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Pharmacy Foundations Pt. 1 > IV Medication Principles > Flashcards

IV Medication Principles Flashcards

1
Q

Central lines are required for administration of…

A
  • highly concentrated drugs (e.g., potassium chloride > 20 mEq/100 mL)
  • long-term antibiotics (e.g., to treat osteomyelitis)
  • toxic drugs that would cause severe phlebitis or tissue damage (e.g., chemotherapy, especially with vesicants) if given peripherally
  • drugs with a pH or osmolality that is not close to blood pH or osmolality (e.g., parenteral nutrition)
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2
Q

advantage of PICC line to a direct central line

A

It is simpler to insert a peripherally inserted central catheter (PICC) line than a direct central line.
- can be inserted at the bedside & a quick X-ray will confirm that the tip reached the right location

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3
Q

Vesicants are preferentially administered through a central line because the line is less likely to become dislodged from the vein. Vesicants include…

A
  • vasopressors (e.g., dopamine, norepinephrine)
  • anthracyclines (e.g., doxorubicin)
  • vinca alkaloids (e.g., vincristine, vinblastine)
  • digoxin, foscarnet, nafcillin, mannitol, mitomycin
  • promethazine
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4
Q

risk of promethazine

A

Promethazine can cause severe tissue injury!
- Some hospitals have removed it from formulary due to this risk
- IM is preferred, but this also has a risk for tissue injury; intra-arterial or SC routes should not be used.
- Do NOT give to children < 2 years
- If using IV -> dilute the drug, limit the dose, & monitor patient

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5
Q

types of incompatibilities

A

Chemical incompatibility causes drug degradation or toxicity due to a hydrolysis, oxidation, or decomposition reaction.

Physical incompatibilities occur between a drug & one of the following:
- the container (e.g., polyvinyl chloride containers)
- the diluent (solution)
- another drug

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6
Q

What can leach from PVC containers into the solution?

A

The majority of polyvinyl chloride (PVC) containers use diethylhexyl phthalate (DEHP) as a “plasticizer” to make the plastic bag more flexible
- DEHP can leach from the container into the solution
- DEHP is toxic & can harm the liver and testes

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7
Q

Drugs with leaching/adsorption/absorption issues with PVC containers (remember acronym)

A

Leach Absorbs To Take In Nutrients (or LATIN)
- Lorazepam
- Amiodarone
- Tacrolimus
- Taxanes*
- Insulin
- Nitroglycerin
*Exception: paclitaxel-albumin bound (Abraxane) can be placed into PVC

Others: carmustine, cyclosporine, ixabepilone, sufentanil, temsirolimus

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8
Q

When drugs are diluted in solution for IV administration, they are commonly placed into a small volume (e.g., 100 mL or less) IV bag that contains ______________ or 0.9% ______________.

A

5% dextrose (D5W) or 0.9% sodium chloride (normal saline, NS)

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9
Q

Drugs that should be placed in saline (NO dextrose) remember acronym

A

A DIAbetic Can’t Eat Pie
- Ampicillin
- Daptomycin (Cubicin)
- Infliximab (Remicade)
- Ampicillin/Sulbactam (Unasyn)
- Caspofungin (Cancidas)
- Ertapenem (Invanz)
- Phenytoin (Dilantin)

Others: abatacept, azacitidine, belimumab, bevacizumab, idarucizumab, iron sucrose, ferric gluconate, natalizumab, trastuzumab

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10
Q

Drugs that should be placed in dextrose (NO saline) remember acronym

A

Outrageous Bakers Avoid Salt
- Oxaliplatin
- Bactrim (SMX/TMP)
- Amphotericin B (all)
- Synercid (Quinupristin/Dalfopristin)

Others: carfilzomib, mycophenolate, pentamidine

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11
Q

Ceftriaxone cannot be mixed with…

A

any calcium-containing solutions due to risk of precipitates
- Lactated Ringer’s contains calcium & cannot be mixed with ceftriaxone, including Y-site admin!
- This combo must be avoided in all age groups (but neonates have highest risk for lethal effects)

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12
Q

What two electrolytes can form a deadly precipitate in IV fluids?

A

Calcium & phosphate can form a deadly precipitate in IV fluids
- When calcium & phosphate are both put into parenteral nutrition, methods must be used to reduce the risk of a precipitate

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13
Q

primary resources for drug-drug incompatibility (mixing at the Y-site, mixing drugs in the same container, etc.)

A
  • ASHP Injectable Drug Information
  • Trissel’s 2 Clinical Pharmaceutics Database
  • King Guide to Parenteral Admixtures
  • The drug’s package insert
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14
Q

The majority of drugs in which filters are necessary use a ___________.

A

0.22 micron filter

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15
Q

What filter size is used for parenteral nutrition to catch calcium-phosphate particulates & injectable lipid emulsions?

A

1.2 micron

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16
Q

Common drugs with filter requirements (remember acronym)

A

my GAL Is PAT who has a MaP
- Golimumab
- Amphotericin B (lipid formulations)*
- Lipids-1.2 micron
- Isavuconazonium
- Phenytoin**
- Amiodarone
- Taxanes (cabazitaxel & paclitaxel)
- Mannitol 20% (& higher concs)
- Parenteral nutrition-1.2 micron
*Larger pore size filter required; prepare using a 5-micron filter
**Phenytoin requires a filter when administered by continuous infusion; a filter is not required for IV push

Others: abatacept, albumin (select products), infliximab

17
Q

medications that cannot be refrigerated (remember acronym)

A

Dear Sweet Pharmacist, Freezing Makes Me Edgy!
- Dexmedetomidine*
- Sulfamethoxazole/Trimethprim
- Phenytoin: crystallizes
- Furosemide: crystallizes
- Metronizaole
- Moxifloxacin
- Enoxaparin
*Optional: diluted dexmedetomidine & furosemide can be kept cold

Others: acetaminophen, acyclovir (crystallizes), deferoxamine (precipitates), levetiracetam, pentamidine (crystallizes), valproate

18
Q

Medications that need to be protected from light during administration (think of acronym)

A

Protect Every Necessary Med from Daylight
- Phytonadione (vitamin K)
- Epoprostenol
- Nitroprusside
- Micafungin
- Doxycycline

Others: Amphotericin B, Deoxycholate, Anthracyclines, Dacarbazine (if extravasates, protect exposed tissues from light), Pentamidine

19
Q

Agitation destroys some drugs, including hormones & other proteins. Drugs that are easily destroyed/damaged should not be shaken during compounding or transport, & cannot be transported via pneumatic tube systems!
Examples include:

A
  • Protein/blood products, such as albumin, immune globulins, monoclonal antibodies, & insulins (note: some manufacturers allow insulin to be transported via pneumatic tube one time)
  • Products that foam, such as alteplase, etanercept (Enbrel), rasburicase, quinupristin/dalfopristin (Synercid), or caspofungin (should only be swirled when reconstituting -> do not shake; wait for foam to dissolve)
  • Vaccines that have been reconstituted, such as varicella zoster virus vaccine
  • Emulsions such as propofol & injectable lipid emulsion
20
Q

Chlorpromazine should not be used if what color?

A

Darker than slight yellow
- slight yellow: potency

20
Q

Dacarbazine should not be used if what color?

A

Pink

20
Q

Oxidation turns dobutamine what color? Is potency lost?

A

Oxidation turns the solution slightly pink, but potency is not lost.

21
Q

Dopamine should not be used if what color?

A

Darker than slight yellow
- slight yellow: potency retained, okay to use

22
Q

Epinephrine should not be used if what color?

A

Pink, then brown

23
Q

Isoproterenol should not be used if what color?

A

Pink or darker
- damaged by air, light, heat

24
Q

Morphine should not be used if…

A

dark

25
Q

Nitroprusside should not be used if what color?

A

Orange -> brown -> blue
- Blue indicates nearly complete dissociation to cyanide!

26
Q

Norepinephrine should not be used if what color?

A

Pink or darker

27
Q

Tigecycline should not be used if what color?

A

Green/black
- normal color: yellow/orange

28
Q

What color is anthracyclines (e.g. doxorubicin)?

A

Red (discolors sweat & urine)

29
Q

What color is rifampin?

A

Red (discolors saliva, urine, sweat, & tears)

30
Q

What color is mitoxantrone?

A

Blue (discolors skin, eyes, & urine)

31
Q

What color is methotrexate?

A

Yellow

32
Q

What color is multivitamins for infusion (MVI)?

A

Yellow

33
Q

What color is tigecycline?

A

Yellow/orange
- discolors teeth (if used during teeth development)

*think orange like a TIGEr (TIGEcycline)

34
Q

What color is IV iron, various?

A

Brown (discolors urine)

Pharmacy Foundations Pt. 1 (4 decks)

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