IV Medication Principles Flashcards
(33 cards)
When is the use of a central line required?
- Osmolarity >900 mOsmol/L
- pH outside of 7.35-7.45
- Highly concentrated drugs
- Long-term antibiotics
- Drugs that cause phlebitis/extravasation
Where are central lines usually placed?
Large vessels such as the superior vena cava or the inferior vena cava
What is a PICC line?
Pheripherally Inserted Venous Catheter: inserted into peripheral vein and tip ends into superior vena cava
What are common vesicants?
- Vasopressors (DA, NE)
- Anthracyclines (rubicins)
- Vinka alkaloids (vin)
- Promethazine
- Digoxin
- Mannitol
- Nafcillin
- fosacarnet
- mitomycin
What is chemical incompatibility?
Drug loss/toxicity due to hydrolysis, oxidation, or decomposition reaction
What is physical incompatibility?
Incompatibility between the drug and the container, diluent, or another drug
Why are some drugs incompatible with PVC containers (polyvinyl chloride)?
- DEHP (diethylhexyl phthalate) is used as a plasticizer to make IV bags more flexible; DEHP is toxic to liver/ male reproductive system and can leach from the container into the solution
- Absorption causes the drug to move into the PVC container
- Adsorption of drug to the container (sticks to container)
What can be used for drugs that are not compatible with PVC containers?
- Polyolefin
- Polypropylene
- Glass
What drugs require non-PVC containers?
- Lorazepam
- Amiodarone
- Tacrolimus
- Taxanes (except Paclitaxel-albumin bound; Abraxane)
- Insulin (know for test, in reality drip rate is adjusted for adsorption)
- Nitroglycerin
Leach Absorbs To Take In Nutrients
Which drugs are only compatible with saline?
- Ampicillin
- Caspofungin (Cancidas)
- Infliximab
- Daptomycin
- Ampicillin/Sulbactam
- Phenytoin (Dilantin)
- Ertapenem
ACID APE
What drugs are only compatible with D5W?
- Oxaliplatin
- Sulfamethoxazole/Trimethoprim
- Amphotericin B (all forms)
Only Sugar Always
What is the difference between additive compatibility and Y site compatibility?
Additive: multiple drugs will be prepared in the same container
Y-site: where multiple drugs mix briefly in the IV tubing
What are high-risk incompatibilities that should always be avoided?
- Ceftriaxone + Calcium-containing sol (ex. Lactated Ringers)
- Phosphate + Calcium
What resources are avalible for IV compatibility questions?
- ASHP Injectable Drug Information
- Trissel’s 2 Clinical Pharmaceutics Database
- King Guide to Parenteral Admixtures
What drugs require filters when prepared/ administered?
- Golimumab
- Amphotericin B (lipid formula)- 5 micron
- Lipids- 1.2 micron
- Isavuconazonium
- Phenytoin (if continuous IV only)
- Amiodarone
- Taxanes (cabazitaxel/ conventional paclitaxel)
- Mannitol 20%
- Parenteral Nutrition-1.2 micron
GAL Is PAT with the MaP
Others: - abatacept
- albumin (select products)
- antithymocyte globulin
- infliximab
What drugs should NOT be refrigerated?
- Dexmedetomidine (Ok if diluted)
- Sulfamethoxazole/trimethoprim
- Phenytoin (crystals will dissolve at room temp)
- Furosemide (OK if diluted, crystals dissolve at room temp)
- Metronidazole
- Moxifloxacin
- Enoxaparin
Dear Sweet Pharmacist Freezing Makes Me Edgy
Others: - acetaminophen
- acyclovir (crystals dissolve)
- deferoxamine (precipitate)
- levetiracetam
- pentamidine (crystals)
- valproate
What drugs need to be protected from light during administration?
- Phytonadione (vit K)
- Epoprostenol
- Nitroprusside
- Micafungin
- Doxycycline
Protect Every Necessary Med from Daylight
Others: - amphotericin B deoxycholate
- anthracyclines
- dacarbazine
- pentamidine
What drugs should not be shaken or agitated?
- Hormones
- Proteins
- Albumin/ Immune globulins/ Monoclonal antibodies/ Insulins
- Foaming products: Alteplase, Etanercept (Enbrel), Rasburicase, capsofungin; swirl gently
- Reconstituted vaccines
- Emulsions
What color of chlorpromazine would indicate that it should NOT be used?
Darker than slight yellow; if slight yellow potency OK
What color of dacarbazine would indicate that it should NOT be used?
Pink
What color of dopamine would indicate that it should NOT be used?
Darker than slight yellow; if slight yellow potency is OK
What color of Epi would indicate that it should NOT be used?
Pink, then brown
What color of Isoproterenol would indicate that it should NOT be used?
Pink or darker; indicates damage by air, heat, light
What color of morphine would indicate that it should NOT be used?
Dark
