfopristin)

Remember: BOAS will strangle the pharmacist who puts these drugs into anything but dextrose

Question 13

What are two examples of high-risk incompatibilities?

Answer 13

1. Ceftriaxone and any calcium-containing solutions due to risk of precipitates (e.g. lactated ringers contains calcium and cannot be mixed with ceftriaxone)
2. Calcium and phosphate

Question 14

What is a 1.2 micron filter used for?

Answer 14

Lipids

Question 15

What size filter should you use for parenteral nutrition?

Answer 15

0.22 micron filter, which will catch calcium-phosphate particulates

Question 16

What are common drugs with filter requirements?

Answer 16

• Golimumab
• Amiodarone
• Lorazepam (when administered by continuous infusion)
• Phenytoin (when administered by continuous infusion)
• Lipids (1.2 micron)
• Amphotericin B (lipid formulations; use 5 micron filter)
• Taxanes (except docetaxel)

Remember: That’s my GAL, PLAT

Question 17

Which key IV drugs crystalize if kept cold and are stored at room temperature?

Answer 17

• Dexmedetomidine (Precedex)
• Sulfamethoxazole/Trimethoprim (Bactrim)
• Phenytoin (crystalizes)
• Furosemide (crystalizes)
• Metronidazole
• Moxifloxacin (Avelox)
• Enoxaparin (Lovenox)

Remember: Dear Sweet Pharmacist, Freezing Makes Me Edgy

Question 18

What are key drugs that must be protected from light during administration?

Answer 18

• Phytonadione (Vitamin K; Mephyton)
• Epoprostenol (Flolan)
• Nitroprusside (Nitropress)
• Micafungin (Mycamine)
• Doxycycline

Remember: Protect Every Necessary Med from Daylight

Question 19

Which drugs are easily destroyed if shaken/agitated?

Answer 19

• Albumin
• Alteplase
• Immune globulins
• Insulins
• Monoclonal antibodies
• Rasburicase
• Some vaccines, including zoster

Question 20

In most cases, discoloration of a drug indicates _____ or another type of decomposition

Answer 20

• Oxidation

Question 21

Oxidation of dobutamine turns the solution slightly ____, but potency is not lost

Answer 21

Pink

Question 22

If nitroprusside turns ____, it indicates complete dissociation to cyanide

Answer 22

• Blue

Question 23

Which two IV drugs come as a red solution

Answer 23

Anthracyclines and rifampin

Question 24

Which IV drug comes as a blue solution

Answer 24

Mitoxantrone

Question 25

Physical incompatibilities occur between a drug and:

Answer 25

• The container
• The diluent
• Another drug

Question 26

The majority of PVC containers use ____ as a “plasticizer” to make the plastic bag more flexible

Answer 26

DEHP

Question 27

Why is DEHP dangerous in PVC containers

Answer 27

It’s toxic & can harm the liver and testes if it leaches from the container and into the solution

Question 28

When drugs are put into solution for IV administration in the pharmacy, they are commonly placed in 50 mL or larger IV piggybacks that contain:

Answer 28

5% dextrose or 0.9% sodium chloride

Question 29

Lactated ringers solution contains

Answer 29

Calcium

Question 30

If compounding IV medications packaged in glass ampules, what is used to prevent particulates from entering the IV bag

Answer 30

Filter needles or filter straws