Learning IV Medications

Question 1

The intrathecal route is often used by anesthesiologists and for some chemo, but when it’s contraindicated (ie vincristine), what can happen?

Answer 1

death!!

Question 2

A commons vein used for peripheral venous catheters is what vein?

Answer 2

cephalic vein - in the arm and the saphenous vein near the ankle

Question 3

What is phlebitis?

Answer 3

vein irritation

can happen when administering drugs into a smaller vein

Question 4

What can happen when administering drugs into small vein? (3)

Answer 4

phlebitis
thrombosis
fluid extravasation

Question 5

Central veins are required for administration of:

Answer 5

highly concentrated drugs (potassium chloride >20 mEq/100mL)

long term antibiotics

toxic drugs

drugs with a pH or osmolality that is not close to blood pH or osmolality (PN)

Question 6

What drugs are known vesicants?

Answer 6

Vasopressors (dopamine, norepinephrine)

anthracyclines (doxorubicin)

vinca alkaloids (vincristine, vinblastine)

digoxin

foscarnet

mannitol

Question 7

What drug is known to cause severe tissue injury even via SC, IM, intra-arterial

Answer 7

promethazine

do not give to children <2y

Question 8

What is the name of the book that is the primary compatibility and stability resource?

Answer 8

the handbook on injectable drugs (Trissel’s)

or the King guide to parenteral admixtures. (King’s)

can also find info in the package insert

Question 9

Chemical instability causes drug degradation or toxicity due to what type of reaction?

Answer 9

hydroloysis

OR

oxidation

OR

decomposition

Question 10

Physical incompatibilities occur between a drug and one of the following:

Answer 10

container (PVC)

diluent (solution – dextrose)

another drug

Question 11

The majority of PVC containers use _____ as a plasticizer to make the plastic bah more flexible. Why is this not good in some instances?

Answer 11

DEHP

it can leach into the solution and it is toxic. can harm the liver and testes

Question 12

Absorption vs adsorption?

Answer 12

absorption: occurs when the drug moves into the PVC container
adsorption: occurs when drug adheres to the container

either will reduce the drugs concentration

Question 13

Drugs that have leaching or absorption/adsorption issues with PVC containers can be placed in what kinds of containers?

Answer 13

polyolefin

polypropylene

glass containers

Question 14

Insulin absorbs/adsorbs to PVC?

Answer 14

adsorbs! (sticks to the PVC)

however, clinicians adjust the rate of insulin infusions to obtain BG control regardless of the type of IV container/tubing used

Question 15

What drugs have sorption or leaching issues with PVC?

Answer 15

LATTIN!!! Leach Absorbs To Take In Nutrients

Lorazepam

Amiodarone

Tacrolimus

Taxanes

Insulin

NTG

Question 16

The one exception in Texans that can be placed into PVC?

Answer 16

paclitaxel-albumin bound (Abraxane)

Question 17

More drugs that have adsorption issues?

Answer 17

carmustine

cyclosporine

ixabepilone

sufentanil - opioid

temsirolimus

teniposide

thiopental

Question 18

What drugs cannot be mixed with Dextrose/ must be mixed with saline only?

Answer 18

SALINE ONLY (no dextrose!)

PEA ACID

Phenytoin (Dilantin)
Ertapenem (Invanz)
Ampicillin

Ampicillin/sulbactam (Unasyn)
Caspofungin (Cancidas)
Infliximab (Remicade)
Daptomycin (Cubicin)

Question 19

What drugs cannot be mixed with saline/ dextrose only?

Answer 19

BOAS

Bactrim
Oxaliplatin
Ampho B
Synercid (Quin/Dalf)

Question 20

What other drugs can only be mixed with saline only?

Answer 20

abatacept 
idarucizumab
iron sucrose/venofer
sodium ferric gluconate complex
natalizumab/ tysabri
trastuzumab

Question 21

What other drugs can one be mixed with dextrose only?

Answer 21

mycophenolate (cellcept IV)

Question 22

Drugs are commonly put in 50mL piggybacks (or larger) that contain what solutions?

Answer 22

D5W

NS

but know what drugs can’t be in which!

Question 23

Drugs that are not compatible - can they be used in Y site?

Answer 23

perhaps… additive compatibility and Y site compatibility = many drugs that can’t be mixed in the same container are compatibility when the drugs are mixed together for aSHORT period of Time (y site)

Question 24

What is a dangerous example of incompatability?

Answer 24

ceftriaxone and calcium-containing solutions (preceipatatE)

LACTATED RINGERS HAS CALCIUM!!!

Ca and Phos

Question 25

can ceftriaxone and LR be mixed?

Answer 25

NO!

Question 26

What size filter do lipids use?

Answer 26

1.2 microns

Question 27

Majority of drugs use what type of filter?

Answer 27

0.22 micron filter

Question 28

What key drugs require filters?

Answer 28

GAL, PLAT Golimumab (simponi) Amiodarone Lorazepam, con't Phenytoin, con't Lipids (1.2m) Ampho B (lipid formulations), 5 micron filter Texanes, except docetaxel

Question 29

The likelihood of a CHEMICAL reaction that would degrade the drug increases/decreases with time

Answer 29

increases ex: zosyn extended infusions

Question 30

Most IV drugs are kept cold to permit longer stability except for ___ &____ which crystallize

Answer 30

furosemide and phenytoin -- crystalize

Question 31

KEY IV DRUGS THAT CANT BE REGRIGERATED

Answer 31

SPF MMED Sulfa/Trim (Bactrim) Phenytoin Furosemide Metronidazole Moxifloxacin (Avelox) Enoxaparin Dexmedetomidine (Precedex)

Question 32

Other iv drugs that can't be refridge

Answer 32

``` APAP (ofirmev) acyclovir - crystallizes deferoxamine (desferal) - precepitates levetiracetam (keppra) pentamidine Valproate ```

Question 33

Light exposure causes: , whichd destroys some drugs or increases drug's toxicity (nitroprusside)

Answer 33

photo degradation

Question 34

Which drugs need to be protected during IV administration?

Answer 34

MD PEN Micafungin (Mycamine) Doxycycline Phyntonadion (vit. k. Mephyton) Epoprostenol (Flolan) Nitroprusside (Nitropress)

Question 35

Drugs that are commonly destroyed with agitation?

Answer 35

albumin alteplase immune globulins insulins Mabs rasburicase vaccines (zoster)

Question 36

In most cases, discoloration indicates what?

Answer 36

oxidation or another type of decomposition

Question 37

DO NOT USE WITH COLOR CHANGE: darker than slight yellow

Answer 37

chlorpromazine dopamine

Question 38

DO NOT USE WITH COLOR CHANGE: pink

Answer 38

dacarbazine

Question 39

DO NOT USE WITH COLOR CHANGE: oxidation turns the solution slightly pink but potency is not lost

Answer 39

dobutamine

Question 40

DO NOT USE WITH COLOR CHANGE: Pink, then brown

Answer 40

epinephrine

Question 41

DO NOT USE WITH COLOR CHANGE: | pink or darker

Answer 41

isoproterenol damaged by air light heat

Question 42

DO NOT USE WITH COLOR CHANGE: | dark

Answer 42

morphine

Question 43

DO NOT USE WITH COLOR CHANGE: | orange --> brown --> blue

Answer 43

nitroprusside

Question 44

what color of nitroprusside indicates nearly complete dissociation to cyanide?

Answer 44

BLUE antidote: cyanokit

Question 45

DO NOT USE WITH COLOR CHANGE: | brown or ANY discoloration

Answer 45

norepinephrine natural color: yellow/organge

Question 46

DO NOT USE WITH COLOR CHANGE: green/black

Answer 46

tigecycline

Question 47

extravasation antidote for dopamine?

Answer 47

phentolamine

Question 48

IV drugs come as colored solutions RED

Answer 48

anthracyclines -- sweat and urine also turn red rifampin - body. fluids and teeth turn red

Question 49

IV drugs come as colored solutions YELLOW

Answer 49

methotrexate MVI :)

Question 50

IV drugs come as colored solutions YELLOW/ORANGE

Answer 50

tigecycline -- teeth is used during development

Question 51

IV drugs come as colored solutions BLUE

Answer 51

mitoxantrone -- skin, eyes, urine

Question 52

IV drugs come as colored solutions BROWN

Answer 52

IV iron -- urine