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Fall 2018/P3 Year' > Phrm 866 Exam 2 > Flashcards

Phrm 866 Exam 2 Flashcards

1
Q

Parenteral Nutrition Lecture:

Basic Components of TPNs?

A 
Carbohydrates
Amino Acids
Fat Emulsion
Trace Elements
Vitamins
Electrolytes
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2
Q

Parenteral Nutrition Lecture:

Primary source of parenteral carbs is _______

A

Dextrose

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3
Q

Excess dextrose leads to what things?

A

hyperglycemia
excess CO2 formation
hepatic steatosis

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4
Q

Gylcerol is a ________

Does or Does not require insulin to get into cells

A

sugar alcohol

does not

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5
Q

1g hydrated dextrose –> ____ kcal

A

3.4

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6
Q

1g gylcerol –> ____ kcal

A

4.3

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7
Q

1g amino acids –> ___ kcal

A

4

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8
Q

Calorie to nitrogen ratio (NPC:N)

what are the 3 different categories/pt factors that decide the pts calorie:nitrogen ratio

A

healthy individual
renal/liver disease
acute stress

(healthy ppl need less nitrogen than acutely stressed ppl)

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9
Q

General Amino Acid Formulations:

Mixture of ____________ L-amino acids

A

essential, conditionally essential and non-essential

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10
Q

Hepatic Amino Acid Formulas:

______ (Val, Leu, Ile)-metabolized by skeletal muscle

A

increase BCAA (branched chain amino acids)

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11
Q 
Hepatic Amino Acid Formulas:
Increased BCAA (Val, Leu, Ile)-metabolized by \_\_\_\_\_
A

skeletal muscles

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12
Q

Hepatic Amino Acid Formulas:

________ (Phe,Tyr,Try)-metabolized by liver

A

decrease aromatic amino acids

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13
Q

Hepatic Amino Acid Formulas:

Decreased amino acids (Phe,Tyr,Try)-metabolized by ______

A

liver

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14
Q

Pediatric Amino Acid Formulas:

______ is ESSENTIAL in neonates

A

cysteine

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15
Q

Pediatric Amino Acid Formulas:

Babies need lower or higher Ca/P concentrations than in adults

A

HIGHER — they gotta build their bones

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16
Q

Cysteine helps enhance _____ solubility

A

Ca/P

important in PEDS TPN!

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17
Q

____ is a good growth medium

A

fat

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18
Q

Fat:

1g –> ___kcal

A

9

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19
Q

what are some of the basic trace elements used in TPN

A

chromium
copper
manganese
zinc

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20
Q

What electrolytes are measured in mEq and what electrolytes are measured in mmol

A

Na, K, Ca, Mg - mEq

P - mmol

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21
Q

(2 in 1) vs (3 in 1) Admixutres

which one has fat

A

3 in 1

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22
Q

(2 in 1) vs (3 in 1) Admixutres

which one is made of only amino acids and dextrose

A

2 in 1….

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23
Q

(2 in 1) vs (3 in 1) Admixutres

which on do you give fat via the y site

A

2 in 1 (because it doesnt have fat…)

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24
Q

(2 in 1) vs (3 in 1) Admixutres

which one is opaque

A

3 in 1 (because is has fat in it)

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25
Q

T or F: filter 3 in 1 admixtures will eliminate all bacteria

A

FALSE

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26
Q

Central Vein Parenteral Nutrition or Peripheral?
for short term use
cannot be fluid restricted

A

peripheral

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27
Q

Central Vein Parenteral Nutrition or Peripheral?

implantable ports for long term

A

central vein…

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28
Q

T or F: Aluminum has no known medical function

A

true

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29
Q

Who is at risk for aluminum toxicity

A

neonates
and
impaired renal function

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30
Q

what are the issues that can from aluminum toxicity

A

fracturing osteomalacia
encephalopathy
microcytic hypochromic anemia

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31
Q

Calculating Aluminum Load:

What is the goal value?

A

< 5 mcg/kg/day

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32
Q

How to calculate Aluminum load

A
  • get amt of Al from each ingredient
  • convert the Al content in mcg/L to mcg/mL
  • multiply the Al content for each ingredient by the volume used to determine the Al contribution
  • add them all up
  • Divide total Al by body weight for mcg/kg/day
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33
Q

when doing an admixture of Ca and P:

add which one first?

A

Add P first

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34
Q

for 3 in 1:

add ____ before fat

A

Ca2+

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35
Q

Filter parenteral nutritions:
0.22 micron air-eliminating for _____
1.2 micron air-eliminating for _____
(which admixture)

A
  1. 22: 2 - in - 1

1. 2: 3 - in - 1

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36
Q

What factors will affect Ca/P

A 
Amino Acid concentration
Amino Acid Product
pH
Dextrose
Calcium Salt
Temperature
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37
Q

what is the best Ca/P equation/ratio

A

??? there isnt??

she said “there is no “magic number” for Ca/P”

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38
Q

3 in 1 Compounding – likes acidic or basic environments?

A

basic

if acidic = more unstable

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39
Q

Ca/P – likes acidic or basic environments?

A

acidic

basic = less unstable – I think ……

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40
Q

what are the references for TPN that she gave us…

A

ASHP
USP 797, yoooo
FDA drug shortages
ASHP drug shortages

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41
Q

abbreviations:

BSC?

A

biological safety cabinet

42
Q

abbreviations:

CAI

A

compoudning aseptic isolator

43
Q

abbreviations:

CACI

A

compounding aseptic containment isolator

44
Q

abbreviations:

CSTD

A

closed system transfer devices

45
Q

abbreviations:

iso

A

international organization for standardization

46
Q

abbreviations:

CVE

A

containment ventilated enclosures

47
Q

abbreviations:

C-PEC

A

containment primary engineering controls

48
Q

abbreviations:

C-SEC

A

containment secondary engineering controls

49
Q

abbreviations:

HEPA

A

high efficiency particulate air

50
Q

what are some personal protective equipment for hazardous drugs?

A 
double gloves
protective grown
eye protection
respiratory protection
ventilated engineering controls
51
Q

PEGylation:
covalent or non-covalent

and hydrophillic or hydrophobic

A

covalent

hydrophillic

52
Q

benefits of PEGylation?

A

Extends a half-life (by increasing hydrodynamic radius)

Reduces immunogenicity and antigenicity

53
Q

What is a reason that pts may not respond to a PEGylated drug?

A

the pt has formed anti-PEG antibodies — body is attacking the protein

54
Q

Define:

Polymer-Drug Conjugates

A

Macromolecular conjugates of water- soluble polymers and low molecular weight drugs.

55
Q

Polymer-Drug Conjugates - why is it beneficial?

A

improve water solubility of hydrophobic drugs

Prolonged circulation in plasma (reduced renal clearance)

56
Q

Examples of Polymers for polymer drug conjugate?

A

HPMA
Hyaluronic acid/dextran
PEG
PG (polyglutamic acid)

57
Q

Define:

Antibody Drug Conjugates

A

Antibody conjugated to drugs via cleavable (peptide or disulfide) or non-cleavable (thioether) linkers

58
Q

Define:

Antibody Drug Conjugates

A

Antibody conjugated to drugs via cleavable (peptide or disulfide) or non-cleavable (thioether) linkers

59
Q

Cleavable or Non-Cleavable Linker?

cleaved in endosomal environment (acidic pH, enzyme. glutathione)

A

cleavable

60
Q

Cleavable or Non-Cleavable Linker?

More stable during circulation; Drug is released upon degradation of Ab by intracellullar proteases.

A

Non-Cleavable

61
Q 
Which of the following bonds is NON-Cleavable (the rest are cleavable)
Disulfide
Valine Citruline
Hydrazone
Thioether
A

Thioether is NON-cleavable!!

62
Q

Define:

liposome

A

Vesicular structures based on one or more lipid bilayers.

63
Q

examples of liposomes (like material??)

A

Phospholipids and Cholesterol

64
Q

When a liposome is formed:
____ drugs are typically found inside of the liposome area
and
____ drugs are typically found imbedded in the liposome

A

inside: hydrophillic inside – where there is water

in the liposome: hydrophobic…

65
Q

why is Doxil a “special drug”

A

it is a PEGylated liposome of doxorubicin – leads to less cardiotoxicity and myleosuppression

Caused hand foot syndrome tho??

66
Q

Explain “doxorubicin Loading”

A

Doxorubicin is hydrophilic – gets encapuslated in liposomal vesicle when the drug is in the liposome it is forced to be hydrophobic….

67
Q

________:Nature’s way to deliver RNA and protein

A

exosomes

68
Q

polymeric micelles

A

is an amphiphilic block co-polymer
Help solubilize hydrophobic drugs in water
(hydrophilic part is almost always PEG)

69
Q

define polymeric nanoparticles

A

Solid, biodegradable, colloidal systems with submicron sizes where the drug is either dissolved, entrapped, adsorbed, or attached into polymers.

70
Q

_____ is a natural carrier of hydrophobic molecules

A

Albumin

71
Q

Albumin will do endothelial transcytosis by binding to _____ receptor

A

gp60

72
Q

____________ is an extracellular matrix glycoprotein overexpressed in a variety of cancers.

(leads to Preferential intratumoral accumulation of paclitaxel via binding to it)

A

SPARC (Secreted Protein Acidic and Rich in Cysteine

73
Q

what is Abraxane and why is it “special”

A

it is albumin + paclitaxel – the max tolerated odse is 50% higher than just paclitaxel by itself

74
Q

what is a “living drug”

A

a cancer vaccine! Kymriah or Provenge

75
Q

what is the EPR effect

A

Enhanced permeability and retention (related to healthy and

76
Q

EPR Effect Explained – why do cancer cells not clear the drug as well as healthy tissues

A

Hypervasculature
Enhanced vascular permeability
Little recovery of macromolecules via the blood vessels
Little recovery from the lymphatic system.

77
Q

what is an example of a protein nanoparticle

A

albumin

*she says it really isnt though because when it gets in the blood it is in just albumin (is “nanoparticle” when it is clumped together in packaging)

78
Q

what things make a drug hazardous?

A 
reproductive toxicity
carcinogencity
genotxocity
teratogenicity/developmental toxicity
organ toxicity at low doses
(any new drug that mimics existing hazardous drugs)
79
Q

3 types of Hazardous drugs

A

antineoplastics
non-antineoplastics
reproductive hazard for men and women

80
Q

Risk to Medical Personal:
No conclusive proof of dangers when HCPs “________” to minimize exposure to HDs
and
____ mandates special handling of hazardous drugs to help assure that risk is minimal

A

“take the necessary steps”

USP 797

81
Q

what are some examples of remote checking?

A

ScriptPro

DoseEdge

82
Q

Quality Oncology Services:

Have policies and procedures on in place for all aspects involving HDs.. (which are what..?)

A 
receiving
storing
preparation
admin
disposal
83
Q 
Handling/Prepping HDs:
Ideal situation ---
\_\_\_\_\_\_ environment
\_\_\_\_\_\_\_ room
minimal traffic in and out of storage and prep areas
A 
ISO class 5  or better
NEGATIVE pressure room
84
Q

When administering a vesicant:
Administer at the RECOMMENDED RATE
Have all drugs/supplies in place prior to starting the infusion
Test the _______ before and during the infusion
Monitor the patient frequently
________ with adequate volumes of saline following the infusion

A

test the INTEGRITY of the line

Flush the devices/lines

85
Q

T or F:

CSTDs are required during the admin of all ANPs

A

Truuuue

86
Q

Managing Extravasation:

______ is the best treatment

A

PREVENTION

87
Q

Managing Extravasation:
stop infusion IMMEDIATELY
Administer antidote if available (______ for ______)
apply _____ x15 mins of each hour for several hours
______ the affected site for 24 hours
(remove 3 - 5 mL of blood if possible and aspirate any extravasated solution)

A

dexrazoxane for anthracyclines
apply ice
elevate the site

88
Q

Isolators:
Ideal for ____ volume
Clean room NOT necessary!!
Make sure to _______ before placing in and removing from chamber

A

LOW volume

clean containers

89
Q

what is the preferred BSC? and why?

A

Class II/Type II

exhaust goes to the OUTSIDE!
there is NO recirculation
product protection is excellent

90
Q

Biological Safety Cabinets:
Leave on CONTINUOUSLY (?)
Certify every _____

A

6 mos

91
Q

Making ANPs:

change gloves every _____ if working for a long time

A

30 mins

92
Q

Making ANPs:

T or F: Double gloving is not needed

A

False! it is recommended

93
Q

Handling ANPs:

_____ and ____ are needed during admin

A

Eye glasses and mask

94
Q

_____ are REQUIRED for compounding HDs if not in a negative pressure environemnt

A

CSTDs

95
Q

what to do for staff that handles HDs?

A

minimize exposure = staff rotation

regular medical check ups (blood work)

96
Q

what drugs are possible vesicants?

A 
Anthracyclines (rubicins)
Vincristine/Blastine
mitomycin/plicamycin
streptozcin
mechlorethamine
97
Q

when administering hazardous drugs

_____ or _____ catheter is preferred

A

forearm or central

98
Q 
Admin of Hazardous drugs:
CAUTION w/
Compromised \_\_\_\_\_\_\_
Lower \_\_\_\_\_\_
Old \_\_\_\_\_
A

circulation
limbs
IV sites

99
Q

For admin of hazardous drugs:

Use _______ access if possible

A

semi-permanent IV access

100
Q

For admin of hazardous drugs:

what are some IV access options?

A

PICC line - peripheral/bedside

Broviac/or hickman (surgery is needed)

Fall 2018/P3 Year' (16 decks)

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