Phrm 866 Exam 2 Flashcards
Parenteral Nutrition Lecture:
Basic Components of TPNs?
Carbohydrates Amino Acids Fat Emulsion Trace Elements Vitamins Electrolytes
Parenteral Nutrition Lecture:
Primary source of parenteral carbs is _______
Dextrose
Excess dextrose leads to what things?
hyperglycemia
excess CO2 formation
hepatic steatosis
Gylcerol is a ________
Does or Does not require insulin to get into cells
sugar alcohol
does not
1g hydrated dextrose –> ____ kcal
3.4
1g gylcerol –> ____ kcal
4.3
1g amino acids –> ___ kcal
4
Calorie to nitrogen ratio (NPC:N)
what are the 3 different categories/pt factors that decide the pts calorie:nitrogen ratio
healthy individual
renal/liver disease
acute stress
(healthy ppl need less nitrogen than acutely stressed ppl)
General Amino Acid Formulations:
Mixture of ____________ L-amino acids
essential, conditionally essential and non-essential
Hepatic Amino Acid Formulas:
______ (Val, Leu, Ile)-metabolized by skeletal muscle
increase BCAA (branched chain amino acids)
Hepatic Amino Acid Formulas: Increased BCAA (Val, Leu, Ile)-metabolized by \_\_\_\_\_
skeletal muscles
Hepatic Amino Acid Formulas:
________ (Phe,Tyr,Try)-metabolized by liver
decrease aromatic amino acids
Hepatic Amino Acid Formulas:
Decreased amino acids (Phe,Tyr,Try)-metabolized by ______
liver
Pediatric Amino Acid Formulas:
______ is ESSENTIAL in neonates
cysteine
Pediatric Amino Acid Formulas:
Babies need lower or higher Ca/P concentrations than in adults
HIGHER — they gotta build their bones
Cysteine helps enhance _____ solubility
Ca/P
important in PEDS TPN!
____ is a good growth medium
fat
Fat:
1g –> ___kcal
9
what are some of the basic trace elements used in TPN
chromium
copper
manganese
zinc
What electrolytes are measured in mEq and what electrolytes are measured in mmol
Na, K, Ca, Mg - mEq
P - mmol
(2 in 1) vs (3 in 1) Admixutres
which one has fat
3 in 1
(2 in 1) vs (3 in 1) Admixutres
which one is made of only amino acids and dextrose
2 in 1….
(2 in 1) vs (3 in 1) Admixutres
which on do you give fat via the y site
2 in 1 (because it doesnt have fat…)
(2 in 1) vs (3 in 1) Admixutres
which one is opaque
3 in 1 (because is has fat in it)
T or F: filter 3 in 1 admixtures will eliminate all bacteria
FALSE
Central Vein Parenteral Nutrition or Peripheral?
for short term use
cannot be fluid restricted
peripheral
Central Vein Parenteral Nutrition or Peripheral?
implantable ports for long term
central vein…
T or F: Aluminum has no known medical function
true
Who is at risk for aluminum toxicity
neonates
and
impaired renal function
what are the issues that can from aluminum toxicity
fracturing osteomalacia
encephalopathy
microcytic hypochromic anemia
Calculating Aluminum Load:
What is the goal value?
< 5 mcg/kg/day
How to calculate Aluminum load
- 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
when doing an admixture of Ca and P:
add which one first?
Add P first
for 3 in 1:
add ____ before fat
Ca2+
Filter parenteral nutritions:
0.22 micron air-eliminating for _____
1.2 micron air-eliminating for _____
(which admixture)
- 22: 2 - in - 1
1. 2: 3 - in - 1
What factors will affect Ca/P
Amino Acid concentration Amino Acid Product pH Dextrose Calcium Salt Temperature
what is the best Ca/P equation/ratio
??? there isnt??
she said “there is no “magic number” for Ca/P”
3 in 1 Compounding – likes acidic or basic environments?
basic
if acidic = more unstable
Ca/P – likes acidic or basic environments?
acidic
basic = less unstable – I think ……
what are the references for TPN that she gave us…
ASHP
USP 797, yoooo
FDA drug shortages
ASHP drug shortages
abbreviations:
BSC?
biological safety cabinet
abbreviations:
CAI
compoudning aseptic isolator
abbreviations:
CACI
compounding aseptic containment isolator
abbreviations:
CSTD
closed system transfer devices
abbreviations:
iso
international organization for standardization
abbreviations:
CVE
containment ventilated enclosures
abbreviations:
C-PEC
containment primary engineering controls
abbreviations:
C-SEC
containment secondary engineering controls
abbreviations:
HEPA
high efficiency particulate air
what are some personal protective equipment for hazardous drugs?
double gloves protective grown eye protection respiratory protection ventilated engineering controls
PEGylation:
covalent or non-covalent
and hydrophillic or hydrophobic
covalent
hydrophillic
benefits of PEGylation?
Extends a half-life (by increasing hydrodynamic radius)
Reduces immunogenicity and antigenicity
What is a reason that pts may not respond to a PEGylated drug?
the pt has formed anti-PEG antibodies — body is attacking the protein
Define:
Polymer-Drug Conjugates
Macromolecular conjugates of water- soluble polymers and low molecular weight drugs.
Polymer-Drug Conjugates - why is it beneficial?
improve water solubility of hydrophobic drugs
Prolonged circulation in plasma (reduced renal clearance)
Examples of Polymers for polymer drug conjugate?
HPMA
Hyaluronic acid/dextran
PEG
PG (polyglutamic acid)
Define:
Antibody Drug Conjugates
Antibody conjugated to drugs via cleavable (peptide or disulfide) or non-cleavable (thioether) linkers
Define:
Antibody Drug Conjugates
Antibody conjugated to drugs via cleavable (peptide or disulfide) or non-cleavable (thioether) linkers
Cleavable or Non-Cleavable Linker?
cleaved in endosomal environment (acidic pH, enzyme. glutathione)
cleavable
Cleavable or Non-Cleavable Linker?
More stable during circulation; Drug is released upon degradation of Ab by intracellullar proteases.
Non-Cleavable
Which of the following bonds is NON-Cleavable (the rest are cleavable) Disulfide Valine Citruline Hydrazone Thioether
Thioether is NON-cleavable!!
Define:
liposome
Vesicular structures based on one or more lipid bilayers.
examples of liposomes (like material??)
Phospholipids and Cholesterol
When a liposome is formed:
____ drugs are typically found inside of the liposome area
and
____ drugs are typically found imbedded in the liposome
inside: hydrophillic inside – where there is water
in the liposome: hydrophobic…
why is Doxil a “special drug”
it is a PEGylated liposome of doxorubicin – leads to less cardiotoxicity and myleosuppression
Caused hand foot syndrome tho??
Explain “doxorubicin Loading”
Doxorubicin is hydrophilic – gets encapuslated in liposomal vesicle when the drug is in the liposome it is forced to be hydrophobic….
________:Nature’s way to deliver RNA and protein
exosomes
polymeric micelles
is an amphiphilic block co-polymer
Help solubilize hydrophobic drugs in water
(hydrophilic part is almost always PEG)
define polymeric nanoparticles
Solid, biodegradable, colloidal systems with submicron sizes where the drug is either dissolved, entrapped, adsorbed, or attached into polymers.
_____ is a natural carrier of hydrophobic molecules
Albumin
Albumin will do endothelial transcytosis by binding to _____ receptor
gp60
____________ is an extracellular matrix glycoprotein overexpressed in a variety of cancers.
(leads to Preferential intratumoral accumulation of paclitaxel via binding to it)
SPARC (Secreted Protein Acidic and Rich in Cysteine
what is Abraxane and why is it “special”
it is albumin + paclitaxel – the max tolerated odse is 50% higher than just paclitaxel by itself
what is a “living drug”
a cancer vaccine! Kymriah or Provenge
what is the EPR effect
Enhanced permeability and retention (related to healthy and
EPR Effect Explained – why do cancer cells not clear the drug as well as healthy tissues
Hypervasculature
Enhanced vascular permeability
Little recovery of macromolecules via the blood vessels
Little recovery from the lymphatic system.
what is an example of a protein nanoparticle
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)
what things make a drug hazardous?
reproductive toxicity carcinogencity genotxocity teratogenicity/developmental toxicity organ toxicity at low doses (any new drug that mimics existing hazardous drugs)
3 types of Hazardous drugs
antineoplastics
non-antineoplastics
reproductive hazard for men and women
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
“take the necessary steps”
USP 797
what are some examples of remote checking?
ScriptPro
DoseEdge
Quality Oncology Services:
Have policies and procedures on in place for all aspects involving HDs.. (which are what..?)
receiving storing preparation admin disposal
Handling/Prepping HDs: Ideal situation --- \_\_\_\_\_\_ environment \_\_\_\_\_\_\_ room minimal traffic in and out of storage and prep areas
ISO class 5 or better NEGATIVE pressure room
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
test the INTEGRITY of the line
Flush the devices/lines
T or F:
CSTDs are required during the admin of all ANPs
Truuuue
Managing Extravasation:
______ is the best treatment
PREVENTION
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)
dexrazoxane for anthracyclines
apply ice
elevate the site
Isolators:
Ideal for ____ volume
Clean room NOT necessary!!
Make sure to _______ before placing in and removing from chamber
LOW volume
clean containers
what is the preferred BSC? and why?
Class II/Type II
exhaust goes to the OUTSIDE!
there is NO recirculation
product protection is excellent
Biological Safety Cabinets:
Leave on CONTINUOUSLY (?)
Certify every _____
6 mos
Making ANPs:
change gloves every _____ if working for a long time
30 mins
Making ANPs:
T or F: Double gloving is not needed
False! it is recommended
Handling ANPs:
_____ and ____ are needed during admin
Eye glasses and mask
_____ are REQUIRED for compounding HDs if not in a negative pressure environemnt
CSTDs
what to do for staff that handles HDs?
minimize exposure = staff rotation
regular medical check ups (blood work)
what drugs are possible vesicants?
Anthracyclines (rubicins) Vincristine/Blastine mitomycin/plicamycin streptozcin mechlorethamine
when administering hazardous drugs
_____ or _____ catheter is preferred
forearm or central
Admin of Hazardous drugs: CAUTION w/ Compromised \_\_\_\_\_\_\_ Lower \_\_\_\_\_\_ Old \_\_\_\_\_
circulation
limbs
IV sites
For admin of hazardous drugs:
Use _______ access if possible
semi-permanent IV access
For admin of hazardous drugs:
what are some IV access options?
PICC line - peripheral/bedside
Broviac/or hickman (surgery is needed)
