Ch. 18 IV Drug Compatibility Administration and Degradation – Flashcards
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- The Handbook on Injectable Drugs (Trissel's) - King Guide to Parenteral Admixtures (King's)
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What are the 2 primary compatibility and stability resources?
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When dilantin and dextrose given together --> crystallizes
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Describe the compatibility between dextrose and dilantin
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polyvinyl chloride
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PVC
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- PVC containers have DEHP (plasticizer) which may affect male fertility - Concern about the DEHP leaching into the solution - Concern about sorption where the drug moves into the PVC container
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What is the concern w/ PVC containers?
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Place the drugs in polyolefin or glass containers instead
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What can we do about drugs that have incompatibility w/ PVC containers?
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Two Tiny Tots Came Dressed In Elephant PJs Tacrolimus Temsiruolimus Teniposide Cabazitaxel Docetaxel Ixabepilone Etoposide Paclitaxel
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List the drugs that leach into PVC.
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- ampicillin - abatacept - unasyn - caspofungin - daptomycin - idarucizumab (praxbind) - phenytoin - ertapenem (invanz) - infliximab (remicade) - iron sucrose (venofer) - sodium ferric gluconate complex
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What are common drugs that require 0.9% saline only?
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- amphotericin B - mycophenolate (CellCept IV) - pentamidine - Bactrim
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What are common drugs that require dextrose 5% solution only?
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When a pt needs to receive more than 1 IV medication at once time, but another IV line might not be available so the 2nd medication can be given through a single IV line using "Y-site" administration.
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What is Y-site administration?
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- additive compatibility - syringe compatibility - Y-site compatibility
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What are some of the different types of compatibility listing
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Cefepime and gentamicin cannot be mixed together in D5W or NS
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Provide an example of an additive compatibility
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amphotericin B
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Which drug is incompatible with majority of IV drugs and with any type of IV administration?
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- zosyn - heparin
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What other drugs are incompatible when mixed with other IV drugs?
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caspofungin
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What is a common hospital drug for treating candida infxns and has many Y-site incompatibility?
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- IV quinolones
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What are other drug classes that have a lot of Y-site incompatibility?
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filters that are inside the IV tubing
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What are in-line filters?
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Use w/ drugs that have risk for particulate, precipitate, crystals, contaminants, etc
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What kind of drugs are in-line filters used for?
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0.22 micron filter, 1.2 micron filter
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What is the most common size for in-line filters?
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1.2 micron
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What size in-line filter is used for most lipids?
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filter needles - used to prevent particulate from entering IV bag
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What kind of needles are used when compounding a drug that comes in a glass ampule?
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compounded sterile products
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CSP
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T
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T/F: As a drug remains in solution longer, the likelihood of a chemical reaction occurring increases.
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- abatacept - abciximab - amiodarone - digoxin - golimumab - infliximab - isavuconazonium - lorazepam - mannitol - phenytoin - thiotepa
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What are common drugs that require 0.22 micron filters during administration?
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- amphotericin B, liposomal and lipid complex
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What are common drugs that require 0.22 micron filters during preparation only?
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F; increases
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T/F: As drug remains in solution longer, the likelihood of a chemical reaction occurring decreases.
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zosyn "extended infusion"
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Which hospital medication has compatibility concerns d/t longer infusion times in recent years?
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obtain a higher T above MIC in order to combat drug resistance - High T > MIC is beneficial, but compatibility issues can occur w/ longer infusion times
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What is the purpose of the extended infusion of zosyn?
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To extend drug stability time, otherwise higher temperatures promote chemical rxns
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Why are the majority of compounded IV drugs kept refrigerated?
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furosemide
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Which drug is stored at room temperature to prevent crystallization?
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crystallization
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What happens when furosemide is refrigerated?
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- APAP (Ofirmev) - Acyclovir (fridge causes crystallization) - Deferoxamine (Desferal) - Dexmedetomidine (Precedex) - Enoxaparin (Lovenox) - Furosemide (fridge causes crystallization) - Hydralazine - Levetiracetam (Keppra) - MTZ - Pentamidine - Propofol (Diprovan) - Moxifloxacin (Avelox) - Phenytoin - Bactrim - Valproate
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List the IV drugs that don't require refrigeration.
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photo-degradation
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What does light exposure cause to the drugs?
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in a light-protective cover
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How do pharmacy staff dispense light-sensitive medications?
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- anthracyclines - dacarbazine - doxycycline - epoprostenol (Flolan) - micafungin (Mycamine) - Nitroprusside (Nitropress) - Pentamidine - Phytonadione
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List the medications that require protection form light during administration
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- alteplase - immune globulins - insulins - rasburicase - zoster vaccine - quinupristin/dalfopristin (synercid) - etanercept (Enbrel) - these meds should only be swirled when reconstituting, never shake.
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Agitation destroys some drugs, which drugs most common?
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discoloration indicates oxidation or decomposition
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What does discoloration of medications mean?
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- light causes decomposition - turns orange/dark brown, blue liquid - blue liquid means complete decomposition
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Describe the discoloration of nitroprusside - vasodilator - antihypertensive
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- slightly yellow OK - Don't use if darker yellow
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Describe the discoloration of chlorpromazine - 1st gen typical antipsychotic
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- turns pink if decomposed, don't use
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Describe the discoloration of dacarbazine - antineoplastic agent, alkylating agent
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oxidation turns the liquid slightly pink, but potency is still OK
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Describe the discoloration of dobutamine
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- slightly yellow OK - Don't use if darker yellow
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Describe the discoloration of dopamine
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- oxidation turns liquid brown - if discolored, don't use
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Describe the discoloration of norepinephrine
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- oxidation turns liquid pink, then brown - if discolored, don't use
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Describe the discoloration of epinephrine
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- Exposure to air, light, or high temp turns liquid pink or darker - if discolored, don't use
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Describe the discoloration of isoproterenol
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- don't use if dark solution
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Describe the discoloration of morphine
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- reconstituted soln is yellow/orange, don't use if green/black
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Describe the discoloration of tigecycline
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dark red don't use if not dark red
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What color should cyanokit (antidote) be? - used for Vit B12 deficiency, cyanide poisoning
