Intravenous Medication Principles Flashcards
what drug makes intrathecal CI
vincristine
makes intrathecal fatal
types of parenteral drug administration
IV
IM
SQ
venous catheter
catheter inside of vein
for fluid and drug delivery
“line”
peripheral venous catheter
inserted into smaller veins
what vein is often used for peripheral venous catheter
cephalic vein in arm
phlebitis
vein irritation
thrombosis
clots
fluid extravasation
catheter dislodged from vein; infusion contents enter surrounding tissue
central line
empties into larger vein (superior vena cava, etc.)
used for highly concentrated drugs, long-term antibiotics, vesicants, pH/osmolality not close to blood (parenteral nutrition)
parenterally inserted central catheters (PICCs)
inserted into peripheral vein until tip ends in superior vena cava
vesicants
cause severe damage if catheter tip comes out of vein
vasopressors (dopamine, NE)
anthracyclines (doxorubicin)
vinca alkaloids (vincristine, vinblastine)
promethazine
severe tissue injury
do not give to children <2 yrs
incompatible
unsuitable to be given together
resources: Handbook on Injectable Drugs (Trissel’s); King Guide to Parenteral Admixtures; package insert
chemical incompatibility
hydrolysis, oxidation, decomposition causes degradation/toxicity
physical incompatibility
between drug and container, diluent, or another drug
what incompatibility can come from container
DEHP from PVC containers; leach from container into solution
replace PVC containers with polyolefin, polypropylene, or glass
drugs with leaching/absorption/absorption issues with PVC containers
Leach Absorbed To Take In Nutrients
Lorazepam
Amiodarone
Tacrolimus
Taxanes (paclitaxel; exception - Abraxane which is Paclitaxel-albumin bound)
Insulin
Nitroglycerin
Diluent incompatibility
cannot be put in 5% dextrose of NS
drugs that have diluent incompatibility and need SALINE
A DIAbetic Can’t Eat Pie
Ampicillin
Daptomycin
Infliximab
Ampicillin/Sulbactam
Caspofungin
Ertapenem
Phenytoin
Others: abatacept, azacitidine, belimumab, bevacizumab, idarucizumab, iron sucrose, sodium ferric gluconate, natalizumab, trastuzumab
drugs that have diluent incompatibility and need DEXTROSE
Outrageous Bakers Avoid Salt
Oxaliplatin
Bactrim
Amphotericin B
Synercid
Others: Caarfilzomib, mycophenolate, pentamidine
High-risk incompatibilities
ceftriaxone with calcium-containing solutions (precipitations) - LR has calcium
calcium and phosphate - precipitates
filter size when needed
usually 0.22 micron filter
1.2 micron used for lipids
filter size used for parenteral
0.22 micron
common drugs with filter requirements
that’s my GAL, PLAT
Golimumab
amiodarone
lorazepam (not for IV push)
phenytoin (not for IV push)
lipids-12 micron
amphotericin B (use 5 micron)
taxanes (not docetaxel)
drug with time in solution issue
pip-tazo (Zosyn) extended infusion
Drugs that are DO NOT REFRIGERATE
Dear Sweet Pharmacist, Freezing Makes Me Edge
Dexmedetomidine
Sulfamethoxazole/Trimethoprim
Phenytoin - crystallizes
Furosemide - crystallizes
Metronidazole
Moxifloxacin
Enoxaparin
drugs that are PROTECT FROM LIGHT
Protect Every Necessary Med from Daylight
Phytonadione (vit K; Mesphyton)
Epoprostenol
Nitroprusside
Micafungin
Doxycycline
DO NOT SHAKE
hormones/other proteins
blood products (albumin/immune globulins, mabs)/proteins (insulin)
foam: alteplase, etanercept, rasburicase (swirl)
vaccines that have been reconstituted
color change
shows oxidation or another decomposition
dobutamine: oxidation turns pink, potency not lost
nitroprusside (blue shows nearly complete dissociation to cyanide)
anthracyclines color
red
rifampin color
red
mitoxantrone
blue
what to do about particulates
discard
