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Chapter 8 notes
chapter 8 notes
| Question | Answer |
|---|---|
| Most parenteral formulations are required to be _______ | Sterile |
| In what ways do parenteral products have special requirements? | how they are made, packaged and administered |
| what types of administration are not required to be sterile? | Vaginal and dermal |
| name the formulation administration sites where the formulation has to be sterile (7) | Intravenous, intramuscular, subcutaneous, intradermal, ophthalmic/intraoccular,intranasal, inhalation |
| Why is sterility required? | The formulations have rapid access to the circulatory system and can cause the greatest harm if an infection develops. |
| what are other considerations for a parenteral formulation? | must be free from pyrogens and particulate material,isotonic, and at a physiological ph |
| Who is required to meet the strile formulation requirements of parenteral formulations? | the manufacturer |
| Where do most manipulations of sterile solution formulations occur? | in a laminar flow hood or biological safety cabinet |
| What kind of technique is needed to handle sterile formulations | aseptic technique |
| Most common sterile formulations manipulated can be classified as: | LVP (large volume parenterals) SVP (small volume parenterals) TPN (total parenteral nutrition , Dialysis solutions, irrigation solutions |
| Special precautions to be taken with parenteral dosage forms (6) | Must be sterile, free of visable particulates, pyrogen free, must be stable for intended use, PH shouldnt vary- should be around 7.4, IV solutions should have an osmotic pressure similar to that of blood |
| Osmotic Pressure | The characteristic of a solution determined by the number of dissolved particles in it |
| Osmolarity | A unit of measure of osmotic pressure, exspressed in osmoles or milliosmoles per liter |
| What is the approx. osmolarity of blood? | 300 milliosmoles per liter |
| What other solutions have a similar osmolarity to blood? | 0.9% sodium chloride solution, 5% dextrose solution |
| Isotonic | When a solution has an osmolarity similar to blood |
| Hypertonic | IV solutions that have a greater osmolarity than blood |
| Hypotonic | IV solution that have a lower osmolarity than blood |
| Possible side effects to hypertonic/hypotonic solutions | Damage to red blood cells, pain, tissue irritation |
| How are Hypertonic/Hypotonic solutions administered usually to avoid some possible side effects? | administered slowly through a large, free flowing vein |
| Beside meaning any route of administration other than enteral, Parenteral is commonly used to describe what.. | Dosage forms administered through syringes or administration sets, also used to describe various bottles, vials and bags used in preparing and delivering solutions for intravenous administration |
| Aseptic technique | techniques or methods that maintain the sterile condition of products |
| pyrogens | chemicals produced by microrganisms that can cause pyretic (fever) reactions in patients |
| LVP | Large volume parenteral solution, solutions packaged in containers holding 100ml or more |
| Common used for LVPs without additives | correction of electrolyte and fluid balance disturbances, nutrition, vehicles for administration of other drugs |
| Common sizes for LVPs | 100,250,500,1000ml |
| name 3 types of of LVP containers | glass botle with an air vent tube, glass bottle without an air vent tube, plastic bags |
| How is an LVP hung for administration | the top of an LVP container is hung on an admin. pole, at the other end of the container is two ports of about the same length, one is admin set port, the other is the medicaion port |
| the plastic diaphram inside a LVP bag makes it impossible for what | the bag to drip out of the admin. port |
| What happens when the spike of the administration set is inserted into the port | the diaphram is punctured and the solution will flow out of the bag into the administration set |
| THe medication port is covered by what | a protective rubber tip |
| How are drugs added to an LVP solution | through the medicaion port, using a needle or syringe |
| Who provides regulartions and requirements on parenteral solutions? | The united states pharmacopeia and the FDA |
| What does the FDA and The USP regulate about parenterals? | manufacturing,compounding,dispensing, and distribution |
| What did chapter 797 in the USP determine in 2009 | Established requirements for Pharmaceutical Compounding- sterile preperations, established requirements for the aseptic preperation of sterile dosage forms |
| CSP | Compounded sterile preperation- a compounded sterile parenteral dosage form that will be parenterally adminstered |
| what is the intent of chapter 797 in the USP | to prevent harm and fatality that could result from microbial contamination, excessive baterial endotoxins, large content errors in the strength of the correct ingredients and incorrect ingredients in CSPs |
| Chapter 797 in the USP provides... | the guidelines for the development and implementation of essential policies and procedures for the safe preperation of CSPs |
| Chapter 797 in the USP states: | pharmacies must provide cleaner facilities, air quality evaluation and maintenance, and specific training and testing of personnel in aseptic manipulation, sterilization and solution stability principals and practices |
| what are 4 common solutions used for LVPs or as a primary part of the admix solution? | Sodium Chloride solution, dextrose solution, ringer's solution,lactated ringer's solution |
| What are the advantages plastic bags have over glass bottles? | unbreakable, weigh less, take up less storage space, take up less disposal space, plastic bag system is not vented to outside air so it collapses as the solution is administered so a vacume is not created inside. |
| When a drug cant be used with a plastic bag because of interactions what is done? | in these cases glass iv bottles ae used. they are packaged with a vacume, sealed with a solid rubber closure, and the closure is held in place with an aluminum band. |
| 2 examples of solutions dispensed in glass bottles | Nitroglycerin and Amiodarone |
| What must happen for solutions to flow out of glass containers? | air must be able to enter the container to relieve the vacume as the solution leaves |
| SVP | Small volume parenteral- a solution packaged to either directly administer to a patient or added to another parenteral formulation |
| Additive | When a drug is added to a parentral solution the drug is referred to as the additive |
| Admixture | The final mixture of a parenteral solution after the additive is added |
| How are SVP solutions dispensed | Prefilled syringes, ampules, glass or plastic vials sealed with rubber closures, or plastic minibags |
| how are powdered drugs dispensed | in vials that must be reconstituted before being added to the IV solution |
| Ampule | an elongated sealed glass container with a neck that must be snapped off |
| If an ampule is not already scored to be broken/opened, what needs to be done | must first be scored and weakened with a file |
| What is a minibag | made of the same material as an LVP, just smaller insize, containing only 50-100ml of solution |
| Why is an LVP used as a continuous infusion | because of its large volume and slow infusion rate |
| What do they call a SVP that is placed into a minibag and added with the LVP | a piggy back |
| 8 steps to using a needle and syringe to add a SVP to an LVP in a laminar flow hood | 1.Assemble needle 2.reconstitute drug if powdered 3.Swab SVP + Med port of LVP w/ alcohol swab 4.Draw vol. of SVP drug into syringe 5.insert needle into med port thru diahram 6.inject SVP solution into LVP 7.Remove needle from LVP 8.Shake and inspect |
| what kind of system consists of a spcially designed minibag with an adapter for attaching a drug vial | ready to mix systems |
| with a ready to mix system, when does the admixing take place | just prior to administration |
| what are major advantages to ready to mix systems? | significant reduction in waste, lower potential for medication error because the drug vial remains attached to the minibag and can be rechecked if nessescary |
| disadvantages of ready to mix system | more expensive than the alternative, potential that the system will not be properly activated so that the patient recieves only the diluent or a partial dose |
| examples of ready to mix systems | add-vantage, add-a-vial, mini-bag plus, CRIS (controlled release infusion system) |
| ready to mix | a specially designed minibag where a drug is put into the SVP just prior to administration |
| Diluent | a solvent that dissolves a luophilized powder ir dilutes a solution |
| what is done before withdrawing a solution from a vial? | An equal volume of air is usually drawn up into the syringe and injected into the vial, pressurizing the vial and helping to withdraw solutions from the vial |
| Single dose vials do not contain | preservatives |
| When should a single dose vial be disposed of | after the first use |
| Multidose vials contain | a preservative to inhibit bacterial contamination once the vial has been used |
| what are 2 kinds of prefilled syringes | a cartridge type package and a glass tube closed at both ends with rubber stoppers |
| How is a cartridge style prefilled syringe used | Its a single syringe and needle unit which is placed in a special holder before use. One the syringe and needle unit is used, it is discarded but the holder can be used again with a nw unit |
| How is the glass tube with rubber stoppers on the end used as a prefilled syringe | the prefilled tube is placed into a specilly designed syringe that has a needle attached to it. after using this type of syringe all of the pieces are discarded |
| TPNs | Total parenteral nutrition solutions- complex admixtures used to provide nutritional support to patients who are unable to tke in dequate nutrients through their digestie tract |
| What are TPN admixtures composed of? | Dextrose, fat, protein, electrolytes, vitamins, and trace elements, |
| What size are base parenteral nutrition solutions available in? | 2000 and 3000ml sizes |
| What does the base solution for parenteral nutrition consist of? | an amino acid solution (for protein) and a dextrose soluton (for carb calorie) |
| What other name does base parenteral nutrition get called | macronutrients |
| What gets added to base parenteral nutrition or macronutrients to meed individual patient requirements? | electrolytes,trace elements, and multiple vitamins |
| When you combine electrolytes, trace elements and multiple vitamins, what can they be called? | micronutrients |
| What are common electrolyte additives? | sodium chloride/acetate, potassium chloride/acetate, calcium gluconate, magnesium sulfate, and sodium or potassium phosphate |
| what are some things a trace element product can include? | zinc, copper, manganese,selenium, and chromium |
| why would you add IV fat (lipid) emulsion to TPN? | as a source of essential fatty acids and a concentrated source of calories. |
| How many clories per gram does fat provide | 9 cal per gram |
| How many calories does dextrose provide | 3.4 cal per gram |
| What is the result when IV fat emulsion is admixed with a TPN solution | the resulting solution is referred to as a total nutrient admixture (TNA) |
| Total parenteral nutrition solution | TPN- complex solutions with two base solutions (amino acids and dextrose) and additional micronutrients |
| Total Nutrient Admixture | (TNA) a TPN solution that contains intravenous fat emulsion |
| What is used in pharmacies to prepare TPN solutons | High speed compounders, automixersm or micromixers |
| What do the machines used in pharmacies to prepare TPN solutions do | deliver from 2-10 different components safely, quickly, accurately |
| what vein are TPN solutions adminstered VIA | subclavien vein |
| Where is the subclavien vein located? | under the collar bone |
| why is the subcavien vein used? | the vein is large and close to the heart, so the solution is diluted rapidly by the large volume of blood in the hart |
| Why are infusion pumps almost always used with nutrition solutions? | to assure accurate delivery |
| How are PNS commonly administered | through an in-line filter in the admniistration set, positioned as close to the patient as possible |
| Dialysis | refers to the passage of small particles through membranes |
| Osmosis | the action in which a drug in a solution of a higher concentration will move through a permeable membrane to a solution of a lower concentration |
| Peritoneal Dialysis solutions | Used by patients who have compromised kidney function. Administered directly into the peritonal cavity to remove toxic substances, excess body waste and serum electrolytes through osmosis |
| where is the peritonal cavity | between the abdominal lining and the internal organs |
| Are peritoneal dialysis solutions hypotonic or hypertonic? | hypertonic to blood so the water will not move into the circulatory system, but the toxic substances will move into the dialysis solution |
| how many times a day are peritonal solutions delivered? | many times a day |
| What is the process with peritoneal dialysis solutions? | the solution is permitted to flow into the abdominal cavity, and then remains in the cavity for 30-90min. its then drained by siphon tube into discharge bottles, and repeated many times a day, using up to 50 liters of solution |
| what size containers is supplied for peritoneal solution | 2000ml or larger |
| Irrigation solutions are subject to the same stringent controls as IV fluids but are not what | administered directly into the venous system |
| What size packaging does irrigation solution come in | larger than 1000ml packaging and designed to empty fast |
| What is surgical irrigation solution used for? | To bathe and moisten body tissue, moisten dressings, wash instruments |
| What solutions are typically used | Sodium Chloride or Sterile Water for irrigation |
| Why would urological irrigation solutions be used? | To maintain tissue integrity or to remove blood to maintain a clear field of vision |
| What is commonly used for urological irrigation solutions? | glycine 1.5% irrigation or Sorbitol 3% irrigation |
| Peritoneal dialysis solution | a solution placed in and emptied from the peritoneal cavity to remove toxic substances |
| Irrigation solution | large volume splash solutions used during surgical or urological procedures to bathe and moisten body tissue |
| What needs to be done to be assured contamination cant happen to paenteral solutions? | aseptic techniques |
| How can contaminiation to parenteral solutions happen? | from the enviroment in which the product is being prepared or from the person preparing it |
| What is the best way to reduce environmentl contamination when preparing paenteral solutions? | use a laminar flow hood |
| How does a laminar flow hood work? | Room air is drawn into a laminar hood + passed thru a prefilter, then air is channeled thru a HEPA filter. The purified air then flows over the work surface at a constant velocity, preventing room air from entering work area making space clean not sterile |
| What velocity does the air flow thru a laminar flow hood at? | 80-100ft/min |
| HEPA | high efficiency particulate air - a high efficiency air filter |
| What size particulates will a hepa filter remove? | larger than .5 microns |
| laminar flow | continuous movement at a uniform rate in one direction |
| Horizontal flow hood | a laminar flow hood where the air crosses the work area in a horizontal direction |
| Vertical flow hood | a laminar flow hood where the air crosses the work area in a verticle direction |
| parts of a laminar flow hood | Hepa filter, blower, intake filter |
| Zone of turbulance | A dead area inside a laminar flow hood in front of larg containers |
| in a laminar hood, where should items be placed? | smaller items should be placed close to the hepa filter, larger items closer to the opening of the hood |
| biological safety cabinets work by | taking air into the cabinet through the work surface vents and recirculate it through a HEPA filter located at the top of the cabinet. |
| parts of a biological safety cabinet | HEPA filter, glass shield, vents |
| 2 types of biological safety cabinets | 1. class 2 type A 2. Class 2 type B |
| What is the difference between Class 2 type A and Class 2 type B biological safety cabinets? | the class 2 type B cabinet has greater intake air flow velocities and are vented outside the building rather than back into the room |
| either type of biological safety cabinet should be used in the preperation of what drugs | Chemotherapy drugs. laminar flow hoods shouldnt be used because they blow air across the work surface toward the operator and into the work environment, making it clean but not sterile |
| 6 Routes for chemotherapy drugs | oral, intravenous, intraarterial, intralesional, intraperitoneal, intrathecal |
| intraarterial | into the arteries |
| intralesional | directly into a tumor |
| intraperitoneal | into the cavity surrounding the abdominal organs |
| intrathecal | into the spinal fluid |
| oral chemotherapy drug (1) | Capecitabine |
| intravenous chemotherapy drug (1) | Doxorubicin |
| intraarterial chemotherapy drugs (5) | Floxuridine, Fluorouracil, Mitomycin-C,Cisplatin, Streptomycin |
| Intralesional chemotherapy drugs (2) | Vinblastine, Vincristine |
| Intraperitoneal chemotherapy drugs (4) | Paclitaxel, mitoxantrone, carboplatin, alpha interferon |
| Intrathecal chemotherapy drugs (2) | Methotrexate, cytarabine |
| How long should the hood or cabinet on a flow hood or safety cabinet be on before using | 30 minutes in order to produce and ultraclean environment |
| 4 steps of cleaning hoods or cabinets | 1.clean inside of the hood with a suitable disinfectant 2.clean the sides o the hood using up and down motions, back to front 3.clean bottom of the hood using side to side motions back to front 4. if using spray bottle be sure not to spray HEPA filter |
| Where are laminar flow hoods and biological safety cabinets required to be kept | in an area of the pharmacy that is isolated from the maine traffic in the pharmacy; referred to as a clean room |
| What does USP/NF <797> mandate? | states that clean room faclities must be in designated area of the pharmacy where traffic is very limited and air flow is unrestricted |
| Who should be aloud in the clean room area | designated personnel and only for aseptic preperation |
| ISO class 7 | means that any air flow unit used in the clean room is capable of producing an environment containing no more than 10,000 airborne particles of a size 0.5 micron or larger per cubic ft of air |
| Clothing and barrier requirements when using aseptic preperation | 1.wear clean lint free clothes,gowns,hair covers, masks 2.wear sterile gloves 3.follow facility or manufacturers guidelines for putting on and removing barrier clothing |
| Aseptic techniques are | the total methods and manipulations required to minimize the contamination of sterile products |
| contamination can be from | microorganisms and or particulate material |
| general aseptic techniques for working inside hoods and cabinets | 1.never sneeze/cough/talk directly into hood 2.close doors/windows 3.perform work @ 6" inside the hood 4.keep open path between hepa + area in hood 5.place nonsterile objects downstream from sterile ones 6.no large objects @ back of work area near filter |
| 2 things sterile supplies have | instructions for use and expiration dates |
| why do you have to do work atleast 6" inside the hood | laminar flow air begins to mix with outside air near the edge of the hood |
| 4 things to do when collecting supplies to use for prep in a hood | 1.assemble all supplies,checking experation dates + particulate material 2.plastic solution containers should be squeeze checked for leaks 3.use only pre-sterilized needles,syringes and filter 4.remove dust coverings before placing supplies in hood |
| 2 types of parenteral vials | one contains a drug already in the solution, the other contains a powder that must be dissolved in diluent to make a solution |
| Coring | when a needle damages the rubber closure of a parenteral container causing fragments of the closure to fall into the container and contaminate its container |
| How do you prevent coring? | place vial on flat surface, position needle point on surface of rubber closure w/ bevel facing up w/ needle at 45-60 degree angle. Put downward pressure on needle while bringing it to up position before penetration is complete needle should be verticle |
| What do you do with a vial containing solution to prevent coring | draw volume of air into syringe = to solution needed, penetrate vial + inject air pressurizing vial, turn vial upside down while pulling back plunger + filling syringe,tap syringe + push plunger to release air bubbles, transfer solution to final container |
| What do you do with a vial containing lyophilized powder? | Determine volume of diluent + withdraw from vial, transfer diluent into vial with powder, remove volume of air into syringe that's slightly more than diluent added, withdraw needle and swirl the vial until drug is dissolved |
| Where are ampules broken? | On the neck |
| what indicator is used when an ampule can be broken on the neck? | a colored stripe if they are prescored |
| what do you do if the neck of an ampule is not prescored? | use a fine file to weaken the glass on the neck so it can be snapped open |
| Steps if the ampule is not prescored | use fine file to score neck,hold ampule upright + tap the top to settle solution into bottom of ampule, swab neck of ampule with alcohol,wrap with gauze, snap ampule neck out + away, inspect for glass shards |
| Ampules | Sealed glass containers with an elongated neck that must be snapped off |
| What is the process for transferring solution from an ampule? | Hold ampule 20deg ang,attach filter needle to syringe,insert filter needle in ampule w/o touching,position needle on beveled edge/shoulder area of ampule, withdraw solution while keeping needle submerged,withdraw needle from ampule,exchange filter needle |
| Why when withdrawing solution into a syringe, do you keep the needle submerged? | To avoid drawing air into the syringe |
| name 4 parts of a syringe | plunger, barel, tip, needle |
| 3 types of syringes | oral, Slip-Tip, Luer-Lok, Eccentric |
| How do you measure volume in a syringe? | volume in a syringe is measured to the edg of the rubber stopper, while the syringe is held upright and all the air has been removed |
| What is the barrel of a syringe? | a tube that is open at one end and tapers into a hollow tip at the other end |
| what is the plunger on a syringe? | a piston-type rod with a slightly cone shaped stopper that passes inside the barrel of the syringe |
| what does the tip of the syringe do? | provides a point of attachment for a needle |
| what is the volume of solution inside the syringe marked by? | graduation lines- usually ml, or fraction of ml, depending on the capacity |
| What is a Slip-Tip syringe tip | a tip that allows the needle to be held on to the syringe by friction. the needle is reasonably secure, but may slip of if not properly attached or if considerable pressure is not used |
| What is a Luer-Lok syringe tip | they have a collar with grooves that lock the needle in place |
| What is an Eccentric syringe tip? | Tips which are off center, used when the needle must be parallel to the plane of injection such as in n Intradermal injection |
| What is an Oral syringe tip? | a larger type tip than a slip-tip. Needles do not fit on oral syringes, therefor they are used to administer liquids other than parenteral administration |
| what sizes do syringes range from | 1ml-60ml |
| What is the rule for picking which size syringe you will use for medication administration? | the correct syringe size is the next size larger than the volume to be measured |
| What does filling a syringe to capacity do? | Easily dislodge the plunger |
| How do you correctly draw liquid into a syringe? | pull back on the plunger while the tip is submerged in the liquid to prevent air from being drawn back,generally an excess of solution is drawn into the syringe to air can be pushed out, hold syringe up and tap out bubbles, depress plunger to release air |
| 3 parts of a needle | Hub, shaft, bevel |
| The hub of a needle is: | At one end of the needle and attaches to the syringe. Designed for quick easy attachment |
| The shaft of the needle is: | the long slender stem of the needle that is angled on one edge to form a point |
| The bevel of the needle is: | The point at the end of the shaft of the needle |
| what is the lumen of the needle | the hollow bore of the needle shaft |
| how are needle sizes indicated | length and gage |
| how is a needle measured | the length of a needle is measured in inches from where the shaft meets the hub, to the tip of the bevel |
| What lengths do needle range | 3/8" to 3 1/2" |
| why is the gauge of needle determined? | used to designate the determined size of the lumen |
| What gauges do needle lumen range? | 27 smallest -13 largest. |
| How do they help decode the gauge of a needle for quick reference? | they color code the hub of the needle |
| What kind of needle should always be used when making admixes, as they are presterilized and prewrapped? | disposable needles |
| What are filters used for on needles? | to remove particulate materials or microorganisms from solutions |
| where are filters added | can be attached to the end of a syringe, to the end of an administration set or they can be part of the needle |
| 2 basic groups of filters | depth filter, membrane filter |
| How does a depth filter work | by trapping particles as solution moves through twisting channels |
| how does a membrane filter work | consists of many small pores of a uniform size that retain particles larger than pores |
| what sizes are the pores on filters | filters have pores ranging from 0.22, 0.45, 1.2, 5 or 10 microns |
| How are filters packaged | round plastic holders that can be attached to the end of syringe, some are attached to admin. sets + serve as final filters. Some sets have filters built into them, some are placed inside needles |
| what are double ended filter needles used for? | transferring solutions directly from a vial into a bottle or bag, eliminating the need for a syringe |
| what are membrane filters intended for? | to filter a solution only as its expelled from a syringe |
| 8 steps of transferring a reconstituted powder drug into an LVP or SVP | attach needle to syringe,pull reconstit. drug sol. in syringe,remove air bubbles,needle removed,membrane filter attached to syringe,new needle attached to end of filter,air eliminated in filter chamber,air is expelled needle introduced in final container |
| What are depth filters constructed of? | randomly oriented fibers or particles that have ben pressed or wound or otherwise bonded together to form a tortuous pathway for the solution to flow |
| What fibers or particles can make up depth filters? | Diatomaceous earth, porcelain or asbestos |
| A depth filter is rigid enough so a solution can be filtered : | as it is pulled in or expelled but not both in the same procedure |
| What re the 5 steps if a drug is to be filtered by a depth filter as it is pulled into the syringe? | filter needle attaches to syringe, solution pulled into syringe, filter needle removed, new needle attached to syringe, solution expelled from syringe |
| where in the needle is a depth filter found | Inside the hub of the needle |
| Final filter | a filter that filters a solution immediately before it enters the patients vein |
| where can filters be found | Some administration sets include final filters, some filters are designed to be attached to the administration sets and serve as final filters |
| membrane filter | a filter that filters solution as the solution is expelled from the syringe |
| How are LVP solutions administered | with an administration set |
| what does an administration set consist of | a length of flexible plastic tubing with a spike at the end and a needle adapter at the other, a drip chamber, and clamp |
| What is the spike for on an administration set? | the spike fits into the administration set port of the LVP container. |
| where is the solution in an administration set | Flowing from the LVP container through the plastic tube to the needle adapter at the other end |
| Where do you attach a needle or catheter | to the needle adapter |
| What is the clamp on an administration set for | to provide one means of regulating the flow rate. the clamp may be a roll clamp or a slide clamp. |
| What is the drip chamber and what is it for? | the drip chamber is a small reservoir in the plastic tubing near the LVP containers, fluid collects and flows continuously thru tubing without mixing with air. reg drip 10 dr/ml, minidrip 60 dr/ml |
| What can counting the number of drops per minute entering a drip chamber help you figure out? | flow rate |
| What is a volume control chamber used for? | often used with a clamp to control flo rate. |
| volume control chamber | a plastic cylindrical device with graduation marks for measuring volume of solution. the chamber fills to a measured volume a clamp is immediately above the chamber , closed when desired volume has been added. |
| what does the volume control chamber do? | Serves as a mini reservoir from which the solution is allowed to flow when a clamp below the chamber on the admin set is opened. also a safety precaution that limits volume of fluid infused accidentally |
| What type of patients are volume control chambers usually used on | pediatric patients |
| what would controller be used for? | to monitor flow rates |
| what do most controllers use and why | a photoelectric sensor to compare the actual gravity flow rate, to a programmed or desired flow rate, and relax or constrict the admin set tubing to increase or decrease the flow rate |
| what do combination controllers/pumps provide? | both the safety of low infusion pressures from the controller part of the device and the availability of a positive pressure pump in the other part of the device |
| who decides whether to use the device as a controller or a pump? | the user |
| flashball | flexible rubber tubing near the needle adapter on an admin set; used to determine if the needle is properly placed in the veins |
| How can the flashball tell you if the needle is properly placed? | The flashball can be squeezed before starting the administration to see if the needle is correctly located in the patients veins. If blood comes up into the flashball it is properly placed |
| How long is a catheter | usually 1-5" |
| Cathetar | flexible plastic tubing connected to a plastic hub that is in turn attached to a syringe or to an administration set. has a needle to allow for insertion |
| why would an IV catheter be used instead of a needle in some cases? | they re more flexible and therefore can be less irritating to the patient |
| what types of medicine are often used in piggybacks? | intermittent intravenous medications |
| How would you administer intermittent IV medication via a piggyback? | involves infusing medications in a small volume of solution at regular intervals, typically 30-60min. intermittent iv solution flows into patients vein thru same admin set as LVP,at same time. when infusion is not being administered,LVP continues to KVO |
| How are the LVP and the piggyback solution connected? | a y-type connector in the admin set |
| why would the mini bag set be placed higher than the LVP set? | so its greater pressure will ensure the mini bag solution will enter the admin set |
| how is the mini bag solution prevented from flowing into the LVP container | by a one way check valve on the LVP |
| An LVP and a piggyback solution are not mixed together except: | in the administration set tubing below the Y connector |
| WHat are piggyback bags made of and how much do they usually hold? | same material as LVP bags, and they hold between 50-100ml of 5% dextrose inj. or 0.9% Sodium Chloride inj |
| Heparin lock | An administration device used when primary LVP solution is not available; a short piece of tubing attached to a needle or IV catheter. |
| When tubing is not being used for a mini bag what is used? | heparin is used to fill the tubing. |
| what does heparin do? | prevents blood from clotting in the tube |
| piggybacks | small volume solutions connected to an LVP |
| Positive pressure infusion device (pumps) | generate pressure that will cause fluid to flow through tubing into the patients vascular system |
| What kind of operating pressure do positive pressure infusion devices usually operate on | 2-12lbs PSI |
| Pressures around 2 PSI are used for | used to keep the vascular access open - KVO access |
| Pressures around 10-12 PSI are used for | Arterial access requires this amount of pressure |
| Cassette Pumps are often used | often used as ambulatory pumps, since many are the size of a hand, allows patient to have freedom of movement |
| a cassette pump works when | the cassette acts as a reservoir and fits into the pump housing. Tubing connects the cassette to the patient, the pump makes the cassette fill and then empty in two separate, sequential cycles to deliver a measured volume of liquid |
| How do syringe type cassette pumps work? | a moving motor driven plunger in + out of fluid filled chamber.a piston activated a flexible diaphragm mounted near moving piston. inward stroke of the piston compresses diaphragm, directing solution at patient. outward stroke allows diaphragm to relax. |
| What do multiple chamber pumps allow | One chamber to refill while the other directs fluid to the patient |
| What are elastomeric reservoirs | tennis ball sized pumps with a balloon like reservoir, surrounded by a rigid protective outer shell, the elastic reservoir is filled with a solution that exerts constant positive pressure forcing solution thru tubing into patient. |
| What determines the flow rate with an elastomeric reservoir | the combination of the pressure and dimensions of the tubing determine the flow rate of the pump |
| how does a syringe pump work | a syringe attached to a pump expels a solution from the syringe by advancing either the plunger or the barrel at a predetermined rate |
| what are syringe pumps commonly used for | infusions of intermittent medication such as antibiotics, administering antineoplastic drugs, analgesics and anesthetics, |
| why would you use a syringe pump for neonatal, infant or critical care applicants? | because they can deliver solutions at very low, precisely controlled flow rates- small volumes over slow rate of time |
| Peristaltic pump | infuses solutions in micropulses produced by massaging action on IV tubing |
| Why are special infusion sets used with peristaltic pumps? | because the tubing has been reinforced with a silastic insert at the point of contact with peristaltic mechanism. reinforcement keeps the tubes from stretching and deforming, which would lead to changes in the flow rate |
| How many types of positive pressure pumps are there? | 4- cassette pump, syringe pump, elastomeric pump, peristaltic pump |
| What could happen with drug incompatabilities? | A patient could not get enough medicine or they could have an adverse reaction |
| what could incompatability with medications be? | color change or hazy appearance, precipitants form in solution, gas may be smelled, |
| if two or more drugs are combined that are incompatible with eachother, and no visible changes are made it could still suffer from | degradation |
| 5 ways to minimize incompatiblities | use solutions promptly,minimize # of drugs added to solution,check incompatibility resources-verify which drugs will produce very high/low ph,check when the drug has Ca,Mg, or Phosphate, check incompatibility ref. when drug contains lactate or acetate |
| 10 contributing factors to compatibility or stability of drugs in IV admixes | 1.PH 2.Light 3. Temp 4.Dilution 5. Buffer Capacity 6.Time 7.Filters 8.Solutions 9.Chemical complexation 10.Plastics |
| How can PH effect compatibility or stability | combining 2 drugs that require two diferent PH values for the final solution can cause one or both drugs to either degrade or precipitate |
| How can light effect compatibility or stability | some drugs will start to break down and lose therapeutic effect if exposed to light |
| How can temp effect compatibility or stability | Storing and maintaining IV solutions at appropriate temps is important in keeping admixes stable. Heat increases the rate of most chemical reactions. most drugs are stable when refridgerated |
| How can dilution effect compatibility or stability | the concentration of a drug in a solution may be a factor of compatibility, Make sure that a drug is properly diluted before combining it with another drug |
| how can a buffer capacity effect compatibility or stability | the ability of a solution to resist a change in PH when either an acidic or alkaline substance is added |
| how can time effect compatibility or stability | Many drugs start to degrade shortly after being added to an IV solution |
| how can filters effect compatibility or stability | filters, especially final filters can reduce the concentration of a drug if it becomes trapped by the filter |
| how can solutions effect compatibility or stability? | some drugs require a specific solution or diluent to be used wit. choosing the wrong solution can cause the drug to be broken down more quickly or can cause a precipitant to form |
| how can chemical complexations effect compatibility or stability | complexation occurs when two drugs are combined and a new chemical combination is formed, often reducing the tto the plasticherapeutic effect of one of the drugs |
| How can plastics effect compatibility or stability | some drugs are incompatible with the plastics in containers or certain administration sets. this is especially true of PVC. Plasticizers can be leached out of the plastic bag or from the administration set in the IV solution, or can bind into the solution |
| USP/NF 797 regulations require | that every parenteral compounding facility to have a quality assurance program |
| Quality Assurance | a series of activities ensuring that a compounded formulation will be safe, stable and of the proper identity, strength, purity and quality and uniformity |
| Why is uniformity important | so people receive the same drug everytime they get a new prescription, no matter who the pharmacy technician is or the time. |
| the final check by the pharmacist should include what 5 things | label is free of errors and completed, correct base parenteral components, correct drug additives, if IV solution- admix is clear and free of particulates and correct beyond use date is stated |
| Visual inspection cannot reveal anything about what 5 charachteristics | Sterility, PH, osmolarity, presence of pyrogens or chemical degradation |
| RCRA | Resource Conservation and Recovery Act- regulates handling hazardous waste from its generation to its disposal |
| when do the RCRA regulations apply | to drugs and chemicals disposed of by pharmacies and hospitals, clinics and other commercial entities |
| Hazardous materials are divided into | 2 lists: P-list and U-list |
| What does P list waste include | epinephrine, nitrogycerine, physostigmine |
| what does U list waste include | Toxic, flammable, corrosive or reactive waste including cyclophosphamide |
| What goes in the SHARPS containers | used syringes, bottles, vials, or other supplies |
| Sharps | needles, jagged glass or metal objects or any items that might puncture or cut the skin |
| Cleaning procedures for sterile compounding facilities | clean/sanitize the direct contiguous compounding area, clean/sanitize work surfaces in the anteroom, mop floors daily when no aspetic procedures are going on, empty storage shelving and clean weekly, clean wall and ceiling monthly |
| Molecular weight | the sum of the atomic weights of a molecule |
| waters of hydration | water molecules that attach to drug molecules |
| anhydrous | without water molecules |
| ions | molecular particles that carry electric charges |
| Molarity | an expression of the number of moles of drug in a volume solution |
| what is a mole | the number of grams numerically equal to the molecular weight of the drug |
| What are molarity concentrations expressed as | mole/liter (mol/L or M) |
| how would you write millimoles per liter | mM/L |
| how much is a millimole | 1/1000th of a mole |
| What must be factored into determining the molecular weight of the drug? | the salt form and waters of hydration |
| Examples of chloride | Sodium salt, potassium salt and calcium salt |
| Examples of forms of Calcium Chloride | anhydrous (no water), dihydrate (2 associated waters), hexahydrate (6 waters) |
| Which form of calcium chloride is used in parenteral solutions? | Dihydrate calcium chloride |
| Osmole | the expression for an amount of drug |
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