IV medication teaching Flashcards
How Ovarian Stimulation
Works
Our goal is for your follicles to grow together at
the same rate, so we can retrieve
as many mature eggs as possible
ow Ovarian Stimulation Works
STIMULATION
Each day, you’ll give yourself
2-3 injections with very tiny
needles for about 8-12 days
MONITORING
You’ll then come in for
~20 minute office visits about 5-
6 times. These visits include
monitoring hormone levels and
follicular growth
FINAL MATURATION
When your ovaries are ready,
you’ll give yourself the “trigger”
shot, typically 34-36 hours
before retrieval
Logistics
Rx Prescriptions: your care team will order the prescriptions, it
is your responsibility to contact the pharmacy to set up
delivery, be sure to have all medications prior to baseline
ultrasound appointment.
* Supplies: double check you have everything upon delivery
* Storage: store them as instructed, at room temperature or in
your fridge
* Timing: choose times you can keep to daily, +/− 2 hours (set
reminders!)
* Videos: watch med videos (1-2 nights) beforehand so you feel
ready
* Injections in Clinic: We discourage you from doing the
injections in the office. If your injection time is close to your
appointment time, please take the injection before you come
in. In rare cases, when you need to administer a medication
while in the office please be sure to alert our team to provide
you with a room, the proper supplies and disposal container.
Never administer medications in our restrooms!
How to Inject: General
Gather all needed supplies, wash your hands
* Choose an injection site a minimum of 2 finger-widths away
from the belly button. Pinch a thick fold of the skin
* Apply an alcohol swab to the area and let dry
* Hold the syringe/pen like a dart and go straight in until the
needle disappears, take deep breathe (count to five),
release the pinch and remove the needle
* Apply a bit of pressure with gauze at injection site to help
with bruising
* Discard in sharps container
Bubbles in the
syringe?
Injecting an air bubble subcutaneously
(into fatty tissue) will not cause you
any harm! Therefore, do not worry
about small bubbles. If you have a large
bubble, hold the syringe so that the
needle tip is pointed at the ceiling.
Lightly flick the syringe until the bubble
is at the top of the syringe and gently
push on the plunger until the bubble
disappears.
Accidentally spilled
medication?
No need to stress! It is very common
for some medication to spill out of the
syringe. Unless you think you have
spilled greater than 50% of the
medication, there is no need to
repeat/adjust your dose.
How to Inject: Follistim or Gonal F (evening)
With clean hands, remove the cap. Notice which end of the
cartridge will go into the pen (unless already inserted or Gonal-F
prefilled)
* Swab rubber tip of cartridge and insert into pen
* Twist on needle cap with cover, gently tighten
* Set the pen to your dosage, by dialing until the number is shown
in the window
* Remove larger needle cover and hold onto it. Remove inner cover
and discard it.
* Prepare for injection. Depress plunger to inject. Please be sure
the plunger is fully depressed before removing the needle.
* Put back on the large needle cover and twist off needle. Discard
into red sharps container
Using “Overfill”: Follistim or Gonal F (evening)
Each 300 IU cartridge has ~400 IU of meds. When your pen is
low, you will likely need two injections to utilize all the
medication left in your original pen.
First, you will dial up to your dose on your pen and inject what is left
in the current cartridge/pen. When the plunger stops and will not
push in any further, look at the number left in the window. This is
the remaining dose you need.
Write this number down, then insert a new cartridge/pen. Dial up
this number and inject. Repeat as needed in successive days, to
reach your daily dosage
How to Inject: Menopur(evening)
Get meds: usually 2 Menopur (powder) and 1 Sodium Chloride
(NaCl - liquid)
* Remove lids of vials, swab rubber top
* Insert the spiky end of the Q cap onto the NaCl liquid vial
* Open the 3 cc/mL syringe, remove larger needle (if attached) and
twist onto Q cap
* Invert vial and pull back on plunger, withdrawing 1 cc/mL of liquid
into syringe
* Puncture Q-cap into Menopur vial #1, inject liquid and swirl until
dissolved, check that fluid is clear
* Invert vial and withdraw full 1 cc/mL of mixed liquid into syringe
* Puncture Q-cap into Menopur vial #2, inject mixed liquid and swirl
until dissolved, check that fluid is clear. Invert vial and withdraw full 1
cc/mL of remixed liquid into syringe
* Twist off Q-cap and twist on 27 gauge ½ inch needle and prepare for
injection
* Discard needle and syringe into red sharps container
How to Inject: Ganirelix orCetrotide (morning)
Ganirelix/Fyremadel
* Comes in pre-filled syringe, need to inject entire amount
* Expel any air bubbles
* Prepare of injection
Cetrotide
* Comes in a kit with powder vial and prefilled syringe with diluent, mixing
and injection needle
* Swab vial top, inject with mixing needle all of the liquid diluent in the
prefilled syringe, swirl until clear
* Draw up full amount of mixed solution back into syringe
* Twist off large mixing needle and twist on smaller injection needle
* Prepare of injection
Note for Cetrotide: you may experience some redness at the injection site
How to Inject: Omnitrope (evening)
Gather 1 diluent and 1 powder vial
* Remove lids of vials, swab rubber tops
* Using 3 cc/mL syringe with 18, 20 or 22 gauge needle, puncture
into liquid/diluent vial and draw up 1 mL of liquid.
* Inject into powder and roll to dissolve until clear
* Use insulin syringe to draw up 25 IU (.25 mL) of mixed solution.
This is your 1.45 mg dose
* Prepare for injection
* Discard in red sharps container
* Store the remainder of mixed solution in fridge, each vial can be
used 4 nights
* On the 5th night make a new mixed solution
Potential side effects:
Bloating, cramping, fatigue
* Headaches
* Water weight gain: 3-5 lbs
* Emotional reactions / heightened sensitivity
* Sensation of swollen ovaries
Lifestyle Modifications
In general, this is a good time to slow down and take it easy.
Indulge in self-care.
* Food: whatever you like, a balanced diet is best
* Alcohol: fine in moderation, <2 drinks daily
* Exercise: until 1 week pre/post retrieval, then go less strenuous, no
jumping but walking, yoga, etc. okay
* Sex: okay with mandatory protection if with a male partner (condoms),
no intercourse for one week after the retrieval
* Caffeine: in moderation, max ~2 cups daily
* Travel: be in town for your stimulation cycle, monitoring, retrieval;
Handling Medical Sharps
All needles, syringes, and Q-caps are considered medical sharps and must be safely disposed
of in appropriate receptacles to protect your safety and the safety of others. Empty vials,
cartridges or pen devices can be disposed of in your household trash, just ensure no needles
are attached.
▪ You will receive a red sharps container with your medications. This is where you will dispose
of all used sharps after injection. If you did not receive this container, please contact the
pharmacy to request one.
▪ Sharps should be disposed of in this container immediately following injection. Insert into
the container with the needle pointing down.
▪ Keep the lid of your sharps container closed and safely store away from children and pets.
▪ Do not dispose of alcohol wipes, gauze, wrappers, or any regular trash in the sharps
container. P
FSH and menopur - when to take
usually night you have baseline - take between 7-10 p.m. one after the other
to stop ovulation
antags - stop premature ovulation
antags usually added around
day 6 or later
antags taken
in the morning - same time every morning
trigger shot
retrieval 2 days later
only use what pain med?
tylenol, ibprofen causes bleeding
