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NAPLEX 21 > Learning IV Medications > Flashcards

Learning IV Medications Flashcards

1
Q

The intrathecal route is often used by anesthesiologists and for some chemo, but when it’s contraindicated (ie vincristine), what can happen?

A

death!!

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2
Q

A commons vein used for peripheral venous catheters is what vein?

A

cephalic vein - in the arm and the saphenous vein near the ankle

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3
Q

What is phlebitis?

A

vein irritation

can happen when administering drugs into a smaller vein

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4
Q

What can happen when administering drugs into small vein? (3)

A

phlebitis
thrombosis
fluid extravasation

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5
Q

Central veins are required for administration of:

A

highly concentrated drugs (potassium chloride >20 mEq/100mL)

long term antibiotics

toxic drugs

drugs with a pH or osmolality that is not close to blood pH or osmolality (PN)

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6
Q

What drugs are known vesicants?

A

Vasopressors (dopamine, norepinephrine)

anthracyclines (doxorubicin)

vinca alkaloids (vincristine, vinblastine)

digoxin

foscarnet

mannitol

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7
Q

What drug is known to cause severe tissue injury even via SC, IM, intra-arterial

A

promethazine

do not give to children <2y

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8
Q

What is the name of the book that is the primary compatibility and stability resource?

A

the handbook on injectable drugs (Trissel’s)

or the King guide to parenteral admixtures. (King’s)

can also find info in the package insert

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9
Q

Chemical instability causes drug degradation or toxicity due to what type of reaction?

A

hydroloysis

OR

oxidation

OR

decomposition

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10
Q

Physical incompatibilities occur between a drug and one of the following:

A

container (PVC)

diluent (solution – dextrose)

another drug

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11
Q

The majority of PVC containers use _____ as a plasticizer to make the plastic bah more flexible. Why is this not good in some instances?

A

DEHP

it can leach into the solution and it is toxic. can harm the liver and testes

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12
Q

Absorption vs adsorption?

A

absorption: occurs when the drug moves into the PVC container
adsorption: occurs when drug adheres to the container

either will reduce the drugs concentration

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13
Q

Drugs that have leaching or absorption/adsorption issues with PVC containers can be placed in what kinds of containers?

A

polyolefin

polypropylene

glass containers

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14
Q

Insulin absorbs/adsorbs to PVC?

A

adsorbs! (sticks to the PVC)

however, clinicians adjust the rate of insulin infusions to obtain BG control regardless of the type of IV container/tubing used

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15
Q

What drugs have sorption or leaching issues with PVC?

A

LATTIN!!! Leach Absorbs To Take In Nutrients

Lorazepam

Amiodarone

Tacrolimus

Taxanes

Insulin

NTG

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16
Q

The one exception in Texans that can be placed into PVC?

A

paclitaxel-albumin bound (Abraxane)

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17
Q

More drugs that have adsorption issues?

A

carmustine

cyclosporine

ixabepilone

sufentanil - opioid

temsirolimus

teniposide

thiopental

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18
Q

What drugs cannot be mixed with Dextrose/ must be mixed with saline only?

A

SALINE ONLY (no dextrose!)

PEA ACID

Phenytoin (Dilantin)
Ertapenem (Invanz)
Ampicillin

Ampicillin/sulbactam (Unasyn)
Caspofungin (Cancidas)
Infliximab (Remicade)
Daptomycin (Cubicin)

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19
Q

What drugs cannot be mixed with saline/ dextrose only?

A

BOAS

Bactrim
Oxaliplatin
Ampho B
Synercid (Quin/Dalf)

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20
Q

What other drugs can only be mixed with saline only?

A 
abatacept 
idarucizumab
iron sucrose/venofer
sodium ferric gluconate complex
natalizumab/ tysabri
trastuzumab
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21
Q

What other drugs can one be mixed with dextrose only?

A

mycophenolate (cellcept IV)

22
Q

Drugs are commonly put in 50mL piggybacks (or larger) that contain what solutions?

A

D5W

NS

but know what drugs can’t be in which!

23
Q

Drugs that are not compatible - can they be used in Y site?

A

perhaps… additive compatibility and Y site compatibility = many drugs that can’t be mixed in the same container are compatibility when the drugs are mixed together for aSHORT period of Time (y site)

24
Q

What is a dangerous example of incompatability?

A

ceftriaxone and calcium-containing solutions (preceipatatE)

LACTATED RINGERS HAS CALCIUM!!!

Ca and Phos

25
Q

can ceftriaxone and LR be mixed?

A

NO!

26
Q

What size filter do lipids use?

A

1.2 microns

27
Q

Majority of drugs use what type of filter?

A

0.22 micron filter

28
Q

What key drugs require filters?

A

GAL, PLAT

Golimumab (simponi)
Amiodarone
Lorazepam, con’t

Phenytoin, con’t
Lipids (1.2m)
Ampho B (lipid formulations), 5 micron filter
Texanes, except docetaxel

29
Q

The likelihood of a CHEMICAL reaction that would degrade the drug increases/decreases with time

A

increases

ex: zosyn extended infusions

30
Q

Most IV drugs are kept cold to permit longer stability except for ___ &____ which crystallize

A

furosemide and phenytoin – crystalize

31
Q

KEY IV DRUGS THAT CANT BE REGRIGERATED

A

SPF MMED

Sulfa/Trim (Bactrim)
Phenytoin
Furosemide

Metronidazole
Moxifloxacin (Avelox)
Enoxaparin
Dexmedetomidine (Precedex)

32
Q

Other iv drugs that can’t be refridge

A 
APAP (ofirmev)
acyclovir - crystallizes
deferoxamine (desferal) - precepitates
levetiracetam (keppra)
pentamidine
Valproate
33
Q

Light exposure causes: , whichd destroys some drugs or increases drug’s toxicity (nitroprusside)

A

photo degradation

34
Q

Which drugs need to be protected during IV administration?

A

MD PEN

Micafungin (Mycamine)
Doxycycline

Phyntonadion (vit. k. Mephyton)
Epoprostenol (Flolan)
Nitroprusside (Nitropress)

35
Q

Drugs that are commonly destroyed with agitation?

A

albumin

alteplase

immune globulins

insulins

Mabs

rasburicase

vaccines (zoster)

36
Q

In most cases, discoloration indicates what?

A

oxidation

or another type of decomposition

37
Q

DO NOT USE WITH COLOR CHANGE:

darker than slight yellow

A

chlorpromazine

dopamine

38
Q

DO NOT USE WITH COLOR CHANGE:

pink

A

dacarbazine

39
Q

DO NOT USE WITH COLOR CHANGE:

oxidation turns the solution slightly pink but potency is not lost

A

dobutamine

40
Q

DO NOT USE WITH COLOR CHANGE:

Pink, then brown

A

epinephrine

41
Q

DO NOT USE WITH COLOR CHANGE:

pink or darker

A

isoproterenol

damaged by air light heat

42
Q

DO NOT USE WITH COLOR CHANGE:

dark

A

morphine

43
Q

DO NOT USE WITH COLOR CHANGE:

orange –> brown –> blue

A

nitroprusside

44
Q

what color of nitroprusside indicates nearly complete dissociation to cyanide?

A

BLUE

antidote: cyanokit

45
Q

DO NOT USE WITH COLOR CHANGE:

brown or ANY discoloration

A

norepinephrine

natural color: yellow/organge

46
Q

DO NOT USE WITH COLOR CHANGE:

green/black

A

tigecycline

47
Q

extravasation antidote for dopamine?

A

phentolamine

48
Q

IV drugs come as colored solutions

RED

A

anthracyclines – sweat and urine also turn red

rifampin - body. fluids and teeth turn red

49
Q

IV drugs come as colored solutions

YELLOW

A

methotrexate

MVI :)

50
Q

IV drugs come as colored solutions

YELLOW/ORANGE

A

tigecycline – teeth is used during development

51
Q

IV drugs come as colored solutions

BLUE

A

mitoxantrone – skin, eyes, urine

52
Q

IV drugs come as colored solutions

BROWN

A

IV iron – urine

NAPLEX 21 (60 decks)

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