Naplex 2026: IV medication principles

Name the parenteral routes of admin

IV

IM

Subq

Intrathecal

What medication is fatal if given intrathecal? (directly into the CSF)

Vincristine

What is osmolarity and tonicity

Terms used to express the solute conc in a soln

Sodium chloride solutions > 0.9% are (hyper/hypotonic)

Hypertonic

eg) 3% and 23.4%

T/F: Hypertonic saline injections should be given in a peripheral line

F

Can be fatal, causes water to move out of RBCs

Preferred is central line

What can happen if a patient receives too much of a hypotonic solution?

RBC will absorb fluid and can cause hemolysis and be fatal

Drugs that are administered IV must be formulated to keep the pH in a narrow range to avoid....

damaging the veins and other tissues and for stability in solution

What is a venous catheter

An IV line access, can be peripheral or central

What is the common vein used for peripheral lines

Cephalic vein

(smaller veins)

What are 3 disadvantages of administering drugs into smaller veins?

1) Phlebitis (vein irritation)

2) Thrombosis

3) Extravasation

Name 5 reasons for using a central line

1) Highly concentrated drugs

2) Long-term antibiotics

3) Vesicant-prone drugs (prevent tissue damage)

4) Drug with a pH not close to blood pH (7.35-7.45)

5) High osmolarity drugs such as parenteral nutrition

A central line tip must be located in what area of the body

Large vessel such as superior vena cava

Explain the placement of peripherally inserted central catheters (PICC)

PICC lines are inserted by placing the line into a peripheral vein until the tip ends in the superior vena cava

List some vesicant drugs

Vasopressors: dopamine, NE

Anthracyclines: doxorubicin

Vinca alkaloids: vincristine

Why do some drugs require non-PVC containers?

PVC = polyvinyl chloride containers use diethylhexyl phthalate (DEHP) as a plasticizer to make the plastic bag more flexible.

Some drugs can leach the DEHP out of the container and into the drugs

List drugs that require non-PVC containers

hint, mnemonic

Leach Absorbs To Take In Nutrients

Lorazepam

Amiodarone

Tacrolimus

Taxanes (except for Abraxane aka Paclitaxel-albumin)

Insulin

Nitroglycerin

T/F: Insulin adsorbs to PVC but clinicians still use PVC containers and tubing

T

Can work around this by adjusting the rate of infusions

What are the two most common diluents for IV bags

D5W and NS

List the drugs that can only be mixed in dextrose

hint, mnemonic

Only Sugar Always

Oxaliplatin

Sulfamethoxazole/trimethoprim

Amphotericin B (all)

List the drugs that can only be mixed in saline

hint, mnemonic

Always Dissolve In A Chloride Electrolyte Pool

A - Ampicillin

D - Daptomycin

I - Infliximab

A - Ampicillin/sulbactam

C - Caspofungin

E - Ertapenem

P - Phenytoin

What diluent contains calcium??

Lactated Ringers

What diluent is lethal if mixed with ___ or ___ due to formation of precipitates?

Lactated Ringers => contains calcium

Cannot mix with ceftriaxone or phosphate due to precipitates that can cause emboli

Name some reputable resources for IV drug compatibilities (4)

1) Package insert

2) ASHP Injectable Drug Info

3) Trissel's 2 Clinical Pharmaceutics Admixtures

4) King Guide to Parenteral Admixtures

Most drugs which require a filter use a ___ micron filter

0.22

A __ micron filter is used for parenteral nutrition and lipid emulsions

1.2

If compounding an IV med packaged in glass ampules, what is needed?

Filter needle or filter straw

List IV meds that require a filter needle

hint, mneumonic

A Pharmacy Tech Prepares Giant IV Meds At Lunch

A: Amphotericin B (lipid formulations)*

P: Parenteral nutrition

T: Taxanes

P Phenytoin

G Golimumab

I: Isavuconazonium

M Mannitol

A: Amiodarone

L Lipids

*requires 5 micron filter

Key drugs that should be kept at room temp

hint, mneumonic

Maintaining Proper Drug Storage For Medication Efficacy

M: Metronidazole

P: Phenytoin

D: Dexmedetomidine

S: Sulfamethaxazole/trimethoprim

F: Furosemide

M: Moxifloxacin

E: Enoxaparin

Key drugs that should be protected from light

hint, mneumonic

Protect Every Necessary Med from Daylight

Phytonadione (vitamin K)

Epoprostenol

Nitroprusside

Micafungin

Doxycyline

List some drugs which should not be shaken/agitated

Proteins:

Albumin

Immune globulins

Monoclonal antibodies

Products that foam:

Alteplase

Etanercept

Rasburicase

Reconstituted vaccines such as varicella

In most cases, discoloration of IV meds indicates....

oxidation or another type of decomposition

If dobutamine is slightly pink, can it be used?

Yes

Oxidation turns it slightly pink but potency is not lost

If nitroprusside turns blue, can it be used?

NO

Indicates nearly complete dissociation to cyanide!

What color is the IV drug rifampin

Red

What color are IV anthracyclines such as doxorubicin

Red

What color is IV Mitoxantrone

Blue

T/F: If particulates are present in an IV soln, it's ok to use

F