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187 Cards in this Set
- Front
- Back
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What is definiation of parenteral products
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administration of medication "outside intestine"
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List Safety requirements for parenteral
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Sterile
Pyrogen-Free Stable Particulate Free |
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What is sterile
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free of any living organisms
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What is Pyrogen-Free
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w/o fever producing organic substances
No-LPS (lipopolysaccarides) No-endotoxins |
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What is stable
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comptible with diluents, and drugs
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What is particulate free
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No contaminatns, glass, corning, and dandruff
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What other types of fluids require sterility
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besides paternal, biologicals, dialysis solutions, adn opthalmic
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What does sterility reduce
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Morbiity-(does not cause of disease
Mortality-(does not cause death) |
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2 Types of Parental fluids
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Small volume (50-100ml)
Large volume >100ml |
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What are disadvantages of parenteral administration
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Infection, Infiltration, Incompatilibties and, Pain Phlebitis, and Hematoma
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What types of infection can parenteral cause
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site or systemic
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What is a hematoma
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BLODD escapes into surronding tissues
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What is infliltration
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DRUG escapes into surrounding tissues
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What is phlebitis
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inflammation of VEIN due to trama
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Other (non-medical) disadvantages of parenteral
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cost, needle-sticks and pump failures
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Deadly risks
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Thromboembolism, and embolism,
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What is disadvantage of side effects/ allergies/overdose
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TO late to reverse
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Differance between Thromboembolism and embolism
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throemboembolism-blood clot
embolism-clot by particle air, glass (anything besides blood) |
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3 Main routs of injection
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Intravenous, Intramuscular, and subcutaneous
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The higher the gauge the
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the smaller the bore ( thinner the needle size)
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What is an IV push/bolus
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direct administration through skin by syringe, or Y-site
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What are continous IV, and tyep
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large volumes, run continually, types are
matinance of fluids, electroyles replacement, adn nutrition requirements, continous basis (prevents up and down, restore hemodynamic stabilty |
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What are some meds that require continous IV
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heparin, inotropic agents, adn chemo drugs
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What is piggyback
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small volume medication is conected to existing line or Y site, adn mixed with mateince fluid (usally D5W or NS)
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What are Pumps
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IV fluid that can be administrated from a syringe, buretrol or IV bag
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Where are IM injections administered
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DEEP into large skeletal muscles
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Response time of IM compared to IV
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response is delayed but lengthened
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What are depot injections
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solid or oil-based, so disolve slowly, increase DOA
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What bioavailabilties affect IM adminitration
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affinity of drug to tissue, diluent, vascularity and size of muscle
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What increase with IM injections
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CPK--serum creatine phosphokinase--indicated muscle damage
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Benifits of Z-track techniquie
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prevent infiltration
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How can pH change in phenytoin affect adsorption
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pH converts phenytoin to free solid, and dissolves more slowly, increasing duration of action
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Best site for IM
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OUTER UPPER quardrant of Gluteral region--stay away from sciatic nerve
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What diluents provides the longest DOA
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olegenous diluents
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Where is a Sub-Q administered
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into interstitial space, just under skin
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What type of fluids can you inject in sub-q
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solutions and suspension
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What type of fluids can you inject IM
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solutions aand suspension, but also Oleaginous solutions
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Why DOA of sub-q slow
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poor tissue vascularity, adn vasoconstrictors
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What are factors that increase adsoprtion
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excercise, heat, and physical manipulation
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What is max amt of fluid can be inject for sub-q
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1ml
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Are isulin usaually self-administered
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yes
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Type of Insulins
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long acting and short acting
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Long actininsulins
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zinc adn isophane
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What is typical measurement of insulin
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100 unit/mL
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Do you need to squeeze skin of sub-q
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YES
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Sub-q site
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butt, stomach, and upper outer arm, and anterior thigh
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Range of syringes
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1ml-60ml
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Types of syringes
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PVC (hard plastic) or glass, and luer-lock
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Gauge of needle, and lengths
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Gauge: 16-29
Length: 5/8" to 1 1/2" |
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Vial can be for single or mulitple use, but mutiple use will always have
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bacteriostatic agent
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What type of vials have higer risk of corning (plastic), and how to prevent
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mutiuse- should enter at 45 degree angle
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What is an ampule
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glass container with thin neck, need to snap neck to open
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How do draw up fluid from ampule
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draw up with regular needle, and then switch to filter needle (to trap any glass particles that entered the seterile solution when broke glass neck
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Type of pre-filled syringes
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emergency, narcotis, and heparin
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What is soprtion, adn how prevent
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drugs attach to containers as porous, put in approtiate container
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Site of IV
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antecubital, large superficial veins
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Site of IM
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gluteral, deltoid, and in children midlateral thigh
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Site of sub-q
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stomach, thigh, adn arms
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Needle size of IV
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15-25
1-2 inches |
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Needle size of IM
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19-22
1-2 inches |
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Site of IV
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antecubital, large superficial veins
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Site of IM
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gluteral, deltoid, and in children midlateral thigh
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Site of sub-q
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stomach, thigh, adn arms
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Needle size of IV
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15-25
1-2 inches |
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Needle size of IM
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19-22
1-2 inches |
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Needle size of sub-q
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24-25
1/4-1/2 inch |
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Volume injected in IV
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no limit
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Volume injected in IM
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Gluteral 5ml max
Deltoid 2 ml max |
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Woume injected in Sub-q
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1/2-1 most common
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What type of material protects from light
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opaque
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What % or dextrose is isotonic,
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5%
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What % of dextrose is hypotonic and hypertonic
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Hypo-2.5
Hyper 10-70 |
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What pH is D5W
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4.8
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What % NaCL is isotonic
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0.9
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What % of Nacl is hypotonic
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1/4 NS Hypo
1/2 NS Hyper |
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What pH is NS
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6
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What tonicity is D5W1/2NS and pH
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Hypotonic 5
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What tonicity is Lacteated ringers and pH
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Isotonic, 6.5
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What happens when you administer a isotonic fluid IV
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Water content is same as body--so water neither leaves no stays
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How do LVP restore hymodynamic stabilty
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dehydration= low blood volume, increase HR, add aduaqte fluids, normailize HR
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What is benifit of LVP providing continuous agents
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keeps normal verus going up and down
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What happens when you parentaleraly add hypotonic fluid
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Full of water, cells in extracellular space adsorb water, and intracellular space
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What happens when you paretnally add hypertonic
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Less WATER then blood, cells in blood will adsorb from EXTRAcelluar--intersitial
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What is distribution of water
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60% is body weight
2/3 intracellular 1/3 extracellular 3/4 is interstital and 1/4 intravacular |
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What type of fluid if you want to replete VENOUS or ATERIAL fluid volume
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INTRAVASULCAR want to keep in veins-so ISOTONIC
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Type of fluid for Mild to moderate dehydration of intersitial sapce
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Add Hypotonic solutiont to IV
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Type of fluid for Severe dehydration (intracellular)
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Start isotonic, adn slowly switch to hypotonic
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What should you do for overload or edema of (intersitial space)
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start diuretic, adn restrict fluids
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What should you do for Cerbral edema (intracellualar)
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Intracellular is selfish, careful administration of Hot Salts (hypertonic)
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What does it mean the intracellular space is selfish
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last to let go of water
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Purpose of USP solvent/diluent added to a medication for
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RDSS
roconstitution dilution stablization solubility |
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What are 7 solvents used in prepartion of paretneral medications
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Sterile Water
Water for injection Bacteriostatic water 0.9 NaCl Oils for injection Non-aqueous vehicles |
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What is most common solvent
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Sterile water
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Properties of sterile water for injection
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single dosed
hypotonic pyrogen free and sterile |
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Properties of bacteriostaic water for injection
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Multi-dose
Sterile Pyrogen Free Bacteriostatic agent |
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Types of bacteriostatic agents
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Benzyl alcohol, Benzalkonium CL, Chlorobutanol, Methylparaben, and polyparaben, and Phenol
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What is largest container of bacteriostatic
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30ml
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Problems with bacteriostatic water
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Changes the solubility and stability, can't exceed 5mL/IV compound, inheret toxicity (liver)
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Biggest waring with
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DO NOT USE IN NEONATES due to gasping syndrome (benzyl alcohol)
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Properties of NS for injection
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sterile,single dose, isotonic, pyrogen free, and flush lines
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Is Regular water for injection purified and how
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distillation adn reverse osmosis
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When does regular water have to be used, and when sterilzied
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used within 24hrs after opening, and sterilaize after prepartion
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Examokes of oils for injections and why hyrdophoic
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steriods, vitamin E, and hormones--4 rings
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Regular water for can only used for what reason?
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PREPARTION--then sterilized after
NOT USED in DILUTION of package parental prodution |
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Examples of acceptable oil injections
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Sesame, Soybean, peanut, olive and corn
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Unacceptable oils for injections
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Mineral oil, and hydrocarbon based
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Can you inject oils by IV?
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ONLY if emulsified--b/c could cause occulsion of pulmonary microcirculation
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Example of emulsifying agent
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Egg yolk
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Example of stabilized
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Glycerin
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What are gold standards of oil
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chemical adn phyiscal stabilty at various temps and ph
fluid at room remp heat sterilization meet standards of purity |
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How does emlusying agent work
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have oil in water (bad),emlusying agents have a hydrophbic head, and and hydrophilic tail, heads with surround that oil, and increase solubility
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What does stabilter do
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oil is not homogenously dispered in water
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Benifits of non-aqueous vechiles
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many meds are both hydrophobic and hydrophilic, only partially water solulbe so non-aqeous increase med solubility and prevent precipitaion
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Common non-aqueous solvents
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propylene glycol
polyethylene glycol glycerin adn ETHYL alcohol Isopropyl myristate, and dimethyl acetamide |
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Do non-aqueous have same gold stands as oil, and when are used
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YES--when drugs are prone to hydrolysis
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Should solvents be non-irritating and NO pharmacologic activity
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YES
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What are 5 reasons to add ADDITIVES to a parental product
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maintain ph,
stabilty sterility solubility, ease administration |
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Example of Diazepam
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not hydrophilic so addition non-aqueous-ethyl alcohol
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What is diazepam raite limited to 5mg/min
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not very soluble, adn can cause vascular irriation and collapse
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What additives increase solubility
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non-aqueous-have both hydrophobic and hydrophilic properties
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Examples of drugs that pooor solubility and need non-aqeous solution
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barbituares, antihistamines, and cardiac glycosides
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What are additives that maintain stability
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Antioxidants and chelating agents
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Do antioxidants have a lower risk of oxidation than drugs
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YES
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Can sodium and potassium salts be used as antioxidants at all pH's
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YES
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Antioxidants used at low pH
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sodium and potassium metasulfite
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Antioxidants used at imtermiedate pH
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sodium bisulfite
potassium bisulfite |
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Antioxidants used at high pH
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sodium sulfite
potassium sulfite |
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What are chelating agents used for
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maintaing STABILTY--enhance activity of antioxidants
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Do buffers also enhance drug stability
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YES
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Examples of Chelating agents
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EDTA, dicarboxcilic acid, tartaric acid, and citric acid
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What is ascobic acid used for
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ANTIOXIDANT/Buffer
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What is recommended expiration for a multidose vial
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30 days
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Does USP limit conentration of bacteriostaic agents
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YES
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What is baxteriostatic
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SUPRESSES bacterial growth
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What do you add to hypotonic solutions to ease administration
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NaCl or dextrose
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What do you add to hypertonic to ease administration
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change route or slow rate of injection
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What are additives that reduce pain
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Benzyl alcohol,
anestetics (xylocaine and procaine), and vasocontrition |
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What does epinephrine do
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vasocontstricts to limit systemic adsoprtion
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Where can injection of hypertonic solutions be least painful
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sights of high blood flow
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What is instability of medication
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involves chemical reactions taht are irreversible and render of medication inactive or toxic
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What can cuase medication instability
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reduction or oxidative reactions
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Incompatiblities are classifed as physical or chemcial,,but all are
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Chemical
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What is expiration
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self-life (90% of active drug) is expired
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Examples of physical incompatibilties
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solubilty changes, precipiatae, changes in concentration with container, and complexation
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Examples of checmial incompatibilies
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hydrolysis, oxidation-reduction, photo-lysis, and racemizatino or epimerization
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A drug is maintained in solution as long as
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its concentration is less then saturation
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Do superstaurated solutions immediately saturate
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NO (time or agitation)
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Examples of supersatured solutions
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Bactrim
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At what concentration is dizepam stable and ont form precipitate
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10mg with 50mg of NS
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Medication is a weak acid, addition of what will make it charged
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addition of Base, will take H+,
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Medication of a weak base should be formulated with what to maximuize solubility
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addition of acid
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Can a precipated occur when high concentration of Ca+ and phosphate?
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YES
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What should you always do when mixing calcium and phosphate
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Calcium is added before phosphate
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What type of calcium should only be used
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Calcium gluconate
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What other things can cause preciptiation of calcium and phospahte
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increase temp (room temp, and ph changes
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What should pharmacist do to prevent precipation of calcium and phosphate
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agitate the base
use of 1.2mcg filter for 3-1 and 0.22 for 2-1 |
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Is heparin compatible with anything adn why
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NO!!! large organic ION precipated easily
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What can result from adsoprtion or soprtion
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sub-therapetuic dosing for drugs at low concentrations
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Is adsoprtion a big deal at high concentrations
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not as relevant
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What are glass bottle treated with
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silanol
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What does silanol specially prevent
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hydrophilic meds from binding, but NOT hydrophobic
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What do PVC containers treated with
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plasticizer to maintain flexibility
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How can placticizer be drawn into solution
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large amount of co-solvents
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What are drugs that exhibit adsoprtion
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VIND
Vitiamin A, Insulin, NTG, and diazpam |
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What is complexion do they always form preciptiates
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when medications form insoluble chelates, not always
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What does tertacyline from complexation with
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Ca, Mg, Al, and Fe
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What do Amphotericin B adn erthyromycin chelate with
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bacteriostaic water
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What is color change a result of
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chemical interaction that changes the molecular structure
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What color change is ok between epinehrine and acyclovir
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Acyvlovir inactivation ok, epinephrine NOT
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What is most common chemical reaction resulting in instability
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hydrolysis
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What is Oxidation and reduction
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OIL,RIG
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What are most medication present in and why problem
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reduced more, so even atmospheic oxygen can create stability problems
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How can you prevent oxidation
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removal of air, adjusting pH, adding antioxidants, and chelating agents
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Reduction reactions are rare, but one example
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Beta-lactams--Penicillin
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What is photolysis
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excites electrons, stimulates oxidation hydrolytic degradation
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What light is most destructive
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ultraviolet
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Stategies for overcoming photodegration
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dark opaque vials or coverings, bag or aluminum foil
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Example of prevention of photodegration
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furosemide
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Do drugs that different optically active chiral centers have different pharamcologic activity
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Sometimes...Epinehire L isomer is 15x more active than D
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Do drugs that different optically active chiral centers have different pharamcologic activity
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Sometimes...Epinehire L isomer is 15x more active than D
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Do drugs that different optically active chiral centers have different pharamcologic activity
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Sometimes...Epinehire L isomer is 15x more active than D
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Why does D5W initally isotonic, and then turns hypotonic
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b/c cells begin to adsorp sugar
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What is hydrolsis
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when water attacks labile bonds, when the drug is in solution
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2 classes of drug suspetible to hydrolsis
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esters, and carboxcillic acids
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What is a 3-1 prepartion
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Dextrose, lipids, and amino acid, (also K phosphate, and calcium gluconate
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2 Problems with 3-1 prepation
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pulmonary emboli, and lipid emlusion will mask precipatiate
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What are cyclic AMIDES
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LACTAMS
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