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MD3001 > Intravenous Drug Administration > Flashcards

Intravenous Drug Administration Flashcards

1
Q

List the 5 ‘rights’ of medicine administration.

A 
Right patient
Right medicine
Right route
Right dose
Right time
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2
Q

List reasons for IV administration.

A

Rapid onset
When a patient can’t swallow or can’t take medicine via any other route
Greater percentage uptake
Medicine might not be available in another form

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3
Q

What are the disadvantages of IV administration?

A 
Increased cost and time to administer
Trained staff required
Rapid onset can also be a disadvantage
Volume of fluid needed to dilute the medicine (e.g. in a severely hypertensive patient)
Discomfort/pain
Health risk (e.g. infection)
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4
Q

There are 3 major types of intravenous device - can you name them?

A

Peripheral venous catheters
Central venous catheters (CVCs) (peripherally inserted or skin tunnelled CVCs)
Arterial catheters

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5
Q

What is a bolus injection and when is it used?

A

A method of administering unstable drugs intravenously or when a rapid response is required

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6
Q

What is the difference between continuous infusion and intermittent infusion?

A 
Continuous:
- stable drugs
- short half life
- time dependant effects
- needs dedicated IV site
Intermittent:
- unstable drugs
- long half life
- concentration dependant effects
- fewer compatibility concerns
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7
Q

Name some environmental factors that affect the stability of drugs.

A

Light
pH
Temperature
Concentration

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8
Q

What is bioavailability?

A

The fraction of unchanged drug that reaches the systemic circulation - IV is therefore 100%

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9
Q

What is the difference between infusion vs repeated injections?

A

Infusion - constant build up of blood plasma drug concentration to a peak (around day 4)
Repeat injections - peaks and troughs as administration of drug is carried out. Again, levels out at a plateau, around which the plasma concentration of drug fluctuates

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10
Q

What is clearance?

A

The volume of blood or plasma cleared of drug in a unit time, e.g. 10ml/min (think glitter bathtub)

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11
Q

What happens to the drug half life if clearance increases?

A

Decreases - inverse relationship

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12
Q

What does the steady state plasma concentration of drug depend on?

A

Rate of drug in and rate of drug clearance from the plasma

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13
Q

What are a few of the complications that can be associated with IV drug administrations?

A 
Fear/phobia/pain
Infection/Sepsis
Thrombophlebitis
Extravasation/Infiltration
Emboli
Anaphylaxis/Hypersensitivity
Overdose
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14
Q

What is thrombophlebitis?

A

Inflammation of a vein wall associated with thrombosis

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15
Q

What is red man syndrome and what chemical release causes its appearance?

A

Hypersensitivity reaction due to histamine release

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16
Q

List some symptoms of red man syndrome.

A

Erythematous rash of face, neck, and upper torso
Diffuse burning
Itching
Generalised discomfort

17
Q

What are red man symptoms in rare cases?

A

Hypotension
Angioedema
Chest pain
Dyspnea

18
Q

What is the drug used for both red man syndrome, but also MRSA?

A

Vancomycin

19
Q

If administered in the wrong way, vancomycin can cause hypertension…what is the correct administration procedure used to reduce this risk of hypertension?

A

Regulated concentrations of vancomycin, administered slowly.

20
Q

Describe what the shape of a plasma drug concentration vs time graph would look like for intravenous drug continuous infusion.

A

Linear increase at the beginning, eventually plateauing as more drug is eliminated, until it reaches a point where infusion = elimination, hence a flat, horizontal line. After all the drug has been infused, the plasma concentration plunges and the line descends steeply, finally levelling out to become horizontal at a plasma drug concentration of 0

21
Q

What does the time taken to reach the plasma steady state concentration depend on?

A

The drug’s half life

22
Q

What can be the result of incorrect vancomycin administration?

A

Hypertension

23
Q

What dosage of vancomycin should be administered for a patient under 40kgs?

A

750mg

24
Q

How much of what solution should vancomycin be mixed with for a patient under 40kgs?

A

0.9% NaCl
OR
5% glucose

250ml

25
Q

What dosage (including solution) of vancomycin should be administered for a patient between 40 and 59kgs?

A

1000mg vancomycin

In 250ml solution

26
Q

What dosage (including solution) of vancomycin should be administered for a patient between 60 and 90kgs?

A

1500mg

In 500ml solution

27
Q

What dosage (including solution) of vancomycin should be administered for a patient over 90kgs?

A

2000mg

In 500ml solution

28
Q

For how long should the vancomycin drug solution be infused in a patient over 90kgs?

A

4 hours

29
Q

For how long should the vancomycin drug solution be infused in a patient between 40 and 59kgs?

A

2 hours

30
Q

For how long should the vancomycin drug solution be infused in a patient under 40kgs?

A

1.5 hours

31
Q

For how long should the vancomycin drug solution be infused in a patient between 60 and 90kgs?

A

3 hours

32
Q

What is the ‘steady state’ and how is this represented on a graph?

A

Rate of drug input = rate of drug output (elimination)

Plateau on graph of plasma drug conc vs time

33
Q

How does clearance differ from amount of drug eliminated per unit time?

A

Clarence is a constant - per unit volume rather than time

34
Q

–>

A

If clearance is at 10ml/min:

100ml –> 100ml –> 100ml –> 100ml
100mg -> 90mg –> 81mg —> 72.9mg
0mins –> 1min —-> 2mins –> 3mins

10mg —> 9mg —-> 8.1mg —> 7.29mg (drug eliminated)

35
Q

What is the relationship between IV bolus and IV infusion?

A

They are opposites of each other: IV bolus starts high, decreases rapidly, then plateaus out at 0; IV infusion starts low, increases rapidly, then plateaus out at 100
As clearance increases, drug half life decreases

36
Q

How is half life of a drug calculated?

A

( ln(2) x Vd (volume of distribution) ) / clearance

MD3001 (63 decks)

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