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C 15 Parenterals
C 15 Parenterals
C 15 Parenterals
Parenteral
sterile
Parenteral Injections
Physician
Physicians assistant
Nurse
Parenterals are administered at:
Hospitals
Clinics
Advantage:
May be a life-saving procedure because of the
placement of the drug directly into the circulation
and the prompt actions which ensues.
Disadvantage:
Once the drug administered, it cannot be
retrieved.
In the case of adverse reaction to the drug, for
instance, the drug cannot be easily removed from
the circulation.
Precautions:
Strict aseptic precautions must be taken at all
times to avoid risk of infection.
The syringes and needles used must be sterilized
and to the point of entrance must be disinfected
to reduce chance of carrying bacteria from the
skin into the blood via the needle
Flow Rates:
Generally, the flow rates of IV are expressed in
mL/hour,
Range from 42 to 150 mL/hour.
Lower rates are used for keep-open (KO, KVO)
Great care must be taken to prevent overdosing
or underdosing.
Example:
Metoprolol (beta blocker)
NOTE:
Not only are the injectable solutions sterile,
syringes, needles must also be disinfected to
reduce the chance of carrying bacteria
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4.
5.
6.
7.
8.
9.
Thrombus
Intramuscular (IM)
Volume of Administration:
limited :
Examples:
Iron dextran injection irritate tissues
Diazepam (Valium) by sealing in the lower
muscle
Subcutaneous Route (SC)
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Intradermal Route
Needle:
A short (3-8 inch) and narrow gauge (23 to
26).
is inserted horizontally into the skin with the
bevel facing upward. The injection is made
when the bevel just disappears into the
corium.
Composed of
polyvinyl chloride
Teflon
Polyethylene
these should be radiopaque to ensure that they are
visible on radiographs.
Injections
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4.
5.
6.
7.
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6.
solvent
Antioxidants
Containers
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METHODS OF STERILIZATION
Sterilization
5 general methods:
1. Steam distillation
2. Dry-heat sterilization
3. Sterilization by filtration
4. Gas sterilization
5. Sterilization by ionizing radiation
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microorganisms by stopping
reproduction as a result of lethal
mutations.
iii.
Filtration
This is a nonthermal method for the
sterilization of select solutions by
removing microorganisms from the
solution while permitting the passage of
all the desired components of the
solution and imparting no undesirable
components from the filter.
They are available in pore sizes from 14 to
0.025 um.
The size of the smallest particle visible to
the naked eye is about 40 um, a red
blood cell is about 6.5 um, the smallest
bacteria, about 0.2 um, and a polio virus,
about 0.025 um
2. Chemical Processes of Sterilization
A. Gas Sterilization
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4.
5.
Filling
Bulk preparations are subdivided into unit
dose containers during filling. This process
forces a measured volume of the
preparation through the orifices of a
delivery tube designed to enter the
constricted opening of a container by
means of gravity, vacuum or with the aid
of a pressure pump.
Sealing
Sealing will retain the contents of a sterile
product and will assure a tamper-proof
presentation
Sterilization
Containers
3.
4.
5.
6.
7.
8.
9.
10.
11.
Containers
1. Mix-O-Vial - that incorporates the cover as part of the
plunger. Once mixed, the small circle of plastic that
covers the injection site is removed. This reduces the
touch contamination
2. Add-Vantage System IVPH - is other example of readyto-mix sterile IV product designed for intermittent IV
administration of potent drugs that do not have long
term stability in solution. Two components:
a. A flexible plastic IV container partially filled
with diluents
b. Glass vial of powdered or liquid drug
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4.
5.
6.
7.
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Onset
Peak
Duration
Short/Fast-Acting (clear)
5 - 30
mins
1 - 3 hrs
4 - 8 hrs
Intermediate-Acting (milky)
1 - 2 hrs
4 - 12
hrs
16 - 24
hrs
1/2 hr
2 - 12
hrs
16 - 24
hrs
Long-Acting (milky)
4 hrs
8 - 24
hrs
28 - 36
hrs
Onset (hr)
Peak (hr)
Rapid acting
Insulin I nj (reg ular)
Insulin Z inc
1 to 1.5
0.5 to 1
8 to 12
5 to 10
12 to 16
all Lente
Prompt
Suspension(semilente)
Lispro Ins ulin Soln
0.25
0.5 to 1.5
6 to 8
Ultralente, NPH
1 to 1.5
4 to 12
24
regular
7 to 15
24
regular, semilente
Intermediate
Isophane Insulin
Suspension (NPH)
Insulin Zinc Suspension(lente) 1to 2.5
Long acting
PZI (Protamine Zinc Insulin)
4 to 8
14 to 24
36
regular
4 to 8
10 to 30
>36
regular, semilente
2 to 12
18 to 24
0.5
regular, NPH
Usual Content
Category/Comments
Fluid/Nutrient replenishe r
Fluid/electrolyte
Lactated Ringers
2.7 mEq calcium, 4 mEq potassium,
Systemic alkalinizer; Injectio n,
USP
130 mEq sodium and 28 mEq
f luid and electro lyte
lactate per liter
replenisher
Sodium Chloride
USP
vehicle
USES:
1. Employed as Maintenance therapy for the
patient entering or recovering from surgery, or for
the patient who is unconscious and unable to
obtain fluids, electrolytes, and nutrition orally.
Maintenance Therapy
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Electrolytes
1. Sodium. 25 mEq
2. Potassium ... 20 mEq
3. Magnesium ..5 mEq
4. Calcium .5 mEq
5. Chloride .. 30 mEq
6. Acetate .. 25 mEq
7. Phosphate ..18 mM
Vitamins
Vitamin A 3300 I.U.
Vitamin D 200 I.U.
Vitamin E 10 I.U.
Vitamin C 100 mg
Niacin 40 mg
Vitamin B2 3.6 to 4.93 mg
Vitamin B1 3 to 3.35 mg
Vitamin B6 4 to 4.86 mg
Pantothenic Acid 15 mg
Folic Acid 400 mcg
Vitamin B12 5 mcg
Biotin 60 mcg
Amino Acids: Essential Amino Acids
1. L - Isoleucine..590 mg
2. L - Leucine .770 mg
3. L - Lysine acetate..870 mg
(free base.620 mg)
4. L - Methionine 450 mg
5. L - Threonine ..340 mg
6. L - Tryptophan 130 mg
7. L - Valine .560 mg
8. L - Phenylalanine ..480 mg
Nonessential Amino Acids
1. L - Alanine ..600 mg
2. L - Arginine .810 mg
3. L - Histidine .240 mg
4. L - Proline 950 mg
5. L - Serine .500 mg
6. Aminoacetic acid 1.19 g
Enteral Nutrition
Ex.:
Protein - ProMod Powder, Propac Powder
Carbohydrates - Moducal Powder
Fat - Lipomul Liquid
Fewer calories- Ensure HN, Sustacal, & Osmolite HN
Intravenous Infusion Devices
Ex.:
1. Chorpromazine HCl
2. Insulin
3. Promethazine HCl
4. Trifluoperazine HCl
5. Thioridazine HCl
6. Diazepam
7. Promazine HCl
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8.
9.
Thiopental sodium
Warfarin sodium
Another Example:
Nitroglycerin
should always be prepared in glass containers, and is
adsorbed (40 to 80% of total dose) to polyvinylchloride
(PVC), a plastic commonly used in administration
components and some infusion containers, therefore, it
should be packaged with special non-PVC tubing to
avoid loss <5% of the drug into the tubing during
administration.
Selected Infusion Devices Used in Parenteral Nutrition Support
1. Volumetric Infusion Pumps - AVI 2000 #200: Flo-Gard
8100; IMED
2. Multiple-rate Programmable Pumps CADD-TPN
3. Volumetric Infusion Pumps - Provider one; Quest 521
Intelligent
4. Multiple-solution Programmable Pumps - Gemini PC 2;
Life Care 5000 Plum;Omni-Flow 4000
5. Others- Breeze Lifecare 175, Coleague 3, Horozon Nxt,
Sabratek 600
NOTE: All these devices have their own features like: safety
alarm, flow rate error, alarm for air in line, door open, low
battery, occlusion, malfunction, invalid rates and others
Handling/Disposal of Chemotherapeuticc Agents for Cancer
In theory, correct and perfect preparation and
handling techniques will prevent drug particles or
droplets from escaping from their containers while they
are being manipulated.
Basic Steps in handling Chemotherapeutic Agents
1. Utilizing vertical laminar flow hoods (or
bacteriological gloves boxes) for the
preparation and reconstitution of cytotoxic
drugs.
2. Wearing protective gloves and mask during
product preparation
3. Handling and disposing of cytotoxic drugs
centrally utilizing specially designed waste
containers and incineration.
4. Periodic monitoring of personnel involved with
handling admixtures of cytotoxic drugs (CBC,
blood chemistry screen, differential cell count)
5. Informing personnel handling cytotoxic drugs
that a potential risk to their health exists.
6. Instituting specialized labeling of containers to
ensure proper handling and disposal of the
cytotoxic agent.
Other Injectable Products
Pellets or Implants
Levonorgestrel Implants
Ex.:
1. Acetic acid Irrigation, USP - This solution is
employed topically to the bladder as a 0.25%
solution for irrigation. It is administered to wash
blood and surgical debris away while
maintaining suitable conditions for the tissue.
2. Neomycin and Polymixin B Sulfate Solution for
Irrigation, USP - Employed as a topical
antibacterial in the continuous irrigation of the
bladder.
3. Ringers Irrigation, USP - It is used topically as an
irrigation and must be labeled not for
injection. The solution is sterile and pyrogen
free.
4. Sodium Chloride Irrigation, USP - This solution is
employed topically to wash wounds and into
body cavities where absorption into the blood is
not likely. The solution also employed rectally as
an enema for simple evacuation and also for
colonic flush.
5. Sterile Water for Irrigation, USP - The label
designations for irrigation only and not for
injection must appear prominently on the label.
The water must not contain any antimicrobial or
other added agent.
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Dialysis Solutions
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