Chapt 10-13

What are commonly used to correct or maintain the fluid status of patients?

Parenteral Solutions

What conditions should patients be monitored for when receiving parenteral fluids?

Anaphylaxis, Cellulitis, Embolism, Extravasation, HAIs, Hepatotoxicity, Nephrotoxicity, Phlebitis, Stevens-Johnson syndrome, Tissuing

What physical or chemical characteristics must be considered regarding CSPs?

Compatibility of solution components, Compatibility of solution additives, pH value, Osmolarity, Osmolality, Tonicity

What are the critical sites that should never be touched or shadowed during CSP Compounding?

Needle, Syringe tip, Vial cap/septa, Luer-to-Luer connector, Plunger

What is administered through an IVPB for intermittent infusion of medications?

SVP (Small Volume Parenteral)

How should needle insertion be performed into the injection port of an IV bag?

Straight into the injection port without bending and without regard for the position of the bevel.

What is the typical administration time for most IVPBs?

15 to 60 minutes

What technique involves adding air or liquid to/from the vial to create a relatively positive pressure?

Milking

What must compounding personnel determine to reconstitute a powder for IV administration?

The amount of diluent needed to provide the desired concentration.

What should be checked prior to attaching an IVA seal on the IVPB?

Leakage for the bag, precipitate formation, and incompatibility.

What are ampules made of?

Thin, medical-grade glass tubing.

What is the volume range for ampule medications?

1mL to 20mL

What is the design feature of an ampule neck that allows it to break easily?

Scored or made of thinner glass, called a break ring.

What must be done to the solution after breaking the neck of the ampule?

Filter it by passing it through a single direction 5 micron filter needle.

What is the most dangerous part of preparing ampules?

Opening the ampule.

What is an ampule considered once the neck is broken?

An open, single use container.

What type of filter is most commonly used when working with ampules?

Single direction filter needle.

What are the parts of an ampule from the top to the bottom?

Head, Neck, Shoulder, Body.

What are the critical sites of an ampule?

The ampule neck and the opening after removing the head.

What must the technician do prior to breaking the ampule?

Clear all the fluid from ampule head and neck by tapping or swirling the ampule and alcohol neck afterwards.

What is a unique risk to ampule preparation?

Exposure to broken glass.

How should the ampule neck be snapped?

Away from you.

How should the needle be inserted into the ampule?

Bevel down.

True or False: Air should be injected into the ampule prior to withdrawing the required volume.

FALSE

True or False: When withdrawing from your ampule, it is important to withdraw at least 0.2mL more than the desired volume.

TRUE

True or False: You should remove all bubbles from the syringe prior to attaching the filter needle.

TRUE

What items are needed when preparing for a verification check of your ampule CSP?

Ampule, IVPB, The syringe with the filter needle attached, The capped used regular needle.

What organization was developed to oversee and enforce the CSA?

DEA

Controlled substances CSPs most often involve compounding medications using narcotics from which schedule?

CII.

How many controlled drug schedules are there?

5

What are PCA devices most often used for?

Short-term control of postoperative pain.

What does PCA stand for?

Patient Controlled Analgesia.

What does the PCA pump do to avoid dosage errors?

Locks out the patient if the next dose is requested before the scheduled time.

What is the highest potential for abuse classification?

CI.

What are some examples of CIs?

LSD, Marijuana, Heroin.

What are some examples of CIIs?

Morphine, Meperidine, Cocaine, Codeine, Hydrocodone, Fentanyl, Oxycodone, Methylphenidate, Hydromorphone.

What are some examples of CIIIs?

Codeine with ASA, APAP, or Ibuprofen, Ketamine.

What are some examples of CIVs?

Diazepam, Lorazepam, Phenobarbital, Zolpidem.

What are some examples of CVs?

Codeine with nonnarcotic analgesic, or antitussive, Antidiarrheal.

What must be used to track C-II controlled substances?

Perpetual Inventory System.

How are all classes of controlled substances stored in most institutional and/or hospital pharmacies?

Under a Double Lock System.

What do patients with end-stage cancer often build up to narcotic medications?

Narcotic Tolerance.

When do you need to sign a narcotic out of the perpetual inventory?

To fill floorstock, to prepare an epidural cassette, to compound a PCA syringe, and every time you remove a controlled substance from inventory.

What should be done if a discrepancy is discovered while recording in the perpetual inventory log?

Report it immediately!

What is sometimes used to transfer fluid from one syringe to another without the use of a needle?

Luer-to-Luer connector.

What should be done if an error is made on the perpetual inventory log?

Indicate the error with a single strike-through line with their circled initials.

What ink should be used for entries and additions to the perpetual record?

Black ink for entries and additions, red ink for withdrawals and to indicate a negative balance.

What must be resolved if the actual narcotics count does not match the existing balance?

A discrepancy.

What should not be injected into the IVPB bag?

No air.

How would you determine the volume of NS to prepare a PCA?

Total Volume of PCA - Narcotic Volume = Volume of NS.

What is used to cover the tip of the syringe after sterile compounding?

Syringe Cap.