IV Admixtures

Question 1

IV admixture

Answer 1

preparation of pharmaceutical product which requires the measured addition of a medication to 50 ml+ bag or bottle of IV fluid

Question 2

Spike adapter

Answer 2

goes into the bag

Question 3

Drip chamber

Answer 3

inserted below the spike

Question 4

Orifice

Answer 4

at the bottom of the adapter controls drop size

Question 5

Toller clamp

Answer 5

controls the number of drops per minute

Question 6

IV set sizes

Answer 6

20 drops/mL and 60 drops/mL (micro or mini drop set for the 60 mL)

Question 7

IV pumps

Answer 7

use when precise administration rates or positive pressure is required
Use as mL/hr or mL/min

Question 8

nomogram

Answer 8

gives the rate of flow given the volume, infusion time, and the drops per milliliter delivered by the infusion set

Question 9

High risk patient groups

Answer 9

Renal/liver impairment
Neonates
Elderly/chronically ill
Multiple medications
Oncology patients
Pregnant/breastfeeding mothers

Question 10

Injection into LVP

Answer 10

Be sure that the needle penetrates both the exterior diaphragm and the inside diaphragm.
Ensure that the needle does not puncture the bag.

Question 11

IV compatibility

Answer 11

incompatibility common in:
other electrolytes
mannitol
bicarbonate
nutritional solutions

Question 12

After preparing IV look for:

Answer 12

physical
chemical
therapeutic
microbiological

Question 13

Physical fitness

Answer 13

precipitation
haze
gas bubbles
cloudiness

Question 14

Bad chemistry

Answer 14

Alters the integrity and potency of active ingredients >10% loss
Depends on:
–drug concentration
–pH of solution (want same pH)
–time
–volume of solution used to mix medications/order of mixing
–temperature
–light

Question 15

DEHP

Answer 15

most common phthalate plasticizer in PVC

Question 16

DEHP advantages

Answer 16

flexibility
strength
temperature tolerance
stability
resistance to kinking

Question 17

DEHP disadvantages

Answer 17

leeching
drug incompatibility
risk of harmful exposure for some populations
reproductive toxicity

Question 18

Excel bags

Answer 18

plastic film contains no plasticizers
no leeching
solvent contact layer of rubberized co-polymer of ethylene and propylene
clear, non-toxic, and biologically inert
reduced exposure to toxins,
safer medication delivery
reduced waste (weigh less)

Question 19

Excel bag types

Answer 19

Large volume: comes in 250 mL, 500 mL, and 1000 mL
PAB: 25 mL, 50 mL, 100 mL fill volumes in 100 mL and 150 mL container sizes

Question 20

Heparin

Answer 20

–Dosing is very complex so there are protocols
–Take into account if they are on other anti-coagulants
–Dosing depends on the situation

Question 21

Low molecular weight heparins

Answer 21

–smaller pieces of the heparin molecule that inhibit clotting factor Xa more than factor IIa
–given subQ in a weight-based dose
–high dose=treat thrombic disease, low dose=prevent thrombosis
–dalteparin, enoxaparin, tinzaparin

Question 22

Heparin stability

Answer 22

–very unstable, discard if discolored and discard unused portion after 24 hours
–don’t mix with other drugs
–protect from light with foil or opaque wrap

Question 23

Maximum IV concentration

Answer 23

400 mcg/mL in IV fluids

Question 24

Aminophylline equipment

Answer 24

20cc syringe
22 g 1” needle
60 drops/mL
Very unstable: filled under N2 with pH 8.6-9

Question 25

PK of theophylline affected by

Answer 25

age, smoking, disease, diet , and DDI

Question 26

USP Chapter <797>

Answer 26

is about a quality system and patient safety

Question 27

Aminophylline dosing

Answer 27

Acute bronchospasm: IV by slow injection/infusion
Rate: 25 mg/min or less
Loading dose 5mg/kg, 250-500 mg given IV over 20-30 min by slow injection or infusion
Maintenance dose: 500 mcg/kg/hr