Phar 331 Exam #3

Front 1

administered by continuous infusion (CI) and are used to replenish fluids and/or electrolytes and can be used for TPNs?

Back 1

large volume parenterals

Front 2

administered in volumes 100 ml to 1000 ml and maybe more for TPN?

Back 2

large volume parenterals

Front 3

IV bags, glass bottles, TPN solutions, dialysis fluids are examples of?

Back 3

large volume parenterals (LVPs)

Front 4

LVP sizes?

Back 4

250, 500, 1000 mL

Front 5

used as primary fluid or base for mixture?

Back 5

LVPs

Front 6

most commonly sterile water, various NaCl strengths, D5W, lactated Ringers?

Back 6

LVPs

Front 7

used for drugs unstable in plastic IV bags due to leaching/absorption?

Back 7

glass bottles for IV infusion

Front 8

hermetic container that when opened cannot be resealed with assurance that sterility has been maintained?

Back 8

single dose container

Front 9

hermetic container that permits withdrawal of successive portions of contents without changing drug in any way?

Back 9

multiple-dose container

Front 10

can sterile water alone be given IV?

Back 10

no, too hypotonic

Front 11

max package volume for sterile water?

Back 11

1000 mL

Front 12

sterile water that contains one or more antimicrobial agents?

Back 12

bacteriostatic water

Front 13

used in preparation of small volume injectables and container must have names and proportions of antimicrobial agents on it?

Back 13

bacteriostatic water

Front 14

why can't bacteriostatic water be used in neonates?

Back 14

risk of toxicity with benzyl alcohol

Front 15

why should preservative containing diluents be avoided in injections intended for the CNS?

Back 15

can cause significant spinal cord damage, CNS toxicity, potential seizures

Front 16

0.9% NaCl in mEq/L and mOsmol/L?

Back 16

154, 308

Front 17

used as sterile vehicle, flush, or fluid replacement?

Back 17

sodium chloride injection

Front 18

hypotonic form of sodium chloride injection?

Back 18

0.45% NaCl

Front 19

bacteriostatic water for injection (BSWI) precautions?

Back 19

large volume use, neonates, CNS injections

Front 20

packaged in multiple dose containers of 30 mL or less?

Back 20

bacteriostatic sodium chloride injection

Front 21

often used with other pharmaceutical ingredients (and combined with D5W) to increase solution osmolarity?

Back 21

0.45% NaCl

Front 22

D5W osmolarity?

Back 22

252 mOsmol/L?

Front 23

dextrose comes in what concentrations?

Back 23

5, 10, 50%

Front 24

administered IV for caloric value and for fluid replenishment?

Back 24

dextrose injection

Front 25

use caution in diabetics, critically ill, chronically malnourished, alcoholics, and those with electrolyte abnormalities with?

Back 25

dextrose

Front 26

sterile solution of sodium chloride, potassium chloride, and calcium chloride in water for injection?

Back 26

Ringer's injection

Front 27

what is key for the concentrations of things in Ringer's injection?

Back 27

similar to that found in physiological fluids

Front 28

Ringer's injection osmolarity?

Back 28

310 mOsmol/L

Front 29

may be used as a vehicle or IV for electrolyte/fluid replacement?

Back 29

Ringer's injection

Front 30

cannot be given in combination with ceftriaxone to neonates (or anyone if in same line)? why?

Back 30

Ringer's injection, because calcium and ceftriaxone precipitate

Front 31

sterile solution of sodium chloride, potassium chloride, calcium chloride, and sodium lactate in water for injection?

Back 31

lactated Ringer's

Front 32

lactated Ringer's osmolarity?

Back 32

273 mOsmol/L

Front 33

IV as an electrolyte/fluid replenisher and as a systemic alkalizer?

Back 33

lactated Ringer's

Front 34

ethyl alcohol, propylene glycol, glycerin, polyethylene glycols, and fixed vegetable oils are all what in terms of injections?

Back 34

non-aqueous vehicles

Front 35

why use non-aqueous vehicles?

Back 35

when solubility or stability problems arise in pure aqueous vehicle

Front 36

must be used in minimum amount necessary and must not exert pharmacologic activity or effect activity of medicinal agents?

Back 36

non-aqueous vehicles

Front 37

what pharmaceutical ingredient is not allowed for IV?

Back 37

colorants

Front 38

what pharmaceutical ingredients must be contained in multiple dose containers unless the drug itself is bacteriostatic?

Back 38

antimicrobial preservatives

Front 39

buffers, solubilizers, perservatives and antioxidants are all types of?

Back 39

pharmaceutical ingredients

Front 40

destruction of all living organisms and their spores or their complete removal from the parenteral preparation?

Back 40

sterilization

Front 41

sterilization methods?

Back 41

steam, dry heat, filtration, gas sterilization, sterilization by ionizing radiation

Front 42

what is the sterilization method choice based on?

Back 42

drug stability under sterilization conditions

Front 43

what, historically, is the concern regarding plastic IV bags?

Back 43

PVC and DEHP

Front 44

why do IV bags often come with plastic overwrap?

Back 44

to prevent loss of liquid through IV bag over time

Front 45

used to supply fluids, electrolytes, and calories to pt recovering from surgery?

Back 45

maintenance therapy

Front 46

what is a consideration to be had for long term maintenance therapy?

Back 46

need to meet higher caloric content

Front 47

used for pt who have suffered heavy loss of fluids and electrolytes?

Back 47

replacement therapy

Front 48

usually replacement therapy transitions to?

Back 48

maintenance therapy

Front 49

daily water requirement?

Back 49

25-40 ml/kg body weight

Front 50

what to consider when giving fluid?

Back 50

overload (give less), hypotension or dehydration (give more)

Front 51

IV fluids containing sodium or salts aka?

Back 51

crystalloids (like NS and LR)

Front 52

IV fluids containing dispersion of large molecular weight molecules aka?

Back 52

colloids (albumin, hetastarch, dextran)

Front 53

IV fluids that distribute in same way as total body water?

Back 53

dextrose-containing fluids

Front 54

remains in extracellular fluid (3/4 interstitial, 1/4 intravascular)?

Back 54

crystalloids

Front 55

used for plasma volume expansion and stays intravascular?

Back 55

colloids

Front 56

2/3 intracellular, 1/3 extracellular distribution with?

Back 56

dextrose-containing fluids

Front 57

patients with life threatening low Na levels get?

Back 57

3% NaCl infusions

Front 58

serum sodium concentration change that would cause osmotic demyelination?

Back 58

more than 12 mEq/L/day

Front 59

target for rise in sodium serum in life threatening cases?

Back 59

4-6 mEq/L/hour

Front 60

electrolyte needed for normal cardiac and skeletal muscle function?

Back 60

potassium

Front 61

max infusion rate for potassium and what conditions?

Back 61

20-40 mEq/hr with central line and cardiac monitoring

Front 62

max infusion rate for magnesium?

Back 62

1 gram per hour

Front 63

max infusion rate for calcium gluconate and calcium chloride?

Back 63

1-2 grams gluconate

1 gram chloride

Front 64

max infusion rate for phosphate?

Back 64

7 mmol/hr

Front 65

which two electrolytes are replaced sort of indirectly as components of other electrolyte replacement additions?

Back 65

phosphate and chloride

Front 66

hyperchloremia can lead to?

Back 66

acidosis

Front 67

patient caloric need is detrmined by?

Back 67

BMR, activity, increased metabolism due to stress of trauma or disease

Front 68

simplest energy expenditure calculation?

Back 68

25 kcal/kg/day

Front 69

protein maintenance requirement?

Back 69

0.8 - 1 gram/kg/day

Front 70

daily lipid requirement?

Back 70

>8% (usually 15-30%) of total kcal/day

Front 71

remaining calorie requirements usually met with?

Back 71

dextrose

Front 72

three macronutrients?

Back 72

dextrose, amino acids, lipids

Front 73

single solution containing all three macronutrients?

Back 73

TNA (total nutrient admixture)

Front 74

preferred route of administration for TPN?

Back 74

central line

Front 75

PPN limitations?

Back 75

<900 mOsm/L

dextrose <10%

amino acids <5%

Front 76

2 in 1 PN?

Back 76

dextrose and amino acids

Front 77

3 in 1 PN?

Back 77

dextrose, amino acids, lipids (TNAs)

Front 78

often come in pre-made bags?

Back 78

dextrose and amino acids

Front 79

used to balance chloride salts in conditions of acidosis?

Back 79

acetate salts

Front 80

micronutrients in PN?

Back 80

electrolytes, vitamins, trace elements

Front 81

too much, re-feeding syndrome, GI atrophy, catheter infections, clots, extravasation are all risks associated with?

Back 81

PPNs

Front 82

the process in which substances can be separated based on differing diffusabilities through membranes?

Back 82

dialysis

Front 83

maintains fluid balance, removes toxic waste products, maintains normal electrolyte balance, removes drugs and metabolites (wanted or unwanted)?

Back 83

dialysis

Front 84

uses principles of osmosis and diffusion, osmotic and chemical equilibrium, allows movement of water, urea/toxins, and electrolytes?

Back 84

peritoneal dialysis

Front 85

dialysis with higher risk for infection?

Back 85

peritoneal dialysis

Front 86

uses artificial kidney to remove waste/chemicals from the blood?

Back 86

hemodialysis

Front 87

what blood is shunted by way of a dialysis fistula/graft or catheter to the dialyzing membrane of the dialysis machine?

Back 87

arterial

Front 88

dialysis electrolyte solution is called?

Back 88

dialysate

Front 89

dialysis used for pt who are critically ill, runs slower and for a longer time, and can add replacement fluids as well as maintain normal electrolyte concentrations?

Back 89

continuous renal replacement therapy (CRRT)

Front 90

dialysis that only lasts a few hours?

Back 90

intermittent hemodialysis

Front 91

dialysis solutions are (hypertonic or hypotonic)? why?

Back 91

hypertonic, to avoid absorption of water from the dialysis solution into the circulation

Front 92

can contain electrolyte or have electrolyte added?

Back 92

dialysis solutions

Front 93

used for bathing or washing wounds, surgical incisions or body tissues (such as the bladder)?

Back 93

irrigation solutions

Front 94

used for uncomplicated wounds?

Back 94

isotonic normal saline

Front 95

irrigation solutions that contain drug products?

Back 95

antiseptics

Front 96

sterile fluids intended for direct contact with internal body fluids or tissues?

Back 96

parenteral solutions

Front 97

SVPs, LVPs, irrigation fluids, dialysis solutions, biologics are all?

Back 97

sterile fluids

Front 98

parenteral means (?) but indicates?

Back 98

outside of the intestine, injectable dosage forms

Front 99

common routes of parenteral administration?

Back 99

IV, IM, SC

Front 100

most injectables are administered by?

Back 100

health care professionals

Front 101

why is parenteral admin used?

Back 101

rapid, uncooperative or unconscious patients, pt unable to take oral meds, low bioavailability drugs, longer acting for compliance reasons

Front 102

which drug admin gives most rapid onset of action?

Back 102

IV

Front 103

provides optimal blood/plasma drug levels?

Back 103

IV

Front 104

can an IV drug be removed once administered? how?

Back 104

not easily, antidote

Front 105

must be sterile, no particulates, no risk of precip in solution and in blood, proper placement, watch for clots are all?

Back 105

IV precautions

Front 106

can emulsions/suspensions be used IV?

Back 106

yes but they must be proven safe for IV use

Front 107

drug is drawn up into a syringe and administered directly into the vein or port?

Back 107

IV push

Front 108

one time or intermittent infusion method, drug solution added to SVP (minibag), attached at Y-site, rate often controlled by infusion pump?

Back 108

Y-site or piggyback

Front 109

aka drip, used for large volume solutions, many drugs possible, rates in mL/hr, infused via infusion pump, compatibility issues are common?

Back 109

continuous infusions

Front 110

used to control the rate of IV infusion?

Back 110

infusion pumps

Front 111

can have both continuous and/or intermittent (bolus) dose of analgesic administered by pt. at pre-set intervals with lockout?

Back 111

PCA pumps (patient controlled analgesia)

Front 112

longer lasting, less rapid effect, gradually releases drug into circulation, used for admin of aqueous or oleaginous solutions or suspensions, can be painful, erratic absorption rates (especially with obesity or low muscle mass) in?

Back 112

IM

Front 113

sites for IM admin?

Back 113

upper outer quadrant of gluteus maximus

deltoid muscle of upper arm

midlateral muscle of the thigh

Front 114

best IM admin site for adults?

Back 114

butt (hard to reach in obese)

Front 115

best IM admin site for infants and young children?

Back 115

deltoid or thigh

Front 116

IM muscle injection angle?

Back 116

90 degrees

Front 117

max volume for gluteal IM?

Back 117

5 ml

Front 118

max volume for deltoid IM?

Back 118

2 ml

Front 119

vaccines, immunoglobulins, sedatives/antipsychotics, vitamin/electrolytes, biologics, hormones given which way?

Back 119

IM

Front 120

used for small volumes of medication in solution or suspension?

Back 120

SC

Front 121

rotating sites of injection is optimal in?

Back 121

SC

Front 122

used when longer duration of action is desired because tissue is very slowly perfused and very slow absorption?

Back 122

SC

Front 123

SC volume?

Back 123

<1.3 ml preferred but up to 2 ml ok

Front 124

angle for SC?

Back 124

45 to 90

Front 125

used for chronic administration of drugs like insulin and opioids?

Back 125

SC infusion pumps

Front 126

for SC administration, volume needs to be low, what does this mean for drugs?

Back 126

more concentrated

Front 127

SC infusion pump size?

Back 127

smaller than IV pumps

Front 128

pump site of SC infusion pump can be dirty and become occluded resulting in?

Back 128

accidental underdosing

Front 129

biologics, hormones, anticoagulants, some vaccines, analgesics, many others are administered via?

Back 129

SC

Front 130

type of injection depends on?

Back 130

physical-chemical properties of the drug substance and the intended use of the medication

Front 131

5 types of injectable materials?

Back 131

injection, for injection, injectable emulsion, injectable suspension, for injectable suspension

Front 132

liquid preparations that are solutions of drug substances?

Back 132

injection

Front 133

dry solids that, upon addition of diluent, yield solutions?

Back 133

for injection

Front 134

liquid preparation of drug dissolved/dispersed in a suitable medium?

Back 134

injectable emulsion

Front 135

liquid preparation of solid drug suspended in suitable medium?

Back 135

injectable suspension

Front 136

dry solid that, upon addition of suitable medium, yields a preparation meeting requirement for an injectable suspension?

Back 136

for injectable suspension

Front 137

must meet special purity and other standards assuring their safety by injection?

Back 137

solvents or vehicles

Front 138

what about coloring agents for injections?

Back 138

strictly prohibited

Front 139

must be sterilized, meet compendial standards for particulate matter, prepared in controlled areas, packaged in hermetic containers, filled to slight excess are all?

Back 139

requirements for preparing products for injection

Front 140

volume of injection permitted in multiple-dose containers is?

Back 140

under restrictions

Front 141

how are sterile powders packaged?

Back 141

lyophilized or freeze-dried

Front 142

what to follow for proper IV compounding procedure?

Back 142

USP 797

Front 143

most injectables fall into this category?

Back 143

small volume parenterals

Front 144

used for piggyback or Y-site administration?

Back 144

small volume parenterals

Front 145

may be admixed in the pharmacy, or may be part of ready-to-use system?

Back 145

small volume parenterals

Front 146

ampules, vials, prefilled syringes, minibags are all?

Back 146

small volume parenterals

Front 147

minibag volumes?

Back 147

50 or 100 ml

Front 148

available in any of the 5 forms of official injectables?

Back 148

vials and mix-o-vials

Front 149

some must be further diluted in large or small volume IV bags?

Back 149

vials and mix-o-vials

Front 150

some can be directly administered to patient without further dilution?

Back 150

vials and mix-o-vials

Front 151

what must always be done in regards to ampules?

Back 151

always start with filter needle to get drug out of ampule then switch to regular needle for dilution

Front 152

do the bubbles in prefilled syringes need to be expelled?

Back 152

no

Front 153

used for direct administration by patient or caregiver?

Back 153

prefilled syringe

Front 154

administers single dose, easy for self admin, usually SC route?

Back 154

auto injector systems

Front 155

often contain multiple doses (single too), some need to be primed, can have adjustable dose or preset single dose, usually administered SC?

Back 155

prefilled pens for injection

Front 156

most common minibag solutions?

Back 156

NS and D5W

Front 157

rarely given by themselves?

Back 157

minibags

Front 158

can be attached to vials using ADD-Vantage systems?

Back 158

minibags

Front 159

powders that contain water that can be released when manipulated or stored in low humidity?

Back 159

efflorescent powders

Front 160

adsorb moisture from the air?

Back 160

hydroscopic powders

Front 161

hydroscopic powders that adsorb so much moisture they transform into liquid?

Back 161

deliquescent powders

Front 162

agglomerates of smaller particles that behave as larger particles?

Back 162

granules