Intravenous Medication Principles

Question 1

Name the vesicants that must be used via central line to prevent extravasation.

Answer 1

Vasopressors (DOPA & NE)
Anthracyclines (Doxorubicin)
Vinca Alkaloids (Vincristine & Vinblastine)
Digoxin

Question 2

Incompatibilities references (primary resources)

Answer 2

1. The Handbook of Injectable Drugs “Trissel’s”
2. King Guide to Parenteral Admixtures “King’s”
3. Package Insert

Question 3

Chemical incompatibility causes drug degradation or toxicity due to what reasons?

Answer 3

Hydrolysis
Oxidation
Decomposition

Question 4

Drugs that can ONLY be mixed with NS (Saline)

Answer 4

A - ampicillin
D - daptomycin (Cubicin)
I - infliximab (Remicade)
A - ampicillin/sulbactam (Unasyn)
C - caspofungin (Cancidas)
E - ertapenem (Invanz)
P - phenytoin (Dilantin)

A DIAbetic Can’t Eat Pie (NO DEXTROSE)

Question 5

Drugs that can ONLY be mixed with dextrose

Answer 5

Oxaliplatin
Bactrim
Amphotericin B (all)
Synercid (quinupristin/dalfopristin)

Outrageous Bakers Avoid Salt (NO SALINE)

Question 6

Drugs that have sorption or leaching issues with PVC

Answer 6

Lorazepam
Amiodarone
Tacrolimus
Taxanes 
Insulin
Nitroglycerin

Leach Absorbs To Take In Nutrients

Question 7

What medications canNOT be mixed with calcium?

High-Risk Compatibility -
risk of precipitates –> emboli –> fatality

Answer 7

Ceftriaxone
Phosphate

**Remember: Lactated Ringers (contains calcium)

Question 8

What drug requires filter needles or filter straws when compounding IV medications?

Answer 8

Golimumab (Simponi)
Amiodarone
Lorazepam

Phenytoin
Lipids - 1.2 micron filter
Amphotericin B
Taxanes (except docetaxel)

GAL PLAT

Question 9

Name the IV drugs that should NOT be refrigerated.

Answer 9

dexmedetomidine (Precedex)
smx/tmp (Bactrim)
phenytoin - crystallizes
furosemide - crystallizes
metronidazole 
moxifloxacin (Avelox)
enoxaparin (Lovenox)

**Dear Sweet Pharmacist, Freezing Makes Me Edgy!”

Question 10

Name the IV drugs that should BE protected from light during administration.

Answer 10

phytonadione (Vit K; Mephyton)
epoprostenol (Folan)
nitroprusside (Nitropress)
micafungin (Mycamine)
doxycycline 

Protect Every Necessary Med from Daylight

Question 11

What drugs are easily destroyed if shaken?

Answer 11

albumin
alteplase
immune globulins
insulin
MAbs
rasburicase
some vaccines**

Question 12

When Synercid and Enbrel forms a foam after being mixed, what should the patient do?

Answer 12

Allow the foam to dissolve and then administer.

Question 13

What drug, when oxidized turns pink? blue?

Answer 13

Pink: Dobutamine

Blue: Nitroprusside

Question 14

Name the IV drugs that comes as color solutions (i.e., not clear)

Answer 14

Anthracycline (doxorubicin) - RED
Rifampin - RED
Mitoxantrone - BLUE

MTX - YELLOW
Multivitamins for infusion - YELLOW