Chapter 5.1: Special Handling

what is NIOSH list?

• the standard for what counts as a hazardous drug

• NIOSH = National Institute for Occupational Safety and Health

• they publish list of harmful drugs to healthcare workers

• UPS <800>

what are characteristics of hazardous drugs?

• carcinogenicity (causes cancer)

• teratogenicity (birth defects)

• organ toxicity at low doses

what are the 3 groups of hazardous drugs?

1. antineoplastic drugs (chemotherapy)

2. non-antineoplastic drugs that still pose a toxicity risk like immunosuppressants (cyclosporine)

3. drugs that pose reproductive risk such as fluconazole or warfarin

   1. most common high risk drug is methotrexate, finasteride (enlarged prostate/hair loss), and various hormone replacements

what are some operational protocols for hazardous drugs?

• must be unpacked in neutral or negative pressure area to prevent spread of dust

• ppl receiving them should wear chemo gloves to protect against residue

• separate hazardous drugs, esp chemo drugs; cannot be stored together with regular stock

  • must have a dedicated fridge to prevent cross contam

what does USP <800> mandate when counting hazardous drugs?

• dedicated counting equipment, usually purple or yellow

• must be cleaned thoroughly with alcohol and deactivating agents followed by neutralizer

• hazardous drugs cannot be put into the robot/auto counting machines bc dust is impossible to clean

what does USP <800> mandate when compounding hazardous drugs?

• use chemo gloves which are tested for resistance to chemical perm

• standard gloves aren’t enough because hazardous chemicals can still permeate through latex/vinyl

• for compounding, double gloving is safer

• techs should also wear non-shedding, disposable gowns

• wear respiratory protection like N95 respiratory mask

what are 2 potent androgens to watch out for?

• finasteride

• dusteride

• both can cause severe birth defects in male fetuses

• warnings on bottles are explicit: do not handle if pregnant/fertile