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99 Cards in this Set
- Front
- Back
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What does PICC stand for?
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Peripherally inserted central catheter
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If a medication has a pH of 4 what infusion line would you use? Peripheral or Central
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Central for pH <5 or >9
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If a medication has a pH of 6 what infusion line would you use?
Peripheral or Central |
Peripheral for pH 5-9
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If a medication causes vesicant what infusion line would you use?
Peripheral or Central |
Central
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If you are doing long term drug therapy, what infusion line would you use?
Peripheral or Central |
Central
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How often should you change a peripheral IV catheter?
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Change every 48-72 hours
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Which catheter's tip resides in the superior or inferior vena cava?
Peripheral or Central |
Central
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The permeation or penetration of substance into cell or tissue is called?
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Infiltration
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Symptoms: coolness of skin around site, shiny taut skin, edema of extremity, absence of back flow, slow infusion rate. What are these describing?
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Infiltration
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What are 3 things that can cause infiltration?
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1. Displaced device
2. Obstruction of blood flow 3. Inflammation |
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Ulceration, tissue necrosis, and muscle/nerve damage are complication of?
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Infiltration
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What 3 things can be done to treat infiltration?
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1. Discontinue infusion
2. Elevate extremity 3. Warm the site. |
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This is a precursor to infection from poor site preparation or catheter material/size incorrect.
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Phlebitis
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Symptoms: warm, induration, erythema with/without pain, edema, streak formation, palpable cord. What are these describing?
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Phlebitis
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The primary cause of phlebitis is?
What other causes are there? |
pH of infusion solution.
Other causes: trauma, condition of vein, improper cleaning of area, particulate. |
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This is caused by leakage of fluid or blood from blood vessel into surrounding tissue or spaces.
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Extravasation
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What should never be administered via a peripheral line due to extravasation adverse effect?
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Anti-neoplastic, dopamine, or vesicants
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Solutions of concentrations greater than what should never be infused via peripheral line?
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Osmolarity >600 mOsm/L
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What is the maximum amount of dextrose that can be infused in a peripheral line?
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<10%
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This term is the number of milliosmoles per kilogram of solvent.
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Osmolality
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This term is the number of milliosmoles per liter of solution.
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Osmolarity
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Is D5W/NS isotonic, hypotonic, or hypertonic?
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Hypertonic
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Is 0.45% NaCl isotonic, hypotonic, or hypertonic?
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Hypotonic
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At what pHs will the solution kill cell tissues on contact?
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<2.3 and >11
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Can you change pH by dilution?
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No
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When amino acids are greater than what do you need to infuse in a central line?
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Amino acids >5%
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This is a chemical process where a compound is cleaved into other compounds with the uptake of H and OH on either side of the bond cleaved.
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Hydrolysis
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What 3 drug structures discussed in lecture can undergo hydrolysis?
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Esters, Amides, Lactams
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This is increasing the valence of an atom/ion by the loss of a hydrogen.
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Oxidation
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What 2 drug structures discussed in lecture can undergo oxidation?
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Phenols, catechols
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In regards to ampicillin, does more degradation occur in a higher or lower concentration?
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Higher Concentration.
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Does ampicillin have more degradation in NS or in dextrose solution?
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More degradation in dextrose
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Manufacturers have formulated Phenytoin to be better stable for which purpose? IV push or IV infusion
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IV infusion
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Diazepam has been formulated for increased what?
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Increased stability
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The pH for D5W is 5. The pH for NS is 5.5 In D5W/NS is the pH higher or lower?
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Lower. pH of D5W/NS is 4.5
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Preservatives should never be given by this route?
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Intraspinal
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What 2 things are incompatible with bicarbonates?
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Acids and calcium ions.
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In a 3:1 TPN bag, lipids should never be less than what percent?
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<2%
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To minimize the risk of calcium/phosphate precipitation in PN, what can be done?
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1. >2.5% amino acids
2. <pH 6 3. Use calcium gluconate(not CaCl) 4. Separate addition of each. 5. Add phos first, dilute, add Ca. 6.Add cysteine 7. Administer with micron filter |
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Does visual compatibility mean it is chemically stable?
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No
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What cations cause incompatibilies with carbonates, phosphates, citrates, and large anions?
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Ca, Mg
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Symptoms: osteomalacia, altered mental status, muscle weakness, bone pain, non-healing fractures, premature osteoporosis. These describe what?
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Aluminum toxicity
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The greatest tendency to photochemical reactions occur with what groups?
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nitrate and sulfur-containing groups
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Which factor(s) may affect drug stability?
Color, temperature, container, disease state, light, or contact with needles |
Color, temperature, container, light, contact with needles
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What organization wrote guideline for pharmacists and technicians in preparing hazardous drugs?
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ASHP
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What organization wrote guidelines for protection of healthcare workers?
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NIOSH
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What organization wrote this guideline: safe handling of hazardous drugs?
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ONS- 2011
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What organization identifies risks to health-care employees exposed to hazardous drugs?
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OSHA
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The HCS is mandated by law. What are health care workers entitled to see?
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MSDS- material safety data sheet for any hazardous substance they may be exposed to.
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The goal of NIOSH in writing the alert for employers and health care workers was to?
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Inform workers of risk of working with hazardous drugs
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Whose responsibility is it to make MSDS available to employees?
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Employer
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Whose responsibility is it to clean up spills according to policy?
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Health care worker
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Who regulates the disposal of hazardous drugs?
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EPA- environmental protection agency
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Who issues permits for management of hazardous waste?
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EPA- environmental protection agency
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Who wrote the RCRA- resource conservation and recovery act?
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EPA- environmental protection agency
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The most significant risk of exposure occurs during?
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Distribution
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All packages should be sealed in _____ and all cartons must be appropriately ________.
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plastic; labeled
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The staff must wear what when stocking shelves of hazardous drugs?
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PPE- must be double gloved.
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Does the labeling of hazardous drugs need to be on the immediate container, outer packaging, or both?
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Both, immediate container and outer packaging
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Compounding of hazardous drugs should be prepared in?
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Class II or III BSC(biological safety cabinet) or negative pressure isolator
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To ensure effectiveness of air containment, this should be worn by workers using hazardous drugs.
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Front shield
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What else is needed in the BSC for hazardous drug prep?
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Pad
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Gloves should be changed how often when working with hazardous drugs?
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every 30 minutes, or each time you reenter the BSC-biological safety cabinet
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Gowns can not be worn for longer than ______ during a compounding session.
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3 hours
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Surgical masks do not provide worker protection in hazardous drug prep; what is recommended instead?
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Respirators
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Attaching tubing and priming IV bags with hazardous drugs should be done where?
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In BSC- biological safety cabinet
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Work areas should be cleaned with what procedure, and how often?
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Two-step decontamination/disinfecting procedure; daily
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No more than what percent of syringe volume should be used to prevent the plunger from separating from the syringe?
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75%
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Decontamination involves cleaning and what else?
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Deactivating hazardous substances
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Hazardous waste must be stored according to whom?
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EPA and Department of transportation
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Hazardous wastes are those listed as toxic by EPA or qualify how?
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One or more of the following: toxicity, ignitability, corrosivity, reactivity
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The waste container should be sealed when it is how full?
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3/4 (three-fourths) full
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Spill kits contain sufficient supplies to absorb a spill how large?
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1000ml spill
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After all contaminated materials are in disposal bags, what should the area be rinsed with?
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Water, and then clean with sodium hypochlorite
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This term is a separate space provided for air circulation.
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Plenum
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What is an example of a Plenum?
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Space between a structural ceiling and a drop down ceiling
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This term is a pipe, tube, or channel that conveys a substance.
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Duct
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An ISO class 5 is a cleanroom that has at most how many particles per m(cubed) of air?
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100,000 particles
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What guideline was written to reduce healthcare employees exposure to hazardous drugs?
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USP 797
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Occupational exposure to hazardous drugs can lead to?
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acute effects, chronic effects, cancer
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Bins that store hazardous drugs should have what?
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High fronts, guards on shelves
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What should be worn when receiving, distributing, stocking, taking inventory, preparing and disposing of hazardous drugs?
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Gloves (double gloved)
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In preparing hazardous drugs, what ISO class should the environment be? what ISO class should the surrounding area be?
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ISO class 5 environment in a ISO class 7 area.
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How often is verification of training done for handling hazardous drugs?
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Annually
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How often is surface sampling done?
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Every 6 months
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When cleaning up hazardous drug spill the worker should begin in areas of greater contamination or areas of lesser contamination?
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Begin in areas of lesser contamination.
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What online resources can be used to check chemotherapy?
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Chemoregimen.com
factsandcomparsions.com |
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What is the equation for BSA?
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Square root of ( (Height (cm) x Weight (kg)) / 3600)
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If a patient weighs 190 pounds and is 72 inches tall; what is the BSA?
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BSA= 2.1 m(squared)
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If the patient is to get doxorubicin 60mg/m2 on day 1; with a BSA of 2.1m2 what dose should they receive?
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126mg Doxorubicin
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Two pharmacists are suppose to check what?
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System order entry and preparation
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This is a closed system drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system.
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PhaSeal system.
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In nutrition should trailing zeros be used? should leading zeros be used?
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No trailing. Yes leading.
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In nutrition, can you abbreviate units and routes?
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No spell them all out.
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How do you calculate IBW for males and females?
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Males: IBW= 50kg +2.3kg for each inch over 5 feet.
Females: IBW = 45.5kg + 2.3kg for each inch over 5 feet. |
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When do you use the adjusted body weight for total Kcal calculations? What is the equation?
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ABW: when actual body weight is > 120% IBW.
ABW = 0.25(actual -IBW) + IBW |
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What is the IBW of a male patient 6'3'' and 285lbs?
What % of IBW is his current weight? |
IBW= 84.5kg
IBW= 50kg + 2.3kg(15inches over 5 feet) %IBW=154% 285lbs x 1kg/2.2lbs=130kg %IBW= 130kg/84.5kg x 100= 154% |
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If a patient is 154% IBW of is current weight, does an adjusted body weight need to be done?
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Yes,
ABW= 0.25(130kg-84.5kg) + 84.5kg ABW= 96kg |
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What is the rule of thumb for kcal of nutrition in normal; severe injury; and trauma/burn?
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Normal: 25-50 kcal/kg
Severe injury: 30-40 kcal/kg Trauma/Burn: 45-55kcal/kg |
