PARENTERAL PREPARATIONS

IV Admixtures, IV Fluids and Electrolytes, Parenteral Antibiotic Preparations, Parenteral Antineoplastic Agents, TPN, Parenteral Biotechnology Products

IV ADMIXTURES
These preparations consist of one or more sterile drug products added to an IV fluid, generally dextrose or sodium chloride solution alone or in combination.

IV ADMIXTURES
Drugs that may cause irritation or toxicity when given as a rapid direct IV injection are also prepared as IV admixtures.

IV FLUIDS AND ELECTROLYTES

1. Fluids- used in the preparation and administration of parenteral products include sterile water and sodium chloride, dextrose, and Ringers solutions, all of which have multiple uses.

IV FLUIDS AND ELECTROLYTES

1. Fluids- These fluids serve as vehicles in IV admixtures, providing a means for reconstituting sterile powders. They serve as the basis for correcting body fluid and electrolyte disturbance and provide caloric source in parenteral

IV FLUIDS AND ELECTROLYTES

A. Dextrose (D-glucose) solutionsthe most frequently used glucose solutions in parenteral preparations.

DEXTROSE (DGLUCOSE) SOLUTIONS Uses: generally, a solution

of dextrose 5% in water (D5W) is used as a vehicle in IV admixtures. May also serve as hydrating solution. In higher concentrations, Dextrose provides a source of carbohydrates in parenteral

DEXTROSE (DGLUCOSE) SOLUTIONS Considerations: Because

the pH of D5W ranges from 3.5 to 6.5, instability may result if it is combined with an acid-sensitive drug. Greater than 15% must be administered through a central vein. And should be used cautiously in patients with diabetes

IV FLUIDS AND ELECTROLYTES

B. Sodium Chloride- usually given as a 0.9% solution termed as a normal saline solution (NSS). A hypotonic solution of 0.45% termed as halfnormal saline solution. 0.225% is termed as quarter-normal saline, and sodium chloride grater than 0.9%

SODIUM CHLORIDE FOR INJECTION

Which is a 0.9% solution, used as a vehicle in IV admixtures and for fluid and electrolyte replacement. In smaller volumes, it is suitable for the reconstitution of various

BACTERIOSTATIC SODIUM CHLORIDE FOR INJECTION

Which is also 0.9% solution, is intended solely for multiple reconstitutions. It contains an agent that inhibits bacterial growth (e.g., benzyl alcohol, propylparaben, methylparaben), which allows for its use in multiple-dose preparations.

IV FLUIDS AND ELECTROLYTES

C. Watersare used for reconstitution and for dilution of such IV solutions as dextrose and sodium chloride. Waters suitable for parenteral preparations include sterile water for injection and bacteriostatic water for injection.

IV FLUIDS AND ELECTROLYTES

D. Ringers Solutions- are appropriate for fluid electrolyte replacement, commonly are administered to postsurgical patients.

LACTATED RINGERS INJECTION

Contains sodium lactate, sodium chloride, potassium chloride and calcium chloride. Frequently it is combined with dextrose (5%).

RINGERS INJECTION
Differs from Lactated ringers Injection in that it does not contain sodium lactate and has slightly different concentrations of sodium chloride and calcium chloride. It may also be combined in solution with dextrose.

IV FLUIDS AND ELECTROLYTES

2. Electrolyte Preparations- with ion present in both intracellular and extracellular fluid, electrolytes are crucial for various biological processes. Surgical and medical patients who cannot take food by mouth.

IV FLUIDS AND ELECTROLYTES

A. Cations- are positively charged electrolytes. 1. Sodium is the chief extracellular cation. Plays a key role in interstitial osmotic pressure, tissue hydration, acid-base balance, nerve impulse transmission and muscle contraction. Parenteral sodium

IV FLUIDS AND ELECTROLYTES

2. Potassium is the chief intracellular cation. Participates in carbohydrate metabolism, protein synthesis, muscle contraction (esp. for cardiac muscle) and neuromuscular excitability. Includes potassium acetate, KCl

IV FLUIDS AND ELECTROLYTES

3. Calcium is essential to nerve impulse transmission, muscle contraction, cardiac function, bone formation and capillary and cell membrane permeability. Includes CaCl, calcium gluconate and

IV FLUIDS AND ELECTROLYTES

4. Magnesium plays a vital part in enzyme activities, neuromuscular transmission ans muscle excitability. Given parenterally as magnesium sulfate.

IV FLUIDS AND ELECTROLYTES

B. Anions- Are negatively charged electrolytes. 1. Chloride is the major extracellular anion. Along with sodium, it regulates interstitial osmotic pressure and helps control blood pH. Includes calcium chloride, potassium chloride and

IV FLUIDS AND ELECTROLYTES

2. Phosphate is the major intracellular anion. Phosphate is critical to various enzyme activities. It also influences calcium levels and acts as a buffer to prevent marked changes in acid-base balance. Include potassium phosphate and sodium phosphate.

IV FLUIDS AND ELECTROLYTES

3. Acetate is a bicarbonate precursor that may be used to provide alkali to assist the preservation of plasma pH. Include potassium acetate and sodium acetate.

PARENTERAL ANTIBIOTIC PREPARATIONS

Available as sterile unreconstituted powders, which must be reconstituted with sterile water, normal saline or D5W, or as a sterile, readyto-use liquid parenteral.

PARENTERAL ANTIBIOTIC PREPARATIONS 1. Administration methods.

Parenteral antibiotics may be given intermittently by direct IV injection, short-term infusion, intramuscular injection, or intrathecal injection.

PARENTERAL ANTIBIOTIC PREPARATIONS 2. Uses. Parenteral antibiotics are

used to treat infections that are serious and require high antibiotic blood levels or when the gastrointestinal tract is contraindicated such as in ileus.

PARENTERAL ANTIBIOTIC PREPARATIONS 3. Dosing frequencies of parenteral

antibiotics vary from once daily to as often as every 2hours depending on the kinetics of the drug, seriousness of the infections, the site of infection and the patients disease or organ status (e.g., renal disease).

PARENTERAL ANTINEOPLASTIC AGENTS

These medication may be toxic to the personnel who prepare and administer them. Occupational safety and Health Administration (OSHA) has published a technical manual Controlling Occupational Exposure to hazardous Drugs.

PARENTERAL ANTINEOPLASTIC AGENTS 1. Administration methods. Parenteral

antineoplastics may be given by direct IV injection, short-term infusion or long-term infusion. Some are administered by a non-IV route, such as the subcutaneous, intramascular, intra-arterial of intrathecal route.

PARENTERAL ANTINEOPLASTIC AGENTS 2. Safe antineoplastic handling

guideline. All pharmacy and nursing personnel who prepare or administer antineoplastics should receive special training in the following guidelines to reduce the risk of exposure to these drugs.

SAFE ANTINEOPLASTIC HANDLING GUIDELINES A. A vertical laminar flow

hood should be used during drug preparation, with exhaust directed to the outside.

SAFE ANTINEOPLASTIC HANDLING B. All syringes and IV tubing should GUIDELINES

have Luer-Lok fittings. C. Clothing. Personnel should wear protective equipment, including closed-front cuffed gowns resistant to liquid penetration or latex gloves when handling chemotherapy.

SAFE ANTINEOPLASTIC HANDLING GUIDELINES D. Final dosage adjustment

should be made into the vial, ampoule, or directly into an absorbent gauze pad.

SAFE ANTINEOPLASTIC HANDLING E. Priming equipment. Special GUIDELINES

care should be taken when IV administration sets are primed. The IV tubing should be primed before adding the drug of the tubing can be primes with drug-free fluid before connecting it to the chemotherapy

SAFE ANTINEOPLASTIC HANDLING GUIDELINES F. Proper procedures must

be followed for disposal of materials used in the preparations and administration of antineoplastics.

PROPER DISPOSAL OF ANTINEOPLASTICS 1. Needles should not be clipped

or recapped. 2. preparations should be discarded in containers that are puncture-proof, leak-proof and properly labeled.

PROPER DISPOSAL OF ANTINEOPLASTICS 3. Hazardous waste. A color-coded

system was created by the Environmental Protection Agency (EPA), of which use is required by facilities to esure safe and proper disposal of hazardous wastes.

SAFE ANTINEOPLASTIC HANDLING G. After removal of gloves, personnel GUIDELINES

should wash hands thoroughly. H. Personnel and equipment involved in the preparation and administration of antineoplastic agents should be monitored routinely.

PARENTERAL ANTINEOPLASTIC AGENTS

3. Patient problems. Infusion phlebitis and extravasation are the most problem that may occur during the administration of parenteral antineoplastics.

INFUSION PHLEBITIS
Inflammation of vein is characterized by pain, swelling, heat sensation and reduces at the infusion site. Drug dilution and filtration can eliminate or minimize the risk of phlebitis.

EXTRAVASATION
Infiltration of a drug into subcutaneous tissues surrounding the vein is especially harmful when anitneoplastics with vesicant properties are administered. Proper measures must be taken immediately if it occurs.

TOTAL PARENTERAL NUTRITION (TPN)

Large-volume admixtures that are used when enteral nutrition cannot be tolerated. 1. Two in one admixture contains both amino acids and dextrose.

TOTAL PARENTERAL NUTRITION (TPN) 2. three in one admixture contains

amino acid, dextrose, and intralipid or lipid. 3. Formulas. Most TPn admixtures contain various amounts of electrolytes and other additives such as insulin, H2 antagonists and

TOTAL PARENTERAL NUTRITION (TPN)

4. Calcium and Phosphorouscontaining solutions form a precipitate when mixed together and are therefore deemed incompatible. This reaction is avoided when these ingredients are added nonconsecutively to a TPN solution

TOTAL PARENTERAL NUTRITION (TPN)

5. Administration. TPN is most commonly administered through central line. TPN can also be administered through a peripheral or femoral line. Osmolality must be taken into consideration when choosing the route of

PARENTERAL BIOTECHNOLOGY PRODUCTS

Created by the application of recombinant technology to the generation of therapeutic agents, such as monoclonal antibodies, various vaccines, and colony simulating factors.

PARENTERAL BIOTECHNOLOGY PRODUCTS 1. Uses of these agents include

cancer therapy, infections, transplant rejection, rheumatoid arthritis, inflammatory bowel disease respiratory diseases and malaria as well as vaccines against cancer, HIV infection and hepatitis

PARENTERAL BIOTECHNOLOGY PRODUCTS Characteristics. Protein

and peptide biotechnology drugs that have a shorter half-life often require special storage such as refrigeration or freezing and must not be shaken vigorously to avoid destroying the protein molecules.

PARENTERAL BIOTECHNOLOGY PRODUCTS 3. Administration. Many

biotechnology products require reconstitution with sterile water or normal saline and may be parenterally administered by direct IV injection or fusion, or by intramuscular or subcutaneous