Week 4: IV Compatibility

Question 1

CSP Stability

Answer 1

the extent to which a medication preparation remains within specified limits in terms of
* chemical composition
* physical composition
* microbiologic activity/contamination

basis for expiration/beyond-use-date

Question 2

What affects stability of CSPs?

Answer 2

1. time in solution (more time = more likelihood of degradation)
2. temperature (hotter = increase rate of reactions; break down proteins and colder extends BUD)
3. light exposure (can degrade drugs or increase toxicity)
4. agitation (shaking destroys some drugs)

levetiracetam, furosemide, phenytoin cannot be stored at colder temps

Question 3

CSP Stability: BUD

Answer 3

1. must assign the shortest beyond use date based on sterility and stability
2. never longer than manufacturer’s expiration for any starting components

Question 4

Chemical incompatibility

Answer 4

chemical reaction results in degradation of drug substances
1. hydrolysis
2. oxidation
3. decomposition

Question 5

Physical Incompatibility

Answer 5

physical incompatibility between drug and
1. the container
2. the diluent
3. another drug

Question 5

container incompatibility

Answer 5

mostly an issue with polyvinyl chloride (PVC) containters
1. DEHP (diethylhexyl phthalate) can leach from the container into the medication/fluid
2. container absorption - drug moves into the container and is absorbed
3. container adsorption - drug adheres to the container (insulin)
4. non-PVC containers can be used - polyolefin, polypropylene, glass

Question 6

diluent incompatibilities

Answer 6

consider when reconstituting and compounding sterile products (some drugs incompatible in D5W and NS)

Question 7

drug compatibility

Answer 7

1. y-site compatibility - to minimize number of lines, infusions may be joined by a Y-site and administered in the same line
2. admixture compatibility - must consider compatibility of drugs mixed in the same container
3. salt form and formulation matters

Question 8

high risk incompatibilities

Answer 8

1. ceftriaxone and calcium
2. calcium and phosphate

Question 9

role of the pharmacist

Answer 9

pharmacists must be proficient with the many IV compatibility drug resources available
1. trissel’s
2. king guide to parenterl admixtures
3. ASHP injectable drug information
4. package insert
5. site or unit specific charts or paper references

Question 10

IV compatibility

Answer 10

1. compatible
2. incompatible
3. uncertain or variable results
4. no data available