Pharmacy Foundations: IV medication principles

Question 1

When is IV route used for drug delivery

Answer 1

When gut needs to be bypassed or patients are NPO in hospital

Drugs with poor oral bioavailability

Fast onset is required

Question 2

Peripheral vs Central lines

Answer 2

Peripheral are cheaper and easier to insert
Common veins for peripheral lines are cephalic or saphenous veins

Central lines empty into larger vein and medication diluted more quickly

Question 3

Central lines are required for administration of….

Answer 3

Highly concentrated drugs (KCl > 20mEq/100ml)
Long term abx
Toxic drugs that would give phlebitis or tissue damage if peripheral
Drugs with pH or osmolality not similar to blood pH

Can also be used for patients with collapsed veins

Question 4

Benefits of central lines….

Answer 4

can give higher volumes and faster infusion rates

Question 5

Vesicant drug info

Answer 5

Drug that will cause severe tissue damage if catheter tip comes out of vein

Central lines are safer with central line

Question 6

Examples of vesicants

Answer 6

Vasopressors (dopamine, norepi)
anthracyclines (doxorubicin)
vinca alkaloids (vincristine, vinblastine)
digoxin
foscarnet
nafcillin
mannitol
mitomycin
promethazine

Question 7

IV promethazine issues

Answer 7

should not be given to children < 2 years old

IM preferred, intra-arterial/subQ shouldn’t be used

Question 8

Chemical incompatibility causes….

Answer 8

hydrolysis
oxidation
decomposition

Question 9

Physical incompatibilities occur between one of the following….

Answer 9

container
diluent
another drug

Question 10

Container absorption vs adsorption

Answer 10

absorption: when drug moves into PVC container
adsorption: when drug adheres or sticks to container

Question 11

Drugs that have leaching, absorption or adsorption issues can be placed into….

Answer 11

polyolefin, polypropylene or glass containers

Question 12

Drugs with leaching, adsorption or absorption properties?

Answer 12

Leach
Absorbs
To
Take
In
Nutrients

Question 13

Leach Absorbs To Take In Nutrients

Answer 13

L = Lorazepam
A = Amiodarone
T = Tacrolimus
T = Taxanes
I = Insulin
N = Nitroglycerin

Question 14

Drugs that require Saline diluent solution

Answer 14

A DIAbetic Cant Eat Pie

Question 15

A DIAbetic Cant Eat Pie

Answer 15

A = Ampicillin
D = Daptomycin
I = Infliximab
A = Ampicillin/Sulbactam
C = Caspofungin
E = Ertapenem
P = Phenytoin

Question 16

Drugs that require Dextrose diluent solution

Answer 16

Outrageous Bakers Avoid Salt

Question 17

Outrageous Bakers Avoid Salt

Answer 17

O = Oxaliplatin
B = Bactrim (SMX/TMP)
A = Amphotericin B
S = Synercid (Quinupristin/Dalfopristin)

Question 18

Y-site vs Additive compatibility

Answer 18

Many drugs that cannot be mixed in container can be given together and have Y-site compatibility

Drugs spend less time together mixing in Y-site

Question 19

Primary Sources for compatibility issues

Answer 19

Trissel’s
Kings

Question 20

High-Risk incompatibilities

Answer 20

Calcium + Ceftriaxone*
Calcium + Phosphate**

• Lactated ringers contain Ceftriaxone
  ** when used in parenteral nutrition, methods have to be used to reduce risk of precipitate

Question 21

Common Drugs that require filters

Answer 21

My GAL Is PAT who has a MaP

Question 22

My GAL Is PAT who has a MaP

Answer 22

G = golimumab
A = Amphotericin B (lipid formulations)
L = Lipids - 1.2 micron size

Is = Isavuconazonium

P = Phenyoin
A = Amiodarone
T = Taxanes (cabazitaxel and paclitaxel)

Ma = Mannitol > 20%
P = Parenteral nutrition - 1.2 micron size

Question 23

IV Drugs that shouldn’t be refrigerated

Answer 23

Dear Sweet Pharmacist, Freezing Makes Me Edgy

Question 24

Dear Sweet Pharmacist, Freezing Makes Me Edgy

Answer 24

D = Dexmedetomidine
S = SMX/TMP
P = Phenytoin = crystalizes
F = Furosemide = crystalizes
M = Metronidazole
M = Moxifloxacin
E = Enoxaparin

Question 25

Drugs that require protection from light during administration

Answer 25

Protect Every Necessary Med from Daylight

Question 26

Protect Every Necessary Med from Daylight

Answer 26

P = Phytonadione, Vitamin K
E = Epoprostenol
N = Nitroprusside
M = Micafungin
D = Doxycycline

Question 27

Drugs that shouldn’t be shaken or agitated

Answer 27

Protein/Blood products such as Albumin, immune globulins, monoclonal antibodies and insulins

Products that foam = alteplase, entanjrcept, rasburicase, Synercid