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SoM 2 sim > Parenteral Administration > Flashcards

Parenteral Administration Flashcards

1
Q

What is parenteral administration?

A

sterile preparations for administration by injection, infusion or implantation into humans or animals

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2
Q

What is critical in parenteral administration?

A
  • ensure sterility
  • avoid contaminants
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3
Q

Why may parenteral administration be chosen?

A
  • poor drug stability in GIT (inactivation, degradation)
  • loacl administation
  • quick onset of action (drug directly into systemic circ)
  • delayed/prolonged release (implants, IM inj)
  • if enteral route not available (unconcious, unable to swallow)
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4
Q

What are the main routes of parenteral administration?

A
  • intramuscular - muscle under skin (90deg)
  • intravenous - veins in dermis (25deg)
  • subcutaneous - fatty tissue under dermis (45deg)
  • intradermal - dermis (15deg)
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5
Q

Describe intravenous administartion.

A
  • single dose
    • <10mL
    • emergency
  • continuous infusion
    • >500mL
    • fluid replacement, nutrition (emulsions)
  • into peripheral or central veins
  • aqueous: solutions, emulsions, nanosuspensions
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6
Q

Why cant suspensions be administered via IV?

A

particles too big - could embolise in smaller capillaries

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7
Q

Where are peripheral and central veins located?

A

peripheral: forearm/elbow, back of hand
central: superior vena cava

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8
Q

When would the central vein by accessed for parenteral administration and what can be given?

A
  • frequent access required
  • limited peripheral access
  • eg
    • antibiotics (long term)
    • parenteral nutrition
    • chemo
    • irritating solution
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9
Q

Why is parenteral nutrition given via peripheral veins?

A
  • high osmolarity = diluted quicker as vein is bigger
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10
Q

What are advantages vs disadvantages of IV admin?

A

+

  • 100% bioavailability
  • rapid onset
  • rapid dilution in blood circ
  • useful if drug too irritating for SC or IM
  • self admin possible

-

  • invasive, inconvenient, restrictive
  • strict sterility requirements
  • aseptic required
  • hard to reverse
  • training required
  • higher production cost
  • risk of embolism = limit to type of formulation
  • risk of extravasation (damage to veins)
  • management of waste (sharps)
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11
Q

Describe subcutaneous administration.

A
  • fatty tissue in:
    • upper arm
    • anterior thigh
    • lower abdomen
  • volume 1-2mL
    • if larger - divided doses, infusion - slow rate (palliative/hydration)
      • mixed with hyaluronidase (breaks down connective tissues)
  • aqueous solutions/suspensions, oily solution/suspensions
  • impact of formulation and liposolubility on diffusion rate and onset of action
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12
Q

Why is hyaluronidase added to large volume for SC admin?

A

breaks down connective tissues = allows admin of large volumes eg rituximab

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13
Q

What are advantages vs disadvantages of SC admin?

A

+

  • more patient friendly than IV
  • patients can be taught to self inject
  • can be suspensions to control release

-

  • invasive, inconvenient, restrictive
  • response not always predictable
    • impact of changes in blood supply, temp, site of inj
  • some enzymatic activity eg peptidases
  • strict sterility requirements
  • aseptic required
  • hard to reverse
  • training required
  • higher production cost
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14
Q

Describe intramuscular administration.

A
  • skeletal muscle below SC tissues
  • far from nerves, blood vessels
  • upper arm (deltoid), thigh in younger, buttock in adults
  • <4mL or up to 10mL in divided doses
  • aqueous solutions/suspensions, oily solutions/suspensions/emulsions
  • impact of formulation and liposolubility on diffusion rate and onset of action
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15
Q

What are advantages vs disadvantages of IM admin?

A

+

  • more patient firnedly than IV
  • rapid onset possible
  • variety of formulations
  • alternative to SC for irritant drugs
  • possible controlled release
  • better than SC for larger volumes

-

  • invasive, inconvenient, restrictive
  • impact of blood supply on absorption - affected by exercise
  • strict sterility requirements
  • aseptic required
  • hard to reverse
  • training required
  • higher production cost
  • management of waste (sharps)
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16
Q

What are formulation considerations for parenteral administration?

A
  • sterility - bypasses barriers
  • excipients - compatabile and non toxic
  • containers - glass or plastic, ideally clear, should protect against contamination, tamper evident
  • endotoxins - cause fever and shock
  • particulates - free of visible particles
17
Q

What is the limits for subvisible particles in parenteral administration?

A
  • depends on ROA
  • higher for SC or IM, IV stricter
  • exemptions:
    • radiopharmaceuticals
    • products to be used with final filter
18
Q

What excipients are added to solutions for parenteral formulation?

A
  • co solvents
    • ethanol
    • glycerol
    • propylene glycol
  • solubilising agent
    • surfactants
    • cyclodextrins
  • suitable oil
19
Q

What excipients are added to emulsions for parenteral formulation?

A
  • emulsifiers
    • lethicin
    • sorbitan fatty acid ester
  • suitable oils
    • arachis oil
    • sesame oil
    • soybean oil
20
Q

What excipients are added to suspensions for parenteral formulation?

A
  • for aq: suspending agents (increase viscocity)
    • methylcellulose IM
  • wetting agents (uniform suspension)
    • surfactant eg polysorbate
  • suitable oils
21
Q

What is the acceptable range of pH for parenteral formulations?

A

3-9

otherwise too painful

22
Q

How can you adjust tonicity of parenteral formulations?

A
  • NaCl
  • dextrose
23
Q

What are the different categories of parenteral preparations?

A
  • injections and infusions
  • gels for injections
  • implants
24
Q

Summarise the use of injections and infusions in parenteral preparations.

A
  • vials, prefilled syrings, infusion bags
  • antimicrobial preservatives should not be used if single dose >15mL
  • infusions are isotonic to blood, LVP are 100-1000mL no preservatives, sterile soluitons/ emulsions with no phase separation (cracking or creaming) eg diazemul
  • injections are sterile, clear and particle free eg insulin, antibitoics
25
Q

Summarise the use of gels for injections in parenteral preparations.

A
  • sterile semi-solid
  • modified release
  • eg somatuline autogel
26
Q

Summarise the use of implants in parenteral preparations.

A
  • SC or IM
  • pellets/rods
    • sterile
    • drug +/- excipients
  • eg zoladex implant, nexoplanon, oxurdex (dexamethasone treats oedema), gliadel water
  • act as reservoirs
    • drug encapsulated in plastic/metal or non-biodegradable polymer
    • drug released by osmotic pressure
    • require surgical removal

SoM 2 sim (21 decks)

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