Parenterals - Basics of Sterile Compounding

parenteral administration bypasses the

GIT

by passing the GIT, parenterally administrated drugs are not subjected to...

pharmacodynamic properties (skips FPE)

what are the three types of routes of administration

topical

enteral

parenteral

Intravenous (IV) injection

into the veins

intramuscular (IM) injection

into the muscle

subcutaneous (SQ or SubQ) injection

into the subcutaneous tissue of the skin

intradermal (ID) injection

into the dermis of the skin

Intrathecal injection

into the subarachnoid space of the spinal cord

epidural injection

into the epidural space of the spinal cord

intra-arterial injection

into the arteries

intra-cardiac injection

into the heart

intra-articular injection

into the joint space

intra-ocular injection

into the eyes

intraperitoneal injection

into the peritoneal cavity

what angle should an IM injection be administered?

90 degrees

what angle should an IV injection be administered?

35-45 degrees

what angle should a SQ injection be administered?

45 degrees

what angle should an ID injection be administered?

10-15 degrees

what is the volume range for an ID injection

0.02-0.5 mL

what is the volume range for IV injections

unlimited

what is the max volume for IM injections

5 mL

what is the volume range for SQ injections

small volumes

what is typically administered via intra-articular injection

steroids

what diseases are usually treated with Intra-ocular injections

retinopathy

glaucoma

macular edema

what meds are usually delivered via intra-ocular injection

avastin and steroids

peritoneum

membrane that lines the abdominal cavity and hold the organs in place

what meds are usually administered via intra-ocular injection

avastin and steroids

what type of injection is the most common

IV

IV administration has ___% bioavailability

100

what are the disadvantages of IV admin

need to have access

difficult or impossible to remove or reverse drug

risk of infection, emboli, infusion related rxns

expensive

what are the advantages of IV admin

good for ppl who cant do PO

bypasses GIT

no FPE

100% bioavail

quick onset of action

localized delivery

extended duration of effects

what are the three kinds of IV injections

continuous infusion

intermittent infusion

IV push or bolus

continuous IV infusion

an IV solution infused at a continuous prescribed rate

intermittent IV infusion

A solution of a small to moderate volume infused intravenously over a short period of time at specific time intervals

IV push or bolus

A small volume of solution injected directly into the vein and infused over a short period of time (can happen in rapid succession if needed but not repeated later at set times)

needles are made of which two metals

aluminum

stainless steel

needles are packaged individually in order to

guarantee sterility

what are the parts of a needle

hub, shaft, bevel, lumen, and cap

needle length is measured from ____ to _______

hub to tip

needle gauge

diameter of the needles opening (lumen)

as gauge increases the diameter of the lumen _______

decreases

what part of the needle is 1?

hub

what part of the needle is 2?

shaft

what part of the needle is 3?

bevel

what part of the needle is 4?

lumen

if syringe size is 1, 3, or 5 mL:

needle gauge = ______

needle length = _______

20 gauge

1 inch

if syringe size is 10, 20, 30, or 60 mL:

needle gauge = ______

needle length = _______

18 gauge

1.5 inches

if syringe size is for a large volume or a viscous solution:

needle gauge = ______

needle length = _______

16 gauge

1.5 inches

what type of needle is needed for withdrawing from ampules

filter

types of needles

-Double ended needles and Transfer Sets

-Filter needle and Filter straws

-Vented Needles

opening needles:

needle must be at least ________ inches in the hood

6

opening needles:

you should tilt the needle hub to the (front or back) of the hood

back

opening needles:

you should pull the packaging from the hub towards _____

you

opening needles:

you should never touch which parts of the needle when opening

the hub or the needle itself

what are the parts of a syringes

collar, barrel, calibrations,tip, flange, ribs, and piston

what part of the syringe is 1?

collar

what part of the syringe is 2?

barrel

what part of the syringe is 3?

calibration

what part of the syringe is 4?

tip

what part of the syringe is 1?

plunger

what part of the syringe is 2?

flange

what part of the syringe is 3?

ribs

what part of the syringe is 4?

piston

what are the types of syringes

luer lock/slip tip

oral

prefilled

glass/plastic

how should you measure when filling a syringe?

the final edge of the plunger piston should be aligned with the calibration marks on the syringe

syringe size = 1 mL

calibration = _____

0.01 mL

syringe size = 3 mL

calibration = _____

0.1 mL

syringe size = 5 mL or 10 mL

calibration = _____

0.2 mL

syringe size = 20 mL or 30 mL

calibration = _____

1 mL

syringe size = 60 mL

calibration = _____

2 mL

how do you select the right sized syringe:

accuracy method

divide the smallest increment of the calibration marks in 1/2

how do you select the right sized syringe:

general rule

dont use a large syringe for a small volume, use the smallest possible syringe to accommodate for the desired volume

T or F:

oral syringes cannot have needles attached to them structurally

T

T or F:

oral syringes are labeled with "for oral use only"

T

pros of prefilled syringes

improved accuracy and safety

convenient

efficient

easy to use

cons of prefilled syringes

complex

potential accidental needle sticks

malfunctions

breakage

clogging

safety syringe:

the plunger is (activated or inactivated) once the plunger is fully depressed

inactivated

safety syringe

needle is shielded either by retracting the needle into the syringe barrel when the plunger is pulled back o by deploying a protective shield over the needle

opening syringes:

you should remove from packaging at least _________ inches inside the hood

6

opening syringes:

you should hold the syringe by the __________

barrel

ampule

glass container that hold a single dose of medication

ampules:

what are the parts

tip, scored point, neck, body

what part of the ampule is 1?

conical tip

what part of the ampule is 2?

neck

what part of the ampule is 3?

body

what part of the ampule is 4?

scored point

ampules:

T or F: must be broken to use

T

ampules:

T or F: have multiple doses

F

ampules must have what type of needle

filter

an ampule when opened should never have _______ injected into it

air

withdrawing from an ampule option 1:

tilt the ampule and place the ______ of the needle in the corner near the opening, then pull the syringe plunger back to w/d

bevel

withdrawing from an ampule option 2:

keep ampule in a _________ position, place needle bevel in the corner space at the bottom of the ampule, pull back on plunger to w/d

vertical

withdrawing from an ampule option 3:

turn ampule over, ending up with opening ___________, insert needle, keep bevel just open opening but surrounded by liquid contents and draw liquid out

down

Vials are made of either _____ or _________

plastic or glass

vials are (open or closed) system containers

closed

vials either have ________ or _________ for reconstitution

solution or powder

T or F:

vials are only for single use

F:

there are single and multi dose vials

T or F:

most vials contain overfill

T

medications that contain preservatives or are prepared with bacteriostatic water for injection should NEVER be used for which kinds of injections?

epidural and intrathecal

how should you pierce a vial, list the steps in order

1. remove the flip tip cap

2. swab the top w/ an alcohol swab

3. let the alcohol dry

4. insert the needle with the bevel up into the rubber closure