Dosage Exam Two Flashcards
PEG can be used in IV’s up to what concentration?
40% v/v
Ethyl Alcohol can be used in IV’s up to what concentration?
~10% v/v
Why do the concentrations of PEG and Ethyl alcohol that can be used differ?
Their hemolytic potentials
What are the three cosolvents used?
-Ethyl alcohol
-Polyethylene Glycol (PEG)
-Propylene Glycol
What are cosolvents used for?
-Solubilize drugs
-Slow hydrolysis
-Intravenous injection
-IV preparation
What are the two isotonic vehicles?
0.9% NaCl solution (Normal Saline or Saline)
5% Dextrose solution (D5W)
What are the requirements for intra-spinal injections?
-Right potency
-Properly labeled
-Sterile
-No particles
-No pyrogens
-Isotonic**
-No preservatives**
-Physiological pH**
What are the pros to IV’s?
-Rapid
-Straight to blood
-Good for irritant drugs
-Suitable for large volume drugs
What are the cons to IV’s?
-Not forgiving
-Drug must be dissolved
Can sterile water be injected into the blood stream?
NO, never inject plain water into the bloodstream
What does WFI stand for?
Water for injection
What are the qualities of WFI?
-Pyrogen free
-Non-sterile
-Single use, sealed container
What does SWFI stand for?
Sterile water for injection
What are the qualities of SWFI?
-Pyrogen free
-Sterile
-Sealed container, <1000mL
What does BWFI stand for?
Bacteriostatic water for injection
What are the qualities of BWFI?
-Pyrogen free
-Sterile
-Antimicrobial agent
What are vehicles used for?
Vehicles are solvents or mediums used for administration of therapeutic agents
What is the preferred/ most common vehicle?
Water
What is the definition of:
[DRUG] Injection
A liquid preparation that is a drug substance or solution
What is the definition of:
[DRUG] for injection?
A dry solid or liquid preparation that, with the addition of a vehicle, yields a solution that conforms to the requirements for injections
What is the definition of:
[DRUG] Injectable Emulsion?
A liquid preparation of drug substance dissolved or dispersed in an emulsion medium
What is the definition of:
[DRUG] Injectable Suspension?
A liquid preparation of solid suspended in liquid medium
What is the definition of:
[DRUG] for injectable suspension?
A dry solid that, with the addition of a vehicle, yields preparations that conform to the requirements for injecatble suspensions
What does the word “for” mean when describing injectable drugs?
It means you must do something to the drug before you can use it
(cannot be used as-is)
-Most likely needs to be added to a vehicle
What needs to be done to a dry, soluble preparation before it can be used?
It needs to be combined with a solvent
What needs to be done done to a dry, insoluble preparation before it can be used?
It needs to be combined with a vehicle
What needs to be done to a liquid concentrate before it can be used?
It needs to be diluted
What are the four risks associated with having particles in a parenteral product?
-Foreign particles can tirgger an immune response
-Can damage the lungs
-Can damage the kidneys
-Can kill people (septic shock)
What is septicemia?
Infection of blood
What is septic shock?
Acute reaction to bacterial endotoxins
What is a pyrogen?
-AKA bacterial endotoxin
-Contaminant that produces fever (and septic shock)
-Remnants from microorganisms
Does sterilization eliminate pyrogens?
NO
-sterilization leaves dead bodies and parts of microorganisms that act as pyrogens
What does “sterile” mean?
Free of microbial agents
Can straight liquid oil be used as an IV?
NO
Can oil emulsion be used as an IV?
YES
-oil distributed into tiny droplets
Can oil solutions be used for IM injections?
YES
What are preservatives used for?
Multiple dose preparations
What are the three preservatives?
-Benzyl alcohol 0.9% (most common)
-Parabens
-Cresol
What are parabens made of?
Methyl-Parabens 0.18%
Propyl-Parabens 0.02%
Are preservatives affective in oil-based formulas?
No
What are the effects of Polysorbate and PVP on preservatives?
Polysorbate and PVP are excipients that inactivate preservatives
-Polysorbate forms micelles
-PVP has complex-like formations
Preservatives and neonates
DO NOT USE benzyl alcohol in neonates
–can produce gasping syndrome since their respiratory system is not fully developed
-Do not use preparations containing antimicrobial preservatives in neonates period!
Can intra-spinal injections have preservatives?
NO, intra-spinal preparations must be free from antimicrobial preservatives
What are the commonly used buffers?
Citrates
–Safe by IV, irritating if used by IM or SC route
Acetates
Phosphates
–Potentially fatal danger
When giving phosphate and calcium as buffers what should be done?
-Phosphate and calcium have a strong tendency to precipitate and can be fatal
-Therefore they need to be given together in PN preparations
Why are buffers used?
They force the pH to remain at a fixed value
Why do we want buffers as dilute as possible?
So the physiological pH takes over and changes teh solution to physiological pH
What are the common antioxidants?
-Metabisulfite salts
-Bisulfite
-Sulfite
-Ascorbic acid
What are metabisulfite salts used as?
Low pH antioxidants
What are bisulfites used as?
Intermediate pH antioxidants
What are sulfites used as?
High pH antioxidants
What is themost common chelating agent?
Sodium EDTA
What type of glass container should be used to hold parenteral products?
Type I
What is an important piece of information to remember about ampules?
The liquid that comes from an ampule always needs to be filtered since it is a glass container which can cause microparticles of glass to float around
How many drops in the drip chamber will equal 1 mL?
15 drops
When should you use a Luer Lok syringe?
Luer Lok syringes are required when working with hazardous materials
What part of the syringe should you use to read the volume of a medication?
The final edge of the plunger piston
What is the accuracy of a syringe reading for the volume of a medication?
Accuracy is about 1/2 of the smallest division
What is the gauge of a needle?
The diameterof the bore
What do the numbers of gauges mean?
The higher the gauge, the smaller the diameter
Range from 13 to 27
What is the range of lengths a needle can be?
3/8” to 3.5”
What needle should be used with an ampule?
Filter needles
What are three common venous complications?
-Phlebitis
-Thrombosis
-Thrombophlebitis
What is phlebitis?
Inflammation from irritation of the tunica intima (side wall) of the vein
-Takes days to months to subside
-Limits vein availability for further use
What is thrombosis?
Formation of a blood clot (thrombus) in the vein
-Could cause pulmonary embolism if it migrates to the lungs
What is the maximum volume of administration for deltoid muscle?
2 mL
What is the maximum volume of administration for the thigh?
5 mL
What is the maximum volume of administration for gluteal muscle?
5 mL
What is the maximum volume of administration for the subcutaneous route?
1.5 mL
Is absorption slower for the IM or SC route?
The subcutaneous route has slower absorption due to lower vascularization of the tissue
What is infusion by the subcutaneous route called?
hypodermoclysis
Where is an intrathecal injection placed?
In the subarachnoid space and cerebrospinal fluid
Where is an epidural placed?
The space at the thoracic or lumbar level between the dura matter and vertebral canal (epidural space)
Intrathecal info.
-Injected directly into CSF
-Bolus administration
-Higher potency to epidural because they reach directly to brain (does not have to cross dura membrane)
-Continuous administration not recommended
Epidural Info.
-Bolus or continuous administration
-Neonates: done at the caudal level, near tip of tailbone (sacrum) into sacral hiatus
What parenteral routes have an absorption step?
-IM and SC routes have an absorption step
***IV route does not!
Do parenteral routes of administration undergo hepatic first-pass metabolism?
No, they bypass it
True or False: The rules for aseptic technique are more stringent for pharmacy than for surgery.
True
What are the three sources of contamination?
- PEOPLE
- Environment
- Equipment
How can we take care of people contamination?
-Train them
-Garb them
-Have them develop habit-forming skills
-Test them
How can we take care of environment contamination?
-We control it
(ex: air quality standards)
How can we take care of equipment contamination?
-Sanitize it
-Sterilize it
How many particles shed off a person per minute when they are motionless?
100,000
How many particles shed off a person per minute when they move their head, arm, neck, or leg?
500,000 particles
How many particles shed off a person per minute when they also have foot motion?
1,000,000
What does CSP stand for?
Compounded Sterile Product
What does SVP stand for?
Small Volume Parenteral
-IV bag or container with less than or equal to 100mL
What does LVP stand for?
Large Volume Parenteral
-IV bag or container with greater than 100mL
What does PEC stand for?
Primary Engineering Control
-Sterile hood that provides ISO 5 air for compounding
What does LAFW stand for?
Laminar Airflow Workbench
-Type of sterile hood, parallel air streams flow in one direction
What does laminar flow mean?
The streamline flow of a fluid where the fluid moves in layers without turbulence
(this occurs at low air velocities about 100 ft/min)
What does ISO Class 5 mean?
No more than 100 particles are allowed (more than 0.5 microns per cubic foot)
-HEPA filtered
What flow hood is used for hazardous drugs?
Vertical flow hood must be used so that hazardous substances are not blown onto person working
What is the critical site?
Anywhere where contamination or microorganisms could enter a parenteral product during compounding
What is the critical area?
Space between the HEPA filter and the critical site
-Must keep first air in this space
What is the direct compounding area (DCA)?
Area within the LAFW where critical sites are exposed to HEPA filtered air
True or False: The laminar flow hood is a sterile environment.
False
-It is just very clean which allows us to maintain the sterility of the products
What is osmolality?
The concentration of particles dissolved in solution
What is isotonicity?
Maintaining and possessing a uniform tension or tone
What membrane is required for diffusion to occur?
Permeable membrane
What membrane is required for osmosis to occur?
Semipermeable membrane
What type of membrane is found in living cells?
Semipermeable membrane
***only water can go through, the solutes are stuck in the cell
What are colligative properties?
Properties of solutions that depend on the quantity of “molecular particles” in the solution rather than the chemical nature of the dissolved materials
-This is not dependent on what type of solute is added, only the amount and the type of solvent
How are osmolarity and osmolality determined?
By the total concentration of solutes dissolved (m-particles)
–Includes the drug
What does tonicity refer to?
The effect on living cells
What does iso-osmotic mean?
Two solutions give the same osmolarity value (same concentration of particles)
What is isotonic?
compatible with living cells
What is the relationship between iso-osmotic and isotonic?
A solution that is isotonic is also iso-osmotic but not necessarily the other way around
Are D5W and Normal Saline interchangeable?
They are not always interchangeable!
–always check the monograph or package insert
(for some products they are but not always)
What is a hyperosmotic solution?
An iso-osmotic solution used to dissolve a large amount of drug
Which is worse, a hyperosmotic solution or a hypo-osmotic solution?
-Iso-osmolarity is preferred but slight hyperosmolarity is ok
—Hypo-osmotic solutions are worse than hyperosmotic
When is the ADD-Vantage system used?
When solids need to get reconstituted into liquid
Macrodrip
-Delivers large quantities of drug at faster rates
10,15, or 20 gtt/mL
Microdrip
-Delivers small quantities of drugs
-For pediatrics or patients who need closely regulated or small amounts of IV solution
60gtt/mL
Why are overages needed?
Some liquid will always be left behind in a container
What are the reasons for central venous therapy?
-Infusion of large volume of liquid
-Multiple infusions
-Long-term infusion therapy
-Infusion of irritating medications (like potassium)
-Infusion of high osmolarity fluids
-Parenteral nutrition (PN)
What does PICC stand for?
Peripherally Inserted Central Catheter
What are lumens?
The different lines that attach to a catheter
What are the two types of central lines?
-Hickman
-Broviac
What type of central line is the Dacron Cuff a part of?
Hickman
What does VAP stand for?
Vascular Access Port
How do controllers work?
Use gravity as driving force to deliver IV
How do pumps work?
Powered devices deliver IV
What is the pressure range associated with infusion pumps?
2-12 psi
Temporal Drug Delivery
-Sustained Release
-Pulsatile Release
Spatial Drug Delivery
-Systemic
-Local
-Targeted
What are the two diffusion-controlled systems?
-Reservoir Devices
-Matrix Systems
What is the rate-limiting step of diffusion-controlled systems?
Drug diffusion through the polymer network
