Dr. K- Composition and Characteristics of Sterile Compounds

based off Dr.K's study guide

True or False: With Bacteriostatic Water for injection, the bacteriostatic agent inhibits the growth of things, and allows us to skip following aseptic technique.

True or False: With Bacteriostatic Water for injection, the bacteriostatic agent inhibits the growth of things, and allows us to skip following aseptic technique.

FALSE- must follow aseptic technique still

Water- Miscible Solvents are usually administered ___.

a. PO

b. IM

c. IV

d. SC

b

For small volume parenteral the volume is ≤_______ mL.

≤100 mL

For large volume parenteral the volume is >_______ mL.

>100 mL

For small volume parenteral (SVP), the typical administration method(s) are:

• IV push

• piggyback (Intermittent Infusion)

For large volume parenteral (LVP), the typical administration method(s) are:

• continuous infusion

IV Push:

• Timing

• Typical Uses

• timing: seconds-minutes/rapid administration

• Typical Uses:

  • urgent medications

  • drugs that are unstable/ precipitate at large volumes

Intermittent Infusion:

• Timing

• Typical Uses

• Timing: minutes- hours

• Typical Uses:

  • “piggyback” onto another running infusion at a Y site

Continuous Infusion:

• Timing

• Typical Uses

• Timing: continuous (so can be for hours-days-months, etc.)

• Typical Uses:

  • dehydration

  • electrolyte imbalances

  • fluid replacement

  • hydration

Biggest Risks w/ Continuous Infusions:

• can cause fluid overload- especially in chronic heart failure patients

• must watch titration rates closely

When would you use (or NOT use) Dextrose as an LVP?

• Used as caloric source for patients

• Don’t Use: in patients w/ diabetic coma

When would you use (or NOT use) Saline as an LVP?

• concentration dependent on patient labs/clinical factors

When would you use Lactated Ringers as an LVP?

• Use in patients with:

  • GI fluid losses

  • dehydration

  • sodium depletion

Hypotonic Solutions:

• relationship of solute conc to blood

• resulting fluid shift

• less conc of solutes than blood

• causes fluid to shift from ECF to ICF

Hypotonic Solutions are typically used to…

to shift water into the cells to treat conditions that cause intracellular dehydration

Hypotonic Solutions:

• risks

• example fluids

• risks: fast infusions can cause rapid movement of water into cells = BAD

  • can cause hemolysis (cells to burst), hyponatremia, and hypotension

• Examples:

  • <0.9% saline

    • 0.2% saline, 0.45% saline

  • <5% dextrose

    • 2.5% dextrose in water

Hypertonic Solutions:

• risks

• example fluids

• risks:

  • circulatory overload

  • osmotic demyelination syndrome

  • venous irritation

• Examples:

  • >0.9% saline

    • 3% and 5% saline

  • >5% dextrose

    • 5% dextrose in Lactated Ringers

Isotonic Solutions:

• risks

• example fluids

• risks:

  • less than hypo or hyper, still risk of fluid overload

• Examples:

  • 0.9% NaCl (NS)

  • Dextrose 5% in water (D5W)

  • Ringer’s Solution

Hypertonic Solutions:

• relationship of solute conc to blood

• resulting fluid shift

• greater conc of solute than blood

• Causes fluids to move from ICF to ECF

Isotonic Solutions:

• relationship of solute conc to blood

• resulting fluid shift

• same conc of solutes as blood

• no/ equal fluid shift in and out of cells

Isotonic Solutions are typically used to…

• rehydration

• vehicles for drug delivery

Hypertonic Solutions are typically used to…

• to correct severe sodium depletion and water overload

• treatment of cerebral edema

Sterile Products components include what 2 things?

1. vehicles

2. solutes

What are some examples of vehicles used in sterile products?

• solvents

• solutions

• diluents

Think: Vehicles are the liquid portion

Do most vehicles have any therapeutic activity?

NO

Vehicles must meet _____ requirements for sterility.

USP

Name the 4 typical diluents used for reconstitution:

1. SWFI (sterile water for injection)

2. BWFI (bacteriostatic water for injection)

3. NS (0.9% NaCl)

4. Bacteriostatic Sodium Chloride 0.9%

Name 3 typical small/large volumes for administration:

1. NS

2. D5W

3. LR (Lactated Ringers)

Are water vehicles (SWFI, BWFI) isotonic?

No, must be adjusted isotonic before use

Should water vehicles (SWFI, BWFI) be used for direct patient administration?

NAH, for only reconstitution

Should aseptic technique still be used with vehicles containing preservatives (anything bacteriostatic)?

YES

Vehicles containing preservatives (anything bacteriostatic), should not be used in _____________ or for ___________________ administration.

Should not be used in neonates (pre-me babies) or for epidural administration.

What is the purpose of water miscible and non-aqueous solvents?

• USED FOR POORLY WATER SOLUBLE DRUGS

Additives are used to…

• maintain:

  • sterility

  • solubility

  • physical/chemical stability

• ease administration

Additives must not interfere w/ what?

therapeutic efficacy

Preservatives are used to maintain

sterility

pH buffers are used to

increase solubility

antioxidants and chelating agents are used to

increase stability

tonicity agents are used to

help make isotonic

Solubilizers are used for

poorly water soluble drugs