Df Exam 2

Front 1

Main parenteral routes

Back 1

intravenous, intramuscular, subcutaneous, intradermal

Front 2

two main devices for parenteral admin

Back 2

needles and catheters

Front 3

Needles are attached to what two containers?

Back 3

syringes for single inj and IV sets for infusions

Front 4

Catheters are made from

Back 4

flexible plastic or silicone.

Front 5

How are catheters introduced into the vein?

Back 5

introduced into vein with a needle. Example "over the needle" catheters.

Front 6

"G"

Back 6

gauge value. Large the G the smaller the needle. Exmaple-insulin 30 needle very thin.

Front 7

Two types of IV injection istes

Back 7

central and peripheral

Front 8

Central IV sitesfor catheters

Back 8

superior vena cava or sometimes the right atrium.

Front 9

catheters insertion sites for central IV

Back 9

subclavian and jugular veins

Front 10

Benefits of central IV admin site

Back 10

rapid diffusion and reduced risk of infection

Front 11

PICC

Back 11

peripherally inserted central catheter. Inserted into perip vein but with tip in central IV site.

Front 12

Peripheral IV admin site

Back 12

Hand, arm, antecubital fossa, scalp in babies.

Front 13

Methods of IV admin

Back 13

continous infusion, intermittent infsion and bolus.

Front 14

Continous infusion

Back 14

prolonged drug admin, uses an administration set.

Front 15

5 parts of the admin set

Back 15

1.spike
2.drip chamber
3.plastic tubing
4.a clamp
5.y port

Front 16

y-port function

Back 16

connects a secondy admin set for secondary admin (piggy back infusion). can allow for one line to flow at a time.

Front 17

intermittent infusion

Back 17

IV therapy administered at perecribed intervals. Usually administered through an already existing IV so, it will use a Y-port.

Front 18

Heparin Lock

Back 18

a small intermittent infusion device that remains in the vein btwn uses. Keeps the vein ready for next infusion.

Front 19

Piggyback infusion and what drugs use them

Back 19

infusion of second IV fluid thru a connection in the primary IV set. Antibiotics.

Front 20

Bolus

Back 20

concentrated med given rapidly (1-5min). If given too fast can be dangerous (KCL or teniposide).

Front 21

time it takes IV drug to reach brain/heart and circulation

Back 21

heart/brain in 10-20 seconds
circulation 1min

Front 22

Intramuscular injection sites

Back 22

striated muscle fibers under the subcut layer at 90 degree angle.

Front 23

primary IM inj sites

Back 23

butt(large mass for large inj), deltoid (more pain but better circulation), vastus lateralis (best for kids under 3)

Front 24

depot inj site

Back 24

for IM. type of inj that serves as storage reservoir from which the drug is slowly removed into systemic ciculation.

Front 25

Pro's and Con's of IM

Back 25

IM can accept diverse formulations like oil and suspensions but can not recieve more than 10ml

Front 26

Subcut inj site

Back 26

in fat tissue below dermis. inj at 45 degree. arms, stomach, thigh.

Front 27

Absorption mechanism of subcut inj

Back 27

can be absorbed in lymph nodes, interstitial fluid or blood. but slower on set.

Front 28

Hypodermoclysis

Back 28

continous sc infusion. normally 2ml is max sc inj.

Front 29

Intradermal INJ site

Back 29

inj at artery and it specificlly targets an organ. Chemo drugs.

Front 30

intraperitoneal inj

Back 30

peritoneal cavity. provides local therapy. chemo drugs.

Front 31

epidural inj

Back 31

epidural (on or over dura mater) which is between dura mater and ct on vertebral canal. anesthetic.

Front 32

requirements of epidural inj

Back 32

1.drug must diffuse across meninges
2. much of drugs maybe absorbed in systemic circ
3. arachoid is the primary barrier for drug transport into the CSF

Front 33

intrathecal inj

Back 33

within spinal cord. inj in the subarachnoid layer in the lumbar region. Example- Balcofen for cerebral palsy

Front 34

intraventricular inj

Back 34

lateral ventricles of the brain. local therapy for CNS infections and cancer.

Front 35

intra-articular inj

Back 35

synovial sac of joints. for local action. rhuematoid, pain, inflamm.

Front 36

intrapleural inj

Back 36

pleural cavity. local action.

Front 37

intraosseous inj

Back 37

with bone marrow cavity. systemic. "noncollapsable vein". example is inj into tibia for emergency meds for children.

Front 38

intralesional inj

Back 38

in or around a lesion. local.

Front 39

intraocular inj

Back 39

local action in eye. intraviteral injs.

Front 40

Disadvantages of Parenteral inj

Back 40

1. nerve or tissue damage
2.phlebitis
3.extravastation
4.infection
5. pyrogenic response
6.cost

Front 41

drug formulations that could be irritating for inj

Back 41

1. non-isotonic drugs
2.non-physiological pH
3. cosolvents/surfactants
4. the drug it's self

Front 42

possible sequelae of phlebitis

Back 42

thrombus (blood clot), Embolus (can lodge in puml artey), Embolism (blood clot).

Front 43

contributing factors to phlebitis

Back 43

1.needle/catheter
2. admin site (small veins less able to dilute prd, leg veins have stagnant flow)
3.technique of inject
4. drug prd can cause endothelial damage or physically irritate endothelium

Front 44

extravasation and infiltration

Back 44

escape of fluid into surrounding tissue

Front 45

sequelae of extravasation

Back 45

swelling/pain, cell death from chemical irritation, tissue death and infection, nerve damage and loss of a limb.

Front 46

contributing factors to extravasation

Back 46

puncture of vein, slippage of catheter out of vein, trauma to venous endothelium, drug prd

Front 47

Vesicants

Back 47

any agent that prd blisters

Front 48

IV agents that cause necrosis

Back 48

dextrose 10%, TPN solutions. These are hypertonic. Also antibiotics, chemo agents, vasopressin.

Front 49

types of infections that could occur with parenterals

Back 49

cellulitis from staphylococcus/streptococcus. septicemia from bacteria. Microbes come from air or skin.

Front 50

main concern of exogenous pyrogens

Back 50

bacterial endotoxin such as LPS which is associated with gram neg bacteria.

Front 51

effects of bacterial endotoxin

Back 51

pyrogenicity, limulus lysate gelation, shock, fever/

Front 52

why parenterals cost more

Back 52

administered by trained personelle. liability. cost of manufacturing and compounding.

Front 53

ommaya resevior

Back 53

a is an intraventricular catheter system that can be used for the aspiration of cerebrospinal fluid or for the delivery of drugs (e.g. chemotherapy) into the cerebrospinal fluid.

Front 54

Purity requirements for parenterals

Back 54

free from pyrogens, pathogens, and particulates.

Front 55

Sterilization methods for parenterals

Back 55

1.thermal (2 types)
2.Filtration (most common)
3.Radiation with gamma
4. Radiation with UV
5.Gas

Front 56

Thermal Moist sterilization

Back 56

1.121 degrees for 15 mins
2.High P in autoclave
3.protein denaturation

Front 57

Pros and Cons for thermal moist steriliatoins

Back 57

pros- can do large batches
cons- can't do oils, fats, or powders

Front 58

Thermal dry sterilization

Back 58

1.170 degrees for 2 hours
2.dehydration then burning
3.best for stuff not able to thermally moist sterilizied

Front 59

Filtration sterilization

Back 59

1. removes and kills microorganisms.
2. pore sizes from 5 micrometers to 0.22 micrometers
3. adsorption or sieving

Front 60

Pro/Cons for filtration sterilization

Back 60

Pro-sterilizes heat sensitive solutions
Con- possible drug adsorption

Front 61

Radiation with Gamma, sterilization

Back 61

1.effects DNA
2.can sterilize in packaging without use of heat

Front 62

Radiation with UV sterilization

Back 62

1.Thymine denaturation
2.Does not penetrate well. Limited to sterilizing air and surfces.

Front 63

Gas sterilization

Back 63

1.interferes with metabolism
2.great penetration
3.difficult and time comsuming

Front 64

Gases used for sterilization

Back 64

ethylene and prolylene oxide

Front 65

Two USP tests used for sterility

Back 65

1. direct transfer to sterile culture media
2.Membrane filtration

Front 66

Membrane filtration test

Back 66

1. filter concentrates microbes for detection
2. filter is 0.45microm and then tranfered to soybean casein/trypticase for 7 days

Front 67

Methods for removing pyrogens from parenterals

Back 67

rinsing, ultrafilatration,distillation

Front 68

MEthods for inactivating pyrogens from parenterals

Back 68

dry heat, moist heat, alkylatoin

Front 69

2 pyrogens test performed for parenterals

Back 69

1.rabbit test- monitor rectal temps for rabbits.
2.Limulus test- contents clot is presence of endotoxin

Front 70

Why particulates are dangerous in parenterals

Back 70

1. particles 8 micrometes in diam can get lodged in arterioles or capillaries
2.Blood vessle collapse
3. Granulomas
4.interaction with reticuloendotheilial system

Front 71

USP limits for particulates for large volume(100ml) parenterals

Back 71

No more than 50 particles per ml. No particles larger than 10micrometers and no more than 5 parts/ml

Front 72

USP limits for particulares for Small Volume (<100ml) parenterals

Back 72

No more than 10,000 particles per container.

Front 73

Methods to remove particulates

Back 73

1.Filters 1-5 micro
2. Air-eliminating, 0.2 micro filters.

Front 74

Ideal IV tonicity range

Back 74

240-340 mOsm/L

Front 75

pH range for IM and SC inj

Back 75

4-9 but this inc their risk for necrosis

Front 76

pH range for central IV

Back 76

3-10.5. Large range because of dilution and blood buffer.

Front 77

pH range for peripheral IV

Back 77

5-9

Front 78

Intrathecal pH range

Back 78

7-7.6, tissue is sensitve and has slow circulation and low volume.

Front 79

four types of parenteral products

Back 79

solutions, suspensions, emulsions, and reconstitutables.

Front 80

Vehicle for parenterals

Back 80

water (most common) and oil (usually for insoluble drugs and depots)

Front 81

Administration of injectables in oil

Back 81

vegetable type of oil. IM.

Front 82

Substances added to parenterals

Back 82

1.solubilizers
2.preservations
3.buffers
4.antioxid
5.tonicity adjusters

Front 83

Method of enhancing solubility

Back 83

Organic co solvents, surfactants, cyclodextrins, salt formation and prodrugs.

Front 84

Most common solubilty enhancers and how they work

Back 84

Ethanol, propylene gylcol, PEG400. They reduce water polarity.

Front 85

examples of non-ionic surfactants (preferred)

Back 85

Tween 80 and polysorbate 80

Front 86

How do surfactants work?

Back 86

solubilzes polar and non-polar drugs by dispersing them in micelles. Mostly works with lipophilic drugs.

Front 87

Example of anti-mircobials and their prescribed limits

Back 87

Chlorobutanol, cresol, phenol - 0.5%

Benzyl alcohol-1%

Front 88

Uses for large volume parenterals

Back 88

hydration, electrolytes, nutrition, TPN, Vehicles, KVO (example- D5W at rate of 10-15ml/hr)

Front 89

Examples of large volume parenterals and thei uses

Back 89

1. dextrose- hydration, calories
2.NaCL-ECF replacement
3.Ringer's- fluid and electrolyte replacement
4.Lactated Ringer's- systemic alkalizer and fluid/elec replac
5.Lipid emulsion- cals and fats

Front 90

Components of Ringer's

Back 90

Nacl, KCL, CaCl

Front 91

Components of lactated ringers

Back 91

Nacl, KCL,CaCL, and sodium lactate

Front 92

Small volume parenterals uses

Back 92

drugs, biologics, diagnostic, allergenic, and radiopharmceuticals.

Front 93

Common DF for small volume parenterals

Back 93

Solutions(insulin) and suspensions (insulin susp)

Front 94

rare df for small volume parenterals

Back 94

Emulsions. Propofol (Diprivan) is an example of one.

Front 95

Techniques of producing sterile solids

Back 95

Aseptic crystallization and lyophilization

Front 96

lyophilization aka freeze dry

Back 96

is a dehydration process typically used to preserve a perishable material or make the material more convenient for transport.

Front 97

other convenient SVPs

Back 97

1. mini-bags
2. ADD-vantage system (2 parts)
3.Disposable pre-fillled syringes
4.double chambered vials

Front 98

Methods to keep air clean and maintained

Back 98

1.HEPA (high effic particulate air)
2.Laminar flow
3.Positive pressure

Front 99

HEPA

Back 99

removes 99.97% of particles 0.3microns or larger. Reduce chances of contamination but do not elim.

Front 100

Laminar flow

Back 100

air moves with uniform velocity along parallel line to minimize turbulence.

Front 101

positive pressure air flow

Back 101

air has to be of a higher pressure than air in surrounding areas. Causes air to move out when doors open.

Front 102

important properties of packaging materials

Back 102

1. Permeation
2.leaching
3.adsorption

Front 103

Most common plastics used for packaging

Back 103

Polyproylene, PVC (polyvinylchloride),polyethylene.

Front 104

Pros/Cons of packaging with polyproylene

Back 104

pros- autoclavable,low gas and water perm, and low additives
Cons-translucent not transparent.

Front 105

PVC pros and cons for packaging use

Back 105

pros-transparent, flexible
cons-high water perm and oxy perm, leaching is a problem

Front 106

Polyethylene pros and cons

Back 106

pros-low additives and leaching is no prob
cons-high or low density

Front 107

Fours types of glass

Back 107

type 1- borosilicate glass, best kind low leachable and chemically resistant.
type 2- treated soda-lime glass. surface treated to improve chem resist.
type 3- soda-lime glass
type 4- Non-parenteral glass

Front 108

Potential leachables in glass

Back 108

alkaline earth and heavy metal oxides can raise pH in product.

Front 109

Imp physical properties of rubber used for stoppers

Back 109

coring-pludding the needle with a piece of rubber
resealability- rubber needs to reseal itself post needle insertion

Front 110

potential leachable in rubber

Back 110

heavy metal salts and lubricants

Front 111

types of containers for parenterals

Back 111

1.ampules
2.vials
3.plastic bags
4.large volume bottles

Front 112

Ampules

Back 112

Heat sealed glass containers for single use. Hermetic but have broken glass particles upon opening.

Front 113

Vials

Back 113

closed with rubber stopper or aluminum crimp

Front 114

plastic bags

Back 114

Dominant for parenterals. Single use. collapsibleso fluid can drip out.

Front 115

Large volume bottles

Back 115

plastic or glass and for single use

Front 116

admixtures

Back 116

combination of parenteral df for administration as a single entity. example- when drugs, nutrients, electrolytes are added to LVPs

Front 117

horizontal vs vertical laminar air flow

Back 117

H- air flows at worker and does not protect worker

V- downward flow protects the worker from potential hazards. (use for antineoplastic handling).

Front 118

DOP smoke test

Back 118

dioctyl phthalate smoke test is used to test for the passage of particles through the HEPA.

Front 119

Barrier isolator

Back 119

physical barrier between worker and HEPA. sometimes class glove boxes.

Front 120

Chemical incompatibilities for mixed parenterals

Back 120

1. mixture led to suboptimal pH
2. photodegradation

Front 121

example of pH related chemical incompatibility

Back 121

ampicillin sodium in D5W

Front 122

examples of drugs affected by photodegradation

Back 122

1.metoclopramide
2.adriamycin
3.cisplatin
4.daunomycin
5.amphtericin
6.b-complex vitamins
7.sodium nitroprusside

Front 123

Physical incompatibilty of mixing parenterals

Back 123

precipitations, visual incompatibility, layering effect, destabilization, drug-containter interaction.

Front 124

example of percipitation caused by changes in pH

Back 124

1.sodium salts of weak acids added to an acidic medium. Cefazolin ppt at pH 4.5
2. HCL salt added to weak base. Metoclopramide and cephalothin.

Front 125

percipitation caused by formation of poorly soluble salts

Back 125

Divalent cations in the presence of bicarb, citrate, sulfite, and phosphate salts.

Front 126

Important example of salt incompatibility

Back 126

calcium-phosphate incompatibility. This mix can form insoluble salt in LVP or in-line. Causes many pulmoney embolism deaths.

Front 127

Layering effect

Back 127

occurs due to diff densities. dangerous. occurs in container or in-line. Imp to mix well!!

Front 128

destabilization

Back 128

for colloidal prds (less than 1 microm). occurs bc of incompatibilities and temp extremes.

Front 129

Example of colloids that show destabilization

Back 129

IV fat emulsions, liposomes, amphotericin B

Front 130

parenteral-container interactions

Back 130

adsorption and leaching

Front 131

adsorption

Back 131

drugs can adsorb to PVC, gladd, rubber, or a filter.

Front 132

drugs that adsorb to PVC

Back 132

lipophilic drugs like insulin, nitroglycerin, warfarin, sodium diazepam

Front 133

drugs that adsorb to glass

Back 133

insulin and denileukin difitox

Front 134

drugs that adsorb to rubber

Back 134

methyl paraben

Front 135

Leaching from plastic components

Back 135

phthalates from PVC and DEHP from surfactants

Front 136

Alternatives to PVC when it presents a problem

Back 136

ethylene vinyl acetate, polyolefin like polyethylene and polypropylene.

Front 137

alternative to DEHP

Back 137

non-DHEP PVC.