ADMIXTURES

INTRAVENOUS ADMIXTURES
IV ADMIXTURES

• Admixture literally means

• Something mixed with something else
• Pharmaceutically defined as sterile iv solutions prepared by
mixing two or more medications in a large bag or bottle to
be administered through(via) the parenteral route.
Characteristics of preparation
• Preparation should not damage the blood vessels

• It should not alter the chemical composition of the blood serum

• NB: the PH of blood is 7.4 slightly alkaline hence preparations should

have a close to neutral PH value.
ROUTE
• Parenteral route is the route of administration.
• Comes from the Greek word Para enteron meaning beside or outside
the intestines
Types of parenteral route of administration
• Intravenous (IV)
• Intramascular (IM)
• Intrathecal (IT)
• Epidural
• Intra articular (IA)
• Intraoseous (IO)
• Intraperitoneal
• Subcutanous (Sc) etc
Solution concentrations
• Isotonic
• Solution that have same concentration of dissolved substances as the blood
cells.(osmosis)

• Iso - osmotic
• Solution having the same number of particles in solution per unit volume
with blood.
• hypertonic
• Solutions that has greater number of particles than blood cells . This can
cause blood cell to shrink .eg 50% Dextrose,3% NaCl etc
• To prepare a hypertonic solution allegation method of pharmaceutical
calculation can be used or conc x vol formula can be used

• Hypotonic
• Solution that has few particles than blood cells. This can cause cells to
swell (turbidity) eg 0.45% NaCl etc
• To prepare hypotonic solution the conc x vol ( C1V1= C2V2) formula can
be used
Millimole calculation
• Mmol = Milliequivalent
Valency

Conversion from Gram(g) to mmole

Molarity = weight in g
molar mass in g/mol
multiply the answer by 1000.
Administration of infusion
• Continuous infusions
• A controlled method of intravenous administration of medication ,fluids , nutrients,
given without interruption.

• This is given by adjusting infusion rate or quantities of fluids can be given over a
period of time and is given in large volumes ( 100ml – 1000ml).

• NB : Some medications come as a pre mixed bag .

• Examples of medication given continuously vasopressors (Dobutamine, Dopamine),

heparin, insulin regular ,parenteral nutrition .etc
• Intermittent infusion
• An infusion of medication given over a set period of time at prescribed
intervals and is stopped until the next dose is required.

• Medications can be given in small volumes of solution (25 – 250ml)

• Examples bolus iv injections,( given for 30minutes every 4hrs),given as

single doses
COMMON DILUENTS USED
• Sterile water

• Sodium chloride

• Ringer lactate

• Dextrose saline

• Dextrose 5%
Responsibility Of The Pharmacist
• To prevent contamination thus ensuring area of work is clean (,good laminar air flow) to
prepare iv.

• Ensure there is fluid compatibility to deterioration ,oxidation and therapeutic drug – drug
interaction.

• Have access to medication stability information to determine storage conditions prior to and
after preparation. To also help with an ideal expiry date of product.

• Product should be cost effective

• Minimize error during the preparation.

• Process of preparation

Determine the dose of the product

Appropriate diluent

Volume of diluent

Rate of administration
Rate of administration calculation
• Rate (ml / hr) = Dose(mcg/kg/min) x Weight x 60 min(hr)
Final Concentration ( mcg/ml)
When using an infusion bag
Calculate the number of drops per min
Know the number of drops per ml from the given set in use
Eg if 20drops is in 1ml of solution .
Then the number of drops per min can be calculated .
Pre – Mixed Bag Admixtures
• Medications that are stable and can be in solution for a longer period
of time sometimes come as already prepared mixtures in volumes of
250ml, 500ml and 1000ml.
• Examples of such medications are
• Lidocaine
• Nitroglycerine
• Dopamine
• Aminophyline
• Dobutamine etc
Medications that can be given Endotracheal route

• Medications can be given endotracheal when the venous access fails

under emergency situations.
• Example of such medications are
• Naloxone
• Atropine
• Verssed (midazolam)
• Epinephrine
• Lidocaine
• Acronym NAVEL
Some medications given intranasal
• Medications that can be given intranasal egs
• Midazolam
• Lorazepam
• Flumazenil
• Fentanyl
• Naxolone
• Ketamine
• Hydromorphine
 VASOPRESSORS /IONOTROPES
DOPAMINE HCL
Is a sympathomimetic amine vasopressor ,is a naturally occurring immediate
precursor of norepinephrine which acts on alpha, beta and dopamine
receptors.
It is used to manage various shock states or heart failure and can also be used
to treat or prevent acute renal failure.
It comes concentrations range of 200mg,400mg and 800mg in 5ml per
ampoules.
Doses of 0.5- 2ug/kg/min – increase renal perfusion /vasodilatation
2 -10 ug/kg /min – increase cardiac output(beta receptors)
up to 20ug/kg/min increases peripheral vasoconstriction
Above 20ug/kg/min the alpha dominates
Dopamine
• COMPATIBLE FLUIDS
Sodium chloride 0.9%, Ringer lactate, 5% Dextrose and Dextrose 10%
in sodium chloride.
• Can be diluted up to a maximum concentration of 3200ug/ml
• Dobutamine ??
• Noradrenaline ??
THANK YOU