HOSPITAL PHARMACY

Lab Exercise No. 10

Parenteral admixture services have become an increasingly important aspect of hospital pharmacy practice. Advances in
medical technology, new drug products, and other changes in the health care environment all contribute to the need for
these services. Parenteral products in the form of injectable drugs have been estimated to account for as much as 40
percent of all drugs administered in hospitals.
The extent of parenteral admixture services varies considerably among institutions. Nevertheless, all such services share
a common goal of providing accurately prepared, sterile products for use by or administration to patients.

I. Objective:
To be able to calculate the amount of additive/s to be admixed with a large volume intravenous or nutrient fluid.

II. Procedures:

1. Recall the mathematical operations important in intravenous admixture and rate of flow calculations.
2. Solve the following medication orders. (Show your solution and write your final answer into 2 decimal places.)
a. A medication order calls for the addition of 25 mEq of sodium bicarbonate to a hyperalimentation formula.
How many milliliters of an 8.4% solution should be added to the hyperalimentation formula? (You have on
hand a 50 mL ampul of 8.4% sodium bicarbonate solution)

𝑚𝐸𝑞
8.4 % 𝑖𝑛 1
𝑚𝐿

𝑚𝐸𝑞
1 𝑥 50 𝑚𝐿 = 50 𝑚𝐸𝑞
𝑚𝐿
50 𝑚𝐿
Convert to mL: 𝑥 25 𝑚𝐸𝑞 = 25 𝑚𝐿
50 𝑚𝐸𝑞

Answer: 25 mL

b. A medication order calls for triamcinolone acetonide suspension to be diluted with normal saline solution to
provide 3 mg/mL of triamcinolone acetonide for injection into a lesion. If each 5 mL of the suspension
contains 125 mg of triamcinolone acetonide, how many milliliters should be used to prepare 10 mL of the
prescribed dilution?

5 𝑚𝐿
10 𝑚𝐿 𝑥 = 0.4 𝑚𝑔
125 𝑚𝑔

3 𝑚𝑔
0.4 𝑚𝑔 𝑥 = 1.2 𝑚𝐿
𝑚𝐿

Answer: 1.2 mL

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Lab Exercise No. 10

c. A physician orders an intravenous solution to contain 10,000 units of heparin in one liter of 5% dextrose
solution to be infused at such rate that the patient will receive 500 units per hour. If the IV set delivers 10
drops/mL, how many drops per minute should be infused to deliver the desired dose?

10,000 𝑢𝑛𝑖𝑡𝑠
= 20 ℎ𝑟𝑠
500 𝑢𝑛𝑖𝑡𝑠
ℎ𝑟

1000 𝑚𝐿 1 ℎ𝑟 10 𝑔𝑡𝑡𝑠 𝑔𝑡𝑡𝑠

𝑥 𝑥 = 8.33
20 ℎ𝑟𝑠 60 𝑚𝑖𝑛𝑠 𝑚𝐿 𝑚𝑖𝑛

Answer: 8.33 gtts/min or 8 gtts/min

d. A nitroglycerin concentrate solution contains 5 mg of nitroglycerin in each milliliter. A 10-mL ampul of the
concentrate is added to 500 mL of D5W and infused into a patient at a flow rate of 3 microdrops per minute.
If the infusion pump system delivers 60 microdrops/ mL, how many micrograms of nitroglycerin would the
patient receive in the first hour of therapy?
5𝑚𝑔 50 𝑚𝑔
𝑥 10 𝑚𝐿 = 50 𝑚𝑔;
𝑚𝐿 500 𝑚𝐿
3𝜇𝑔𝑡𝑡𝑠 1 𝑚𝐿 𝑚𝐿
𝑥 = 0.05
𝑚𝑖𝑛 60 𝜇𝑔𝑡𝑡𝑠 𝑚𝑖𝑛
50 𝑚𝑔 0.05 𝑚𝐿 0.005 𝑚𝑔
𝑥 =
500 𝑚𝐿 𝑚𝑖𝑛 𝑚𝑖𝑛
0.005 𝑚𝑔 60 𝑚𝑖𝑛𝑠
𝑥 = 0.3 𝑚𝑔/ℎ𝑟
𝑚𝑖𝑛 1 ℎ𝑟
Answer: 0.3 mg/hr or 300µg/hr

III. Questions:

1. What is a sterile product?

- Sterile products are products that are free from microbes and is usually administered in a parenteral route. These
types of products are free from bacteria and other physical contamination that can alter or change the stability
and effectivity as well as the safety of the drug when administered to patients. These products may have
undergone sterilization to completely free the product from any bacteria, fungus, etc. Sterile products are usually
absorbed in the bloodstream that is why complete sterility is needed. In the manufacture and compounding of
sterile products, it is important to know the different guidelines and standardization needed. Different sterile
products are packaged into ampoules, vials, bottles, and tubes.

Reference: API. nd. Sterile Products. Accessed from: https://www.apl.se/in-english/life-science/commercial-

manufacture/sterile-products.html
2. What are the common injectable routes of administration? Define each route.
- Injections are administered parenterally to ensure 100% bioavailability and more rapid absorption. There are
different common injectable routes of administration which includes (a) Intravenous, (b) Intramuscular, (c)
Subcutaneous, (d) Intrathecal,

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Lab Exercise No. 10

(a) Intravenous route of administration is a type of injection route that is directly to the vein which ensures 100%
bioavailability of the drug and a much faster adsorption rate. A solution may be containing a drug that can be
given in a single dose or by continuous infusion. Since the drug is immediately delivered to the bloodstream,
it tends to take effect more quickly than any other route.
(b) Intramuscular route of administration means that the drug is administered directly into the muscle. In this
type of administration, a longer needle is needed since the injection should be administered in a 90-degree
angle to ensure that the drug will be administered into the muscle. Drugs with this type of administration is
usually injected to the muscle of the upper arm, thigh or buttock.
(c) Subcutaneous route of administration is wherein the needle is inserted into the fatty tissue just beneath the
skin. In this type of administration, a shorter needle is preferred. Medication given in this route is usually
absorbed more slowly than if the drug is administered directly into the vein.
(d) Intrathecal route of administration is wherein a needle is inserted between two vertebrae in the lower spine
and into the space around the spinal cord. The drug is directly injected into the spinal canal. A local anesthetic
is usually used to numb the injection site.

Reference: Le, J. 2020. Drug Administration. Accessed from:

https://www.msdmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-administration

3. What are the characteristics of parenteral products?

- The following are just a few characteristics of parenteral products:
(a) All parenteral products must be sterile
(b) All parenteral products must be free from any contamination
(c) Injectable solutions must be free from visible matters including reconstituted sterile powders
(d) Products that are administered into the cerebrospinal fluid must be isotonic
(e) IV infusions must be isotonic
(f) All sterile products must be stable
(g) All sterile products must be compatible with IV diluents, delivery systems, and other drug products co-
administered
Reference: Eprints. nd. Parenteral Preparations. Accessed from:
https://eprints.ugd.edu.mk/19270/3/5%20Parenteral%20preparations%3B%20Formulation%20and%20packaging.pdf

4. What are the reasons for administering injectable drug products?

- Medications are administered as injectables for the reason that some drug substances may not be absorbed orally
and that rapid absorption is needed like in the case of emergencies. Also, in this type of administration, it can
avoid the first pass effect. Drug are administered parenterally have a faster onset of action. Also, it is more
beneficial to those patients who cannot take drugs orally, like those who are nauseated, vomiting, restricted from
taking oral fluids, or unable to swallow.

Reference: Le, J. 2020. Drug Administration. Accessed from:

https://www.msdmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-administration

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