Intravenous Medications Principles

Question 1

What are some common vesicants? (3 classes)

Answer 1

Vesicants - drugs that will start to kill the surrounding tissue if they extravasate

• vasopressors (dopamine, norepinephrine)
• anthracyclines (doxorubicin)
• vinca alkaloids (vincristine, vinblastine)

Question 2

What is the antidote for anthracycline extravasation? What about vincristine extravasation?

Answer 2

Anthracyclines -> Dexrazoxane (Totect) or dimethyl sulfoxide

Vincristine -> hyaluronidase

Question 3

Should you apply a warm or cold compress if extravasation occurs? Any exceptions?

Answer 3

Usually you would use a cold compress

EXCEPT use warm compress with vinca alkaloids and etoposide

Question 4

What two resources can we use to research IV incompatabilities

Answer 4

Trissel’s (The Handbook on Injectable Drugs)

King’s (The King Guide to Parenteral Admixtures

(Lexicomp has all of this too)

Question 5

Which drugs have sorption or leaching issues with PVC? (LATTIN)

Answer 5

Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin (not really clinically significant)
Nitroglycerin

leaching - DEHP goes into the solution (bad because it would inject into the blood)

sorption - drug sticks to or absorbs into the bag

Question 6

which drugs must go into saline (NO dextrose) (ACID APE)

Answer 6

Ampicillin
Caspofungin
Infliximab
Daptomycin

Ampicillin/Sulbactam
Phenytoin
Ertapenem

Question 7

which drugs must do into dextrose (NO saline) (BOAS)

Answer 7

Bactrim
Oxaliplatin
Amphotericin B
Synercid (Quinupristin/dalfopristin)

Question 8

Why can’t ceftriaxone be mixed with calcium-containing solutions?

Answer 8

They can’t be mixed due to risk of precipitates.

LR contains calcium so it CANNOT be mixed with ceftriaxone, including with a Y site

Highest risk in neonates

Question 9

Why can’t calcium and phosphate be mixed together?

Answer 9

Romeo and Juliet

They with precipitate!! and die and kill the patient

There is a way to mix them together when preparing parenteral nutrition though

Question 10

What drugs require a filter? (That’s my GAL, PLAT who’s head is flat)

Answer 10

Golimumab
Amiodarone
Lorazepam (continuous infusion)

Phenytoin (continuous infusion)
Lipids - 1.2 micron
Amphotericin B - 5 micron
Taxanes (except docetaxel)

common filter size is 0.22 microns, but lipids are bigger, so they need a larger filter (1.2 microns)

Question 11

Which IV drugs do not require refrigeration? (Dear Sweet Pharmacist, Marry Me - Forever, Eternally!)

Answer 11

Dexmedetomidine (Precedex)
Sulfamethoxazole/Trimethoprim (Bactrim)
Phenytoin (crystallizes)
Metronidazole
Moxifloxacin
Furosemide (crystallizes)
Enoxaparin

Question 12

What meds need to be protected from light during administration? (Deliver Every Needed Medication Protected)

Answer 12

Doxycycline
Epoprostenol (Flolan)
Micafungin (Mycamine)
Nitroprusside (Nitropress)
Phytonadione (Mephyton, vitamin K)

Question 13

What does it mean if dobutamine turns pink? What does it mean if nitroprusside turns blue and what is the antidote?

Answer 13

Dobutamine turning pink means it was oxidized. BUT you can still use it.

Nitroprusside turning blue indicates nearly complete dissociation to cyanide.
- If the patient has had cyanide poisoning from this, the antidote is Cyanokit

Question 14

What color do these IV drugs come in: anthracyclines, mitoxantrone, rifampin

Answer 14

Anthracyclines: red

Mitoxantrone: blue

Rifampin: red

*Will turn bodily fluids these colors