ACPE IV sterile compounding

To protect patient safety the three core values which must be demonstrated by those involved in compounding sterile preparations include safety, accuracy, and attitude

True

USP Chapter

True

Which of the following is an advantage of parenteral administration?

Avoids absorption limitations of the intestinal track

Which of the following can help to avoid a risk associated with the parenteral administration?

Proper training of all personnel, maintaining proper environment, using aseptic technique, and manipulations

Which of the following USP chapters relates specifically to endotoxin testing

Which of the following statements is correct regarding requirements for compounding sterile Preparations

State board of pharmacy may implement strict requirements then those required by USP chapter

USP Chapter 797 provides standards for :

Places where compounded sterile preparations are prepared, those who transport sterile preparations, and those who store sterile Preparations

There are 5 routes of parenteral administration. Is subcutaneous one of them?

True

Proper selection of glove and gown sizes are NOT important and compounding sterile products

False

A pharmacist must check all sterile compounds prepared by pharmacy technicians

True

The gauge of the needle represents

The diameter of the needle lumen

A needle that is 18 gauge 1/2 can be interpreted as

18 gauge diameter and 1/2 inch long

Which of the following needles would I used to prepare an Ativan (lorazepam) drip as the Ativan can be viscous

16 G

A 16G needle should be used for

Viscous solutions

The purpose of a Vente needle is to

Avoid pressure differences when withdrawing and transferring solutions

Which of the following statements is correct regarding viles and ampules

Vials with preservatives are multiple-use, but ampules are single use

Which of the following is an advantage of an adaptable system

Decreased preparation time

A pharmacist attends an emergent patient situation in the hospital. At the bedside of the patient, the physician asked for amiodarone to be administered STAT. The pharmacist reaches for the amiodarone ampule. Which of the following statements describes the most appropriate action that should be performed

A filter needle should be placed on the syringe to withdraw the solution from the Apple. Although the situation is emergent, the filler needle should be replaced with a regular needle to eject the solution from the syringe

Which of the following solution should be administered with a 0.22 micron in-line filler

Mannitol

Which of the following should never be directly infused into a patient?

SWI

An example of chemical contamination is:

Endotoxin

The person compounding parenteral preparations has the most influence on the sterility of the preparation

True

Which of the following is the most common source of contamination of a parenteral preparation?

Touch

You are training a pharmacy technician on compounding sterile preparations. You notice that she has nail polish on her nails. How should you advise her?

Tell her that the nail polish must be removed to compound

You are a pharmacist working in a hospital on the weekend with a small pharmacy technician staff. Your primary sterile compounding technician is feeling as if he is becoming ill. What is the most appropriate course of action?

Tell the technician that he cannot compound

Which of the following statements is correct regarding multi does vials?

The contain preservatives to extend the expiration date to 28 days after accessing

Which of the following increase the likelihood of microbial contamination of a compound preparation

Accessing contents from an open system

Several patients in a hospital are receiving vancomycin 1 gram doses. A 10 gram multi dose vial will be used to prepare 10 doses for multiple patients at one time. Which of the following risk levels is the most appropriate classification?

Medium-risk

Which of the following statements is true regarding immediate use sterile preparations?

Administration of the preparation must begin within 1 hour of time compounding begins

How long should alcohol remain on work surfaces to ensure adequate disinfection ?

30 seconds prior to use

Which disinfecting agent is recommended by USP Chapter

Sterile 70% isopropyl alcohol

Which of the following statements is true regarding bacterial spores?

Non-sterile 70% isopropyl alcohol may contain spores

Negative pressure results from excess air residing inside the vial

False

The main difference between the airflow from a HLFW and BSC is that a HLFW first air is moving from top to bottom and the first air in a BSC is moving from back to front

False

Horizontal laminar airflow workbench is the type of primary engineer control is most appropriate for use for preparation of non-hazardous products

True

Cleaning should take place for primary engineering controls at the beginning of each shift, prior to each batch preparation, after spills, and when contamination of the surface is known or suspected. Otherwise, if preparations are ongoing, then no more than 30 minutes should pass between cleaning

True

Which of the following parts of a primary engineering control should not be blocked by i teams such as a trash can?

Pre-filter

The HEPA protective screen should be cleaned:

Every 6 months

What is the main differentiating factor between a BSC and a LAFW

The BSC provides personnel protection

If turned off, how long should a BSC and LAFW run prior to use

The BSC should run for at least 4 minutes and the LAFW should run for at least 30 minutes

Rinsing should be a part of the cleaning process for which of the following primary engineering controls?

Isolator

When compounding hazardous preparations, the primary engineering control must be located in an area with:

Negative pressure relative to adjacent areas

When removing a needle from the package, you may either peel the plastic protective wrap or you can force the needle through the paper covering, such as pushing the hub of the needle through the paper package.

False

Which of the following is required on a batch label, but not on a patient label for use in an institutional setting?

Pharmacy lot number

Which of the following needle parts is considered a critical site?

All of the above

Which of the following syringe parts is considered a critical site

Ribs of the plunger

If moving hands between holding the vial and the syringe, passing hands between the critical sites and the HEPA filter will result in blacked first air Which of the following is statement regarding aseptic technique?

A small amount of air should be added until slightly resistant, followed by depressing the plunger to allow a small amount of solution to enter the syringe

Which of the following is statement regarding aseptic technique?

If moving hands between holding the vial and the syringe, passing hands between the critical sites and the HEPA filter will result in blacked first air

Hands and forearms should be washed did at least 30seconds

True

Manipulation inside of a horizontal laminar airflow workbench should occur 6 inches from the font of the hood

True

PPE should be replaced with new garb prior to re-entering the buffer room

True

Stability refers to the retention of product properties and characteristics throughout its storage and use, while compatibility refers to the interaction between substances, substances and excipients, or substances and their container

True

Absorption occurs when drug molecules adhere at the surface of a container while adsorption results when the molecules penetrate into the matrix of the container

False

Incompatibilities can result in decreased drug efficiency

True

An example of medication that crystallizes at room temperature is:

Mannitol

Precipitation is of most concerned with/

Parenteral nutrition

A medication order is received for an amiodarone piggyback. The pharmacy technician prepares the order with amiodarone in a 250 ml PCV bag. Which of the following statements describes the most appropriate course of action?

There is a concern with the loss of potency secondary to sorption. The preparation should be discarded and prepared again in a non- PVC bag or glass container

A pharmacist is verifying an admixture prior to it being dispensed for administration to a patient. During the visual inspection she notes a significant amount of gas bubbles in the admixture. What is the most likely cause of this effect?

Gas formation from the addition of an acidic drug solution to a solution containing carbonate or bicarbonate

A home infusion pharmacy compound a sterile preparation that is costly, at $10,000 per dose. The preparation will be administered in the patient's home by a caregiver. During delivery, the transporting vehicle experiences mechanical difficulties for five hours. The preparation was not placed in a cooler during transportation and the outside temperature is 107 what course of should be taken?

The preparation should be discarded

Sodium nitroprusside is being dispensed to a patient in a hospital setting. Upon visual inspection, the pharmacy technician knows that the solution is blue in color. He checks a new container and sees that the solution is a brown/orange color. What is the most likely cause of the change in color?

Exposure to light

Which of the following calcium formulations is preferred to decrease potential for interactions?

Calcium gluconate

Use gallons should be disposed of as hazardous drug waste

True

At least three pharmacist should be involved in the verification process of chemotherapy Preparations

False

When withdrawn chemotherapy solutions from the vial positive pressure should always be used.

False

The preferred BSC for compounding hazardous drugs is:

Class II type B 2

Close system transfer devices

Should be use for compounding hazardous preparations and administration of these drugs

Which of the following is used for decontamination of hazardous contamination?

Sodium hypochlorite

Which of the following is a required component of a medication order for chemotherapy

BSA

Which of the following preparation techniques will result in the least risk of exposure to the operator?

CSTDS

Which of the following statements is incorrect regarding disposal of supplies use for compounding hazardous preparations?

Supply should be placed in a label bag that is located within the PEC. Following completion of compounding, the bag should be sealed and removed from the PEC. Sharp should be placed in a puncture proof container labeled as hazardous

Competency evaluation and training for pharmacy technicians involved in compounding hazardous preparation should include:

Safe handling of chemotherapy

Which of the following ingredients are prone to photo degradation

Vitamins

2-in-1 formulations offer the advantage of greater as compared to TNA's

Stability

Which of the following components of TPN will result in the formation of precipitation

Calcium gluconate and sodium phosphate

Cracking of an emulsion is a concern with:

TNA TPN formulation

Maximum concentrations and rate of infusions such as with potassium chloride are limited with:

Peripheral lines

Which type of TPN preparation method introduces a higher likelihood of contamination

Manual addition of components

The addition of which of the following TPN components is associated with inhibited bacteria growth if contamination occurs?

Fat emulsion

Which of the following ingredients of TPN should be added just prior to the compound being dispense to the patient?

Vitamins

TPN is classified as risk if prepared from powder amino acids; otherwise, if the formulation is prepared from crystalline amino acids, TPN is classified as risk.

High, medium

The filter size of micron should be used when infusing a TNA formulation

1.2

Which type of pump should the nurse use to infused dopamine for an infant?

Syringe pump

is a solvent agent found in parenteral drugs which has been associated with in hyperosmortality, seizures, cardiac arrest, lactic acid associated hemolysis and respiratory depression

Propylene glycol

Which of the following pumps is the most appropriate for administrating a pediatric TPN for a 12-year-old child

Large volume pump

__________ is A preservative found in a parenteral drug which has been associated with severe metabolic acidosis, respiratory depression and central nervous system depression, convulsions, paralysis and death in infants

Benzoyl alcohol

Which of the following is a way to prevent medication errors in pediatric patients?

Limit the concentration of drugs

DEHP is a chemical found in:

IV tubing sets

What is the risk or concern of dopamine were to be infused through a peripheral line in this infant ?

Extravasation

Which of the following considerations is important in determining what concentration to prepare for administration to the infant?

Site of infusion

_______________ solutions contribute to the overall daily intake of benzyl alcohol.

Heparin/ saline lock flushes

Which of the following statements about obtaining and maintaining IV access in infants and hound children is correct?

Numerous attempts are typically required, which can weaken and damage the vessel

__________ generally involves evaluation of the final preparation and the facilities in which it is compounded

Quality assurance

The three stimulation test required for personnel who compound sterile preparations includes passing three gloved fingertip test, completion of media -fill test with a negative result and….

Surface sampling

Primary and secondary engineering controls must be certified every:

6 months

How often should air sampling be performed?

Every six months

A compounding employee performs a media filters. After the proper amount of time for incubation of the media, a positive result is noted. Based on the observation, which of the following is the most reasonable explanation?

The employee did not perform effective aseptic technique and/or hand hygiene

_________ generally refers to those processes which can be measured as the CSP is being produced.

Quality control

How often should fours be clean according to requirements in USP chapter 797

Daily

A physician who works at a small hospital emergency room compounds sterile preparations on occasion. Is he required to have an education and training based on USP chapter 797 requirements?

Yes