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Dosage Exams > Dosage Exam Two > Flashcards

Dosage Exam Two Flashcards

1
Q

PEG can be used in IV’s up to what concentration?

A

40% v/v

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2
Q

Ethyl Alcohol can be used in IV’s up to what concentration?

A

~10% v/v

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3
Q

Why do the concentrations of PEG and Ethyl alcohol that can be used differ?

A

Their hemolytic potentials

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4
Q

What are the three cosolvents used?

A

-Ethyl alcohol
-Polyethylene Glycol (PEG)
-Propylene Glycol

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5
Q

What are cosolvents used for?

A

-Solubilize drugs
-Slow hydrolysis
-Intravenous injection
-IV preparation

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6
Q

What are the two isotonic vehicles?

A

0.9% NaCl solution (Normal Saline or Saline)

5% Dextrose solution (D5W)

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7
Q

What are the requirements for intra-spinal injections?

A

-Right potency
-Properly labeled
-Sterile
-No particles
-No pyrogens
-Isotonic**
-No preservatives**
-Physiological pH**

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8
Q

What are the pros to IV’s?

A

-Rapid
-Straight to blood
-Good for irritant drugs
-Suitable for large volume drugs

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9
Q

What are the cons to IV’s?

A

-Not forgiving
-Drug must be dissolved

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10
Q

Can sterile water be injected into the blood stream?

A

NO, never inject plain water into the bloodstream

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11
Q

What does WFI stand for?

A

Water for injection

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12
Q

What are the qualities of WFI?

A

-Pyrogen free
-Non-sterile
-Single use, sealed container

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13
Q

What does SWFI stand for?

A

Sterile water for injection

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14
Q

What are the qualities of SWFI?

A

-Pyrogen free
-Sterile
-Sealed container, <1000mL

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15
Q

What does BWFI stand for?

A

Bacteriostatic water for injection

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16
Q

What are the qualities of BWFI?

A

-Pyrogen free
-Sterile
-Antimicrobial agent

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17
Q

What are vehicles used for?

A

Vehicles are solvents or mediums used for administration of therapeutic agents

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18
Q

What is the preferred/ most common vehicle?

A

Water

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19
Q

What is the definition of:
[DRUG] Injection

A

A liquid preparation that is a drug substance or solution

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20
Q

What is the definition of:
[DRUG] for injection?

A

A dry solid or liquid preparation that, with the addition of a vehicle, yields a solution that conforms to the requirements for injections

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21
Q

What is the definition of:
[DRUG] Injectable Emulsion?

A

A liquid preparation of drug substance dissolved or dispersed in an emulsion medium

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22
Q

What is the definition of:
[DRUG] Injectable Suspension?

A

A liquid preparation of solid suspended in liquid medium

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23
Q

What is the definition of:
[DRUG] for injectable suspension?

A

A dry solid that, with the addition of a vehicle, yields preparations that conform to the requirements for injecatble suspensions

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24
Q

What does the word “for” mean when describing injectable drugs?

A

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

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25
Q

What needs to be done to a dry, soluble preparation before it can be used?

A

It needs to be combined with a solvent

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26
Q

What needs to be done done to a dry, insoluble preparation before it can be used?

A

It needs to be combined with a vehicle

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27
Q

What needs to be done to a liquid concentrate before it can be used?

A

It needs to be diluted

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28
Q

What are the four risks associated with having particles in a parenteral product?

A

-Foreign particles can tirgger an immune response
-Can damage the lungs
-Can damage the kidneys
-Can kill people (septic shock)

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29
Q

What is septicemia?

A

Infection of blood

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30
Q

What is septic shock?

A

Acute reaction to bacterial endotoxins

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31
Q

What is a pyrogen?

A

-AKA bacterial endotoxin
-Contaminant that produces fever (and septic shock)
-Remnants from microorganisms

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32
Q

Does sterilization eliminate pyrogens?

A

NO
-sterilization leaves dead bodies and parts of microorganisms that act as pyrogens

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33
Q

What does “sterile” mean?

A

Free of microbial agents

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34
Q

Can straight liquid oil be used as an IV?

A

NO

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35
Q

Can oil emulsion be used as an IV?

A

YES
-oil distributed into tiny droplets

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36
Q

Can oil solutions be used for IM injections?

A

YES

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37
Q

What are preservatives used for?

A

Multiple dose preparations

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38
Q

What are the three preservatives?

A

-Benzyl alcohol 0.9% (most common)
-Parabens
-Cresol

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39
Q

What are parabens made of?

A

Methyl-Parabens 0.18%
Propyl-Parabens 0.02%

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40
Q

Are preservatives affective in oil-based formulas?

A

No

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41
Q

What are the effects of Polysorbate and PVP on preservatives?

A

Polysorbate and PVP are excipients that inactivate preservatives

-Polysorbate forms micelles
-PVP has complex-like formations

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42
Q

Preservatives and neonates

A

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!

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43
Q

Can intra-spinal injections have preservatives?

A

NO, intra-spinal preparations must be free from antimicrobial preservatives

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44
Q

What are the commonly used buffers?

A

Citrates
–Safe by IV, irritating if used by IM or SC route

Acetates

Phosphates
–Potentially fatal danger

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45
Q

When giving phosphate and calcium as buffers what should be done?

A

-Phosphate and calcium have a strong tendency to precipitate and can be fatal
-Therefore they need to be given together in PN preparations

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46
Q

Why are buffers used?

A

They force the pH to remain at a fixed value

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47
Q

Why do we want buffers as dilute as possible?

A

So the physiological pH takes over and changes teh solution to physiological pH

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48
Q

What are the common antioxidants?

A

-Metabisulfite salts
-Bisulfite
-Sulfite
-Ascorbic acid

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49
Q

What are metabisulfite salts used as?

A

Low pH antioxidants

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50
Q

What are bisulfites used as?

A

Intermediate pH antioxidants

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51
Q

What are sulfites used as?

A

High pH antioxidants

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52
Q

What is themost common chelating agent?

A

Sodium EDTA

53
Q

What type of glass container should be used to hold parenteral products?

A

Type I

54
Q

What is an important piece of information to remember about ampules?

A

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

55
Q

How many drops in the drip chamber will equal 1 mL?

A

15 drops

56
Q

When should you use a Luer Lok syringe?

A

Luer Lok syringes are required when working with hazardous materials

57
Q

What part of the syringe should you use to read the volume of a medication?

A

The final edge of the plunger piston

58
Q

What is the accuracy of a syringe reading for the volume of a medication?

A

Accuracy is about 1/2 of the smallest division

59
Q

What is the gauge of a needle?

A

The diameterof the bore

60
Q

What do the numbers of gauges mean?

A

The higher the gauge, the smaller the diameter

Range from 13 to 27

61
Q

What is the range of lengths a needle can be?

A

3/8” to 3.5”

62
Q

What needle should be used with an ampule?

A

Filter needles

63
Q

What are three common venous complications?

A

-Phlebitis
-Thrombosis
-Thrombophlebitis

64
Q

What is phlebitis?

A

Inflammation from irritation of the tunica intima (side wall) of the vein
-Takes days to months to subside
-Limits vein availability for further use

65
Q

What is thrombosis?

A

Formation of a blood clot (thrombus) in the vein
-Could cause pulmonary embolism if it migrates to the lungs

66
Q

What is the maximum volume of administration for deltoid muscle?

A

2 mL

67
Q

What is the maximum volume of administration for the thigh?

A

5 mL

68
Q

What is the maximum volume of administration for gluteal muscle?

A

5 mL

69
Q

What is the maximum volume of administration for the subcutaneous route?

A

1.5 mL

70
Q

Is absorption slower for the IM or SC route?

A

The subcutaneous route has slower absorption due to lower vascularization of the tissue

71
Q

What is infusion by the subcutaneous route called?

A

hypodermoclysis

72
Q

Where is an intrathecal injection placed?

A

In the subarachnoid space and cerebrospinal fluid

73
Q

Where is an epidural placed?

A

The space at the thoracic or lumbar level between the dura matter and vertebral canal (epidural space)

74
Q

Intrathecal info.

A

-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

75
Q

Epidural Info.

A

-Bolus or continuous administration
-Neonates: done at the caudal level, near tip of tailbone (sacrum) into sacral hiatus

76
Q

What parenteral routes have an absorption step?

A

-IM and SC routes have an absorption step

***IV route does not!

77
Q

Do parenteral routes of administration undergo hepatic first-pass metabolism?

A

No, they bypass it

78
Q

True or False: The rules for aseptic technique are more stringent for pharmacy than for surgery.

A

True

79
Q

What are the three sources of contamination?

A
  1. PEOPLE
  2. Environment
  3. Equipment
80
Q

How can we take care of people contamination?

A

-Train them
-Garb them
-Have them develop habit-forming skills
-Test them

81
Q

How can we take care of environment contamination?

A

-We control it
(ex: air quality standards)

82
Q

How can we take care of equipment contamination?

A

-Sanitize it
-Sterilize it

83
Q

How many particles shed off a person per minute when they are motionless?

A

100,000

84
Q

How many particles shed off a person per minute when they move their head, arm, neck, or leg?

A

500,000 particles

85
Q

How many particles shed off a person per minute when they also have foot motion?

A

1,000,000

86
Q

What does CSP stand for?

A

Compounded Sterile Product

87
Q

What does SVP stand for?

A

Small Volume Parenteral

-IV bag or container with less than or equal to 100mL

88
Q

What does LVP stand for?

A

Large Volume Parenteral

-IV bag or container with greater than 100mL

89
Q

What does PEC stand for?

A

Primary Engineering Control

-Sterile hood that provides ISO 5 air for compounding

90
Q

What does LAFW stand for?

A

Laminar Airflow Workbench

-Type of sterile hood, parallel air streams flow in one direction

91
Q

What does laminar flow mean?

A

The streamline flow of a fluid where the fluid moves in layers without turbulence
(this occurs at low air velocities about 100 ft/min)

92
Q

What does ISO Class 5 mean?

A

No more than 100 particles are allowed (more than 0.5 microns per cubic foot)

-HEPA filtered

93
Q

What flow hood is used for hazardous drugs?

A

Vertical flow hood must be used so that hazardous substances are not blown onto person working

94
Q

What is the critical site?

A

Anywhere where contamination or microorganisms could enter a parenteral product during compounding

95
Q

What is the critical area?

A

Space between the HEPA filter and the critical site
-Must keep first air in this space

96
Q

What is the direct compounding area (DCA)?

A

Area within the LAFW where critical sites are exposed to HEPA filtered air

97
Q

True or False: The laminar flow hood is a sterile environment.

A

False
-It is just very clean which allows us to maintain the sterility of the products

98
Q

What is osmolality?

A

The concentration of particles dissolved in solution

99
Q

What is isotonicity?

A

Maintaining and possessing a uniform tension or tone

100
Q

What membrane is required for diffusion to occur?

A

Permeable membrane

101
Q

What membrane is required for osmosis to occur?

A

Semipermeable membrane

102
Q

What type of membrane is found in living cells?

A

Semipermeable membrane

***only water can go through, the solutes are stuck in the cell

103
Q

What are colligative properties?

A

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

104
Q

How are osmolarity and osmolality determined?

A

By the total concentration of solutes dissolved (m-particles)
–Includes the drug

105
Q

What does tonicity refer to?

A

The effect on living cells

106
Q

What does iso-osmotic mean?

A

Two solutions give the same osmolarity value (same concentration of particles)

107
Q

What is isotonic?

A

compatible with living cells

108
Q

What is the relationship between iso-osmotic and isotonic?

A

A solution that is isotonic is also iso-osmotic but not necessarily the other way around

109
Q

Are D5W and Normal Saline interchangeable?

A

They are not always interchangeable!
–always check the monograph or package insert
(for some products they are but not always)

110
Q

What is a hyperosmotic solution?

A

An iso-osmotic solution used to dissolve a large amount of drug

111
Q

Which is worse, a hyperosmotic solution or a hypo-osmotic solution?

A

-Iso-osmolarity is preferred but slight hyperosmolarity is ok

—Hypo-osmotic solutions are worse than hyperosmotic

112
Q

When is the ADD-Vantage system used?

A

When solids need to get reconstituted into liquid

113
Q

Macrodrip

A

-Delivers large quantities of drug at faster rates

10,15, or 20 gtt/mL

114
Q

Microdrip

A

-Delivers small quantities of drugs
-For pediatrics or patients who need closely regulated or small amounts of IV solution

60gtt/mL

115
Q

Why are overages needed?

A

Some liquid will always be left behind in a container

116
Q

What are the reasons for central venous therapy?

A

-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)

117
Q

What does PICC stand for?

A

Peripherally Inserted Central Catheter

118
Q

What are lumens?

A

The different lines that attach to a catheter

119
Q

What are the two types of central lines?

A

-Hickman
-Broviac

120
Q

What type of central line is the Dacron Cuff a part of?

A

Hickman

121
Q

What does VAP stand for?

A

Vascular Access Port

122
Q

How do controllers work?

A

Use gravity as driving force to deliver IV

123
Q

How do pumps work?

A

Powered devices deliver IV

124
Q

What is the pressure range associated with infusion pumps?

A

2-12 psi

125
Q

Temporal Drug Delivery

A

-Sustained Release
-Pulsatile Release

126
Q

Spatial Drug Delivery

A

-Systemic
-Local
-Targeted

127
Q

What are the two diffusion-controlled systems?

A

-Reservoir Devices
-Matrix Systems

128
Q

What is the rate-limiting step of diffusion-controlled systems?

A

Drug diffusion through the polymer network

Dosage Exams (2 decks)

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