IV Incompatibilities- Dr.K

based off outline

Incompatibility is the physicochemical phenomena that create a product ____________ for ________________.

unsuitable for administration

3 categories of incompatibilities:

1. therapeutic

2. physical

3. chemical

Therapeutic Imcompatibilites deals with what 2 things?

• Pharmacokinetics

  • ADME

• Pharmacodynamics

  • drug MOA

Physical Incompatibility is defined as two or more drugs in a solution resulting in ______________________.

change of appearance

What are some changes in appearance of a solution that indicate a physical incompatibilty?

• cloudy

• precipitate

• color change

• viscosity change

• effervescence

What are some sources of physical incompatibilty?

1. concentration

2. cosolvent system

3. ionic interactions

4. pH

5. sorption

adsorption vs. absorption

adsorption- drug adheres to surface of container/administration materials

absorption- drug integrates into matrix of container/administration materials

Chemical Incompatibilities are interactions resulting in _____________ changes or rearrangements to ____________________________________.

molecular changes or rearrangements to different chemical entities

Are chemical interactions usually reversible?

no- irreversible

What are some of the chemical rxns that cause chemical incompatibilies? (Ex: hydrolysis)

• hydrolysis

  • water breaks bonds

• oxidation

  • electron loss

• reduction

  • electron gain

• complexation

  • rxn between metal ion and ligand

• displacement

  • replacement of 1 element by another

What properties affect the degradation of drugs?

• photolysis

  • light

• pH

• temp

  • increase temp= increase rxn rate

• concentration

  • increase conc= increase rxn rate

What can be used to maintain proper pH?

buffers

What are the advantages/disadvantages of refrigeration of drugs?

advantages- increase chemical stability, reduce microbial growth

disadvantages- solubility generally decreases

In a syringe, because it has a _________ total volume, there is increased potential for issues.

small

What is a Y-site?

the location of ports where you can attach another IV line or a syringe for IV push medications

contact time is _________ at y-sites.

brief

What is an admixture?

multiple components combined in 1 bottle/bag

What are some of the causes of compatibility issues associated with admixtures?

• contact time

• multiple ingredients

• ambient temp

• exposure to light

Which containers minimize compatibility issues? (glass or plastic)

glass

What are some potential issues with plastic containers?

• permeation, leaching, sorption

• physical/chemical incompatibilities

• easily punctured

• melts

What is the most common issue with rubber closures? How can we prevent it?

Problem- coring

Solution- insert needle at 45 degree angle, use minimum gauge, bring refrigerated bottles to room temp

Which resource only shows compatibility at Y-sites?

Trissel’s Tables

HBID, Trissel’s 2, and King’s Guide all show compatibility in …

• in admixtures

• in syringes

• at y-sites

What additional info is in the HBID resource?

• product info

• administration

• stability/storage

What additional info is in the Trissel’s Tables resource?

contains drugs in different solutions

What additional info is in the Trissel’s 2?

single drug in solution

Which resource is available to us students at LECOM?

Trissel’s 2

What additional info is in the King’s Guide?

view up to 10 solutions together