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187 Cards in this Set

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What is definiation of parenteral products
administration of medication "outside intestine"
List Safety requirements for parenteral
Sterile
Pyrogen-Free
Stable
Particulate Free
What is sterile
free of any living organisms
What is Pyrogen-Free
w/o fever producing organic substances
No-LPS (lipopolysaccarides)
No-endotoxins
What is stable
comptible with diluents, and drugs
What is particulate free
No contaminatns, glass, corning, and dandruff
What other types of fluids require sterility
besides paternal, biologicals, dialysis solutions, adn opthalmic
What does sterility reduce
Morbiity-(does not cause of disease
Mortality-(does not cause death)
2 Types of Parental fluids
Small volume (50-100ml)
Large volume >100ml
What are disadvantages of parenteral administration
Infection, Infiltration, Incompatilibties and, Pain Phlebitis, and Hematoma
What types of infection can parenteral cause
site or systemic
What is a hematoma
BLODD escapes into surronding tissues
What is infliltration
DRUG escapes into surrounding tissues
What is phlebitis
inflammation of VEIN due to trama
Other (non-medical) disadvantages of parenteral
cost, needle-sticks and pump failures
Deadly risks
Thromboembolism, and embolism,
What is disadvantage of side effects/ allergies/overdose
TO late to reverse
Differance between Thromboembolism and embolism
throemboembolism-blood clot
embolism-clot by particle air, glass (anything besides blood)
3 Main routs of injection
Intravenous, Intramuscular, and subcutaneous
The higher the gauge the
the smaller the bore ( thinner the needle size)
What is an IV push/bolus
direct administration through skin by syringe, or Y-site
What are continous IV, and tyep
large volumes, run continually, types are
matinance of fluids, electroyles replacement, adn nutrition requirements, continous basis (prevents up and down, restore hemodynamic stabilty
What are some meds that require continous IV
heparin, inotropic agents, adn chemo drugs
What is piggyback
small volume medication is conected to existing line or Y site, adn mixed with mateince fluid (usally D5W or NS)
What are Pumps
IV fluid that can be administrated from a syringe, buretrol or IV bag
Where are IM injections administered
DEEP into large skeletal muscles
Response time of IM compared to IV
response is delayed but lengthened
What are depot injections
solid or oil-based, so disolve slowly, increase DOA
What bioavailabilties affect IM adminitration
affinity of drug to tissue, diluent, vascularity and size of muscle
What increase with IM injections
CPK--serum creatine phosphokinase--indicated muscle damage
Benifits of Z-track techniquie
prevent infiltration
How can pH change in phenytoin affect adsorption
pH converts phenytoin to free solid, and dissolves more slowly, increasing duration of action
Best site for IM
OUTER UPPER quardrant of Gluteral region--stay away from sciatic nerve
What diluents provides the longest DOA
olegenous diluents
Where is a Sub-Q administered
into interstitial space, just under skin
What type of fluids can you inject in sub-q
solutions and suspension
What type of fluids can you inject IM
solutions aand suspension, but also Oleaginous solutions
Why DOA of sub-q slow
poor tissue vascularity, adn vasoconstrictors
What are factors that increase adsoprtion
excercise, heat, and physical manipulation
What is max amt of fluid can be inject for sub-q
1ml
Are isulin usaually self-administered
yes
Type of Insulins
long acting and short acting
Long actininsulins
zinc adn isophane
What is typical measurement of insulin
100 unit/mL
Do you need to squeeze skin of sub-q
YES
Sub-q site
butt, stomach, and upper outer arm, and anterior thigh
Range of syringes
1ml-60ml
Types of syringes
PVC (hard plastic) or glass, and luer-lock
Gauge of needle, and lengths
Gauge: 16-29
Length: 5/8" to 1 1/2"
Vial can be for single or mulitple use, but mutiple use will always have
bacteriostatic agent
What type of vials have higer risk of corning (plastic), and how to prevent
mutiuse- should enter at 45 degree angle
What is an ampule
glass container with thin neck, need to snap neck to open
How do draw up fluid from ampule
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
Type of pre-filled syringes
emergency, narcotis, and heparin
What is soprtion, adn how prevent
drugs attach to containers as porous, put in approtiate container
Site of IV
antecubital, large superficial veins
Site of IM
gluteral, deltoid, and in children midlateral thigh
Site of sub-q
stomach, thigh, adn arms
Needle size of IV
15-25
1-2 inches
Needle size of IM
19-22
1-2 inches
Site of IV
antecubital, large superficial veins
Site of IM
gluteral, deltoid, and in children midlateral thigh
Site of sub-q
stomach, thigh, adn arms
Needle size of IV
15-25
1-2 inches
Needle size of IM
19-22
1-2 inches
Needle size of sub-q
24-25
1/4-1/2 inch
Volume injected in IV
no limit
Volume injected in IM
Gluteral 5ml max
Deltoid 2 ml max
Woume injected in Sub-q
1/2-1 most common
What type of material protects from light
opaque
What % or dextrose is isotonic,
5%
What % of dextrose is hypotonic and hypertonic
Hypo-2.5
Hyper 10-70
What pH is D5W
4.8
What % NaCL is isotonic
0.9
What % of Nacl is hypotonic
1/4 NS Hypo
1/2 NS Hyper
What pH is NS
6
What tonicity is D5W1/2NS and pH
Hypotonic 5
What tonicity is Lacteated ringers and pH
Isotonic, 6.5
What happens when you administer a isotonic fluid IV
Water content is same as body--so water neither leaves no stays
How do LVP restore hymodynamic stabilty
dehydration= low blood volume, increase HR, add aduaqte fluids, normailize HR
What is benifit of LVP providing continuous agents
keeps normal verus going up and down
What happens when you parentaleraly add hypotonic fluid
Full of water, cells in extracellular space adsorb water, and intracellular space
What happens when you paretnally add hypertonic
Less WATER then blood, cells in blood will adsorb from EXTRAcelluar--intersitial
What is distribution of water
60% is body weight
2/3 intracellular
1/3 extracellular

3/4 is interstital and 1/4 intravacular
What type of fluid if you want to replete VENOUS or ATERIAL fluid volume
INTRAVASULCAR want to keep in veins-so ISOTONIC
Type of fluid for Mild to moderate dehydration of intersitial sapce
Add Hypotonic solutiont to IV
Type of fluid for Severe dehydration (intracellular)
Start isotonic, adn slowly switch to hypotonic
What should you do for overload or edema of (intersitial space)
start diuretic, adn restrict fluids
What should you do for Cerbral edema (intracellualar)
Intracellular is selfish, careful administration of Hot Salts (hypertonic)
What does it mean the intracellular space is selfish
last to let go of water
Purpose of USP solvent/diluent added to a medication for
RDSS
roconstitution
dilution
stablization
solubility
What are 7 solvents used in prepartion of paretneral medications
Sterile Water
Water for injection
Bacteriostatic water
0.9 NaCl
Oils for injection
Non-aqueous vehicles
What is most common solvent
Sterile water
Properties of sterile water for injection
single dosed
hypotonic
pyrogen free
and sterile
Properties of bacteriostaic water for injection
Multi-dose
Sterile
Pyrogen Free
Bacteriostatic agent
Types of bacteriostatic agents
Benzyl alcohol, Benzalkonium CL, Chlorobutanol, Methylparaben, and polyparaben, and Phenol
What is largest container of bacteriostatic
30ml
Problems with bacteriostatic water
Changes the solubility and stability, can't exceed 5mL/IV compound, inheret toxicity (liver)
Biggest waring with
DO NOT USE IN NEONATES due to gasping syndrome (benzyl alcohol)
Properties of NS for injection
sterile,single dose, isotonic, pyrogen free, and flush lines
Is Regular water for injection purified and how
distillation adn reverse osmosis
When does regular water have to be used, and when sterilzied
used within 24hrs after opening, and sterilaize after prepartion
Examokes of oils for injections and why hyrdophoic
steriods, vitamin E, and hormones--4 rings
Regular water for can only used for what reason?
PREPARTION--then sterilized after
NOT USED in DILUTION of package parental prodution
Examples of acceptable oil injections
Sesame, Soybean, peanut, olive and corn
Unacceptable oils for injections
Mineral oil, and hydrocarbon based
Can you inject oils by IV?
ONLY if emulsified--b/c could cause occulsion of pulmonary microcirculation
Example of emulsifying agent
Egg yolk
Example of stabilized
Glycerin
What are gold standards of oil
chemical adn phyiscal stabilty at various temps and ph
fluid at room remp
heat sterilization
meet standards of purity
How does emlusying agent work
have oil in water (bad),emlusying agents have a hydrophbic head, and and hydrophilic tail, heads with surround that oil, and increase solubility
What does stabilter do
oil is not homogenously dispered in water
Benifits of non-aqueous vechiles
many meds are both hydrophobic and hydrophilic, only partially water solulbe so non-aqeous increase med solubility and prevent precipitaion
Common non-aqueous solvents
propylene glycol
polyethylene glycol
glycerin adn ETHYL alcohol
Isopropyl myristate, and dimethyl acetamide
Do non-aqueous have same gold stands as oil, and when are used
YES--when drugs are prone to hydrolysis
Should solvents be non-irritating and NO pharmacologic activity
YES
What are 5 reasons to add ADDITIVES to a parental product
maintain ph,
stabilty
sterility
solubility,
ease administration
Example of Diazepam
not hydrophilic so addition non-aqueous-ethyl alcohol
What is diazepam raite limited to 5mg/min
not very soluble, adn can cause vascular irriation and collapse
What additives increase solubility
non-aqueous-have both hydrophobic and hydrophilic properties
Examples of drugs that pooor solubility and need non-aqeous solution
barbituares, antihistamines, and cardiac glycosides
What are additives that maintain stability
Antioxidants and chelating agents
Do antioxidants have a lower risk of oxidation than drugs
YES
Can sodium and potassium salts be used as antioxidants at all pH's
YES
Antioxidants used at low pH
sodium and potassium metasulfite
Antioxidants used at imtermiedate pH
sodium bisulfite
potassium bisulfite
Antioxidants used at high pH
sodium sulfite
potassium sulfite
What are chelating agents used for
maintaing STABILTY--enhance activity of antioxidants
Do buffers also enhance drug stability
YES
Examples of Chelating agents
EDTA, dicarboxcilic acid, tartaric acid, and citric acid
What is ascobic acid used for
ANTIOXIDANT/Buffer
What is recommended expiration for a multidose vial
30 days
Does USP limit conentration of bacteriostaic agents
YES
What is baxteriostatic
SUPRESSES bacterial growth
What do you add to hypotonic solutions to ease administration
NaCl or dextrose
What do you add to hypertonic to ease administration
change route or slow rate of injection
What are additives that reduce pain
Benzyl alcohol,
anestetics (xylocaine and procaine), and vasocontrition
What does epinephrine do
vasocontstricts to limit systemic adsoprtion
Where can injection of hypertonic solutions be least painful
sights of high blood flow
What is instability of medication
involves chemical reactions taht are irreversible and render of medication inactive or toxic
What can cuase medication instability
reduction or oxidative reactions
Incompatiblities are classifed as physical or chemcial,,but all are
Chemical
What is expiration
self-life (90% of active drug) is expired
Examples of physical incompatibilties
solubilty changes, precipiatae, changes in concentration with container, and complexation
Examples of checmial incompatibilies
hydrolysis, oxidation-reduction, photo-lysis, and racemizatino or epimerization
A drug is maintained in solution as long as
its concentration is less then saturation
Do superstaurated solutions immediately saturate
NO (time or agitation)
Examples of supersatured solutions
Bactrim
At what concentration is dizepam stable and ont form precipitate
10mg with 50mg of NS
Medication is a weak acid, addition of what will make it charged
addition of Base, will take H+,
Medication of a weak base should be formulated with what to maximuize solubility
addition of acid
Can a precipated occur when high concentration of Ca+ and phosphate?
YES
What should you always do when mixing calcium and phosphate
Calcium is added before phosphate
What type of calcium should only be used
Calcium gluconate
What other things can cause preciptiation of calcium and phospahte
increase temp (room temp, and ph changes
What should pharmacist do to prevent precipation of calcium and phosphate
agitate the base
use of 1.2mcg filter for 3-1 and 0.22 for 2-1
Is heparin compatible with anything adn why
NO!!! large organic ION precipated easily
What can result from adsoprtion or soprtion
sub-therapetuic dosing for drugs at low concentrations
Is adsoprtion a big deal at high concentrations
not as relevant
What are glass bottle treated with
silanol
What does silanol specially prevent
hydrophilic meds from binding, but NOT hydrophobic
What do PVC containers treated with
plasticizer to maintain flexibility
How can placticizer be drawn into solution
large amount of co-solvents
What are drugs that exhibit adsoprtion
VIND
Vitiamin A, Insulin, NTG, and diazpam
What is complexion do they always form preciptiates
when medications form insoluble chelates, not always
What does tertacyline from complexation with
Ca, Mg, Al, and Fe
What do Amphotericin B adn erthyromycin chelate with
bacteriostaic water
What is color change a result of
chemical interaction that changes the molecular structure
What color change is ok between epinehrine and acyclovir
Acyvlovir inactivation ok, epinephrine NOT
What is most common chemical reaction resulting in instability
hydrolysis
What is Oxidation and reduction
OIL,RIG
What are most medication present in and why problem
reduced more, so even atmospheic oxygen can create stability problems
How can you prevent oxidation
removal of air, adjusting pH, adding antioxidants, and chelating agents
Reduction reactions are rare, but one example
Beta-lactams--Penicillin
What is photolysis
excites electrons, stimulates oxidation hydrolytic degradation
What light is most destructive
ultraviolet
Stategies for overcoming photodegration
dark opaque vials or coverings, bag or aluminum foil
Example of prevention of photodegration
furosemide
Do drugs that different optically active chiral centers have different pharamcologic activity
Sometimes...Epinehire L isomer is 15x more active than D
Do drugs that different optically active chiral centers have different pharamcologic activity
Sometimes...Epinehire L isomer is 15x more active than D
Do drugs that different optically active chiral centers have different pharamcologic activity
Sometimes...Epinehire L isomer is 15x more active than D
Why does D5W initally isotonic, and then turns hypotonic
b/c cells begin to adsorp sugar
What is hydrolsis
when water attacks labile bonds, when the drug is in solution
2 classes of drug suspetible to hydrolsis
esters, and carboxcillic acids
What is a 3-1 prepartion
Dextrose, lipids, and amino acid, (also K phosphate, and calcium gluconate
2 Problems with 3-1 prepation
pulmonary emboli, and lipid emlusion will mask precipatiate
What are cyclic AMIDES
LACTAMS