IV medication principles

What is osmolarity and tonicity?

Both terms are related and are used to express the solute concentration in solution

Osmolarity: solutes per liter of solution

Tonicity: pressure gradient that created by solutes that do not cross biological membrane

Hypertonic solutions vs Hypotonic solutions and their effects on RBC?

Hypertonic: fluid moves out of RBCs→ shriveled and dysfunctional

Hypotonic: RBCs absorb fluid→hemolysis

Which vein is used for peripheral venous catheters?

Cephiliac

Risks associated with peripheral lines?

• phelbitis(inflammation of veins)

• venous thrombosis

• fluid extravasation( leakage of fluid into surrounding tissues)

What are the five conditions where a central line is required?

• highly concentrated drugs

• long-term antibiotics

• vesicants or drugs that may cause tissue damage

• drugs with pH not close to blood pH

• drugs with high osmolartity (parenteral nutrition)

What is typically used for central line placement?

• to be considered central line, the catheter tip must be located in a large vessel(i.e Superior vena cava)

• Peripherally inserted central catheters are inserted into peripheral vein and go until tip is in SVC

What are vesicants?

Vesicants: drug that could cause severe tissue damage if it extravasates

Substances like these are preferred in Central lines

How do chemical incompatibilties occur?

hydrolysis, oxidation, or photolysis; all degradation reactions

What is Oxidation?

Happens due to losing electrons 

Catalyzed by heat, light, and metal ions→ produces free radicals 

Mostly likely occurs to hydroxyl(-OH) group 

How to prevent oxidation?

• Light protection—>amber glass 

• Temp control 

• Antioxidants→ ascorbic acid(Vitamin C) and tocopherol(Vitamin E)

• Chelating agents(prevents reaction by tying up catalyst)→EDTA 

• pH buffer 

What is Hydrolysis?

water causes cleavage of a bond in a molecule

Mostly likely happens in ester, amide(𝑅−𝐶-(=𝑂)−𝑁𝑅-𝑅), or lactam groups(ring with amide)

How to prevent Hydrolysis reaction?

• Adsorbants/descicants 

• Lyophilized(freeze-dried) powder

• hygroscopic(holds water) salt 

• Light protection, temp control, chelating agents, and pH control(same things as mentioned of for preventing oxidation)

What is Photolysis

Happens when UV light exposure causes breaking of covalent bonds

Compounds sensitive to light are 

• ascorbic acid

• Nitroprusside

• phytonadione(Vitamin K)

What are the types of physical incompatibilities

• the container(polyvinyl chloride container/PVC)

• the diluent(solution)

  • dextrose or saline

• another drug

  • Y-site

  • same container

What drugs require Non PVC containers?

Leach Absorbs To Take In Nutrients

Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin
Nitroglycerin

What drugs can only be mixed in dextrose only?

Only Sugar Always

• Oxaliplatin

• SMX/TMP

• Amphotericin B

Dextrose is a sugar

What drugs can only be mixed in saline only

A DIAbetic Can't Eat Pie

• Ampicillin

• Daptomycin

• Infliximab

• Ampicillin/Sulbactam

• Caspofungin

• Ertapenem

• Phenytoin

mostly anti-invectives

What are the two known high risk incompatibilities?

• Calcium + ceftriaxone

• calcium + phosphate

What drugs require a filter needle with IV administration?

GAL TIP MAT

• Golimumab
• Amp B
• Lipids (1.2 micron)
• Taxanes
• Isavuconazonium
• Phenytoin
• Mannitol ≥20%
• Amiodarone
• TPN (1.2 micron)

What drugs can not be refrigerated?

Dear Sweet Pharmacist Freezing Makes Me Edgy

Demedetomidine

SMX/TMP

Phenyotin

Furosemide

Metronidazole

Moxifloxicain

Enxoaparin

What drugs need to be protected from light?

Very Early mornings need daylight

• Vitamin K
• Epoprostenol
• Micafungin
• Nitroprusside
• Doxycycline

What products are not to be shaken?

• protein/blood products(Albumin, Insulin, Immune Globulins, monoclonal AB)

• products that foam(alteplase, etancercept, rasburicase)

• reconstituted vaccines(i.e MMR)

• emulsions

Do Not Use If these drugs if this color is present:

IV Drugs That Are Naturally Colored + Body Fluid Discoloration