Parentals

Question 0

What advantages are there to parentals?

Answer 0

For products that cannot be given orally
When patient is unconscious
When patient cannot tolerate oral medicine
Patients who cannot swallow
They give a predictable responce 100% bioavalibility
Emergency use
Rapid onset
No issue of compliance

Question 1

What is a parental?

Answer 1

A sterile preparation intended for administration by injection,infusion or implantation in the body.

Question 2

What requirements must be met in parental?

Answer 2

Has to be completely sterile and free from viable microorganisms as it doe not go through intestinal system and skips bodies defences
All materials used must already be sterile
Be free from particles, pyrogens and endotoxins
Prepared in. Way as to minimise contamination during preparation, storage and use.

Question 3

What is IC/ID injections?

Answer 3

Intracutaneous or intradermal injections just into the skin, between dermis and epidermis.
Small volume only 0.1/0.2 ml as there is poor vascular its
Use for diagnostic tests and vaccinations.

Question 4

What is SC/hypodermic?

Answer 4

Subcutaneous injection just into subcutaneous tissue,under skin.
Up to 1ml
Not suitable for suspension or oily solutions as this causes pain
Vaccines, local anaesthetics, insulin, heparin
Good if patient has blood problem, as it’s not deep and should reduce bleeding

Question 5

What is IM?

Answer 5

Intramuscular injection,directly into muscle.
Usually under 2ml but can be up to 4ml
Can use aqueous and oily solutions, and suspension.
This means they can be used for sustained release as the drug will slowly disperse from site of administration
Vaccines, antipsychotics - good for patients who cannot will not take medicine, get injections every 3 weeks etc.

Question 6

What is IC?

Answer 6

Intracardiac
Directly into hear muscle or ventricles
Emergency use only
Adrenaline/isopreneline if no other route possible. Uk not licensed

Question 7

What is IV?

Answer 7

Intravenous. 
From less than 1ml to 500ml as infusion
Rapid body dispersion
Mostly solutions but can be o/w emulsions, particle size tightly controlled
Cannot use w/o emulsions.

Question 8

What is IA?

Answer 8

Intra arterial
For immediate effect on peripheral organs
Cytotoxics such as methotrexate or radioactive materials
Can cause arterial spasms
Injected into site whee medicine is needed to act

Question 9

What is intrasponal - intrathecal?

Answer 9

Less that 20ml
Into space surrounding spinal chord
Used for spinal anaesthetics,cytotoxic and treatment of bacterial meningitis

Question 10

What is intraspinal intracisternal?

Answer 10

Into cisterns magna
Use to remove CSF - cerebral spinal fluid
Or to deliver antibiotics and dyes

Question 11

What is intraspinal peridural?

Answer 11

Into space between dura mater and inside of vertebrae
Various locations along spinal column
Spinal anaesthetics - specific gravity must be controlled so that the medication affects correct location
IE epidural

Question 12

What is intramural or infra articular.

Answer 12

Into either nurse between movable parts or synovial fluid.
Commonly used in shoulder elbow and knee
Inject solutions and suspensions
Corticosteroids

Question 13

What is opthalmic injections are there?

Answer 13

Subconjunctival - close to eye but not in it
Intravireous - vitreous chamber
Intracameral - anterior chamber
Intraocular - posterior segment of the globe
Use to treat local infections or symptoms
Less than 1ml

Question 14

What is intraosseous?

Answer 14

Into bones - replace bone marrow

Question 15

What is intracerebral?

Answer 15

Into the brain, ie for brain tumour

Question 16

What is intraperitoneal?

Answer 16

Into the peritoneum for dialysis solutions

Question 17

How does pH affect parental products?

Answer 17

Needs to be tightly controlled.
Ideal - 7.4
IV must be 3-10.5 cause rapidly diluted
All others 4-9
Otherwise tissue necrosis is above 9, pain and phlebitis if under 3
Buffers used only if will not effect area it is injected into

Question 18

Why is osmosis important in parentals?

Answer 18

If we inject a drug which cannot cross into cells, the liquid will rush out of the blood cells to try and create a balance over the membrane

As it is hard to measure osmotic pressure we use colligative properties IE blood plasma freezes at -.52 degrees, so if the medicine will freeze at this temperature, they are isotonic with the blood.

Must make medicines to be the same osmolality to minimise the unnecessary effects on the patient .

Question 19

What is osmolality?

Answer 19

The mass of solute required to create an osmotic pressure equal to that seen when dissolving one mole of an ideal substance( does not dissociate) in 1kg of solvent

Question 20

What happens if a blood cell comes into contact with a solution that is of higher osmolality and lower osmolality?

Answer 20

• greater osmolality than their contents,water passes out of the cell and they will shrink.
• lower osmolality, water will move into the cell and eventually burst.

Question 21

What is isotonic?

Answer 21

This is when a solution is the same osmolality as the cell, so there is no flow of water.

Question 22

What is hypotonic solution?

Answer 22

This is a solution which is lower in concentration that a cell that is placed into it. If placed around a cell, water will rush into the cell

Question 23

What is a hyper tonic solution?

Answer 23

One that is more concentrated, when a cell is placed into it the water will rush out of the cell.

Question 24

What should be taken into account if more than one drug is to be delivered in IV?

Answer 24

Make sure infusion can be given together without a change in ph, a loss in potency, increase in toxicity, and no precipitation which can cause blockage or pain.

Question 25

What is it necessary to be especially with any parental delivery of medicine?

Answer 25

Once delivered it cannot be removed, must make sure right drug delivered in the right way

Question 26

What complications can occur during administration of parentals?

Answer 26

Incorrect delivery causing blistering,swelling,hypersensitivity
Air injected into blood vessel causing blockage
Hypersensitivity causing reaction
Thrombosis or phlebitis - a blood clot or inflammation of the vein