Parenteral Medications - NAPLEX

1. What does the term "vesicant" mean for an IV medication if extravasation occurs?

   Can cause tissue necrosis and severe local injury. Vesicants damage tissues upon extravasation due to their irritant properties, leading to blistering and potential long-term injury.

2. What is the USP <797> definition of a "single-dose container" for parenteral products?

   Container intended for one-time use for a single patient/procedure. USP <797> specifies single-dose containers to prevent microbial growth by limiting use to one entry, ensuring sterility for individual patient needs.

3. Which filter size is standard for most aqueous IV solutions: $0.22\ \mu m$ or $5\ \mu m$?

   $0.22\ \mu m$. The $0.22\ \mu m$ size effectively removes bacteria and small particles from aqueous solutions without impeding flow.

4. What is the formula to calculate an IV infusion rate in mL/hr from volume (mL) and time (hr)?

   $\text{mL/hr} = \frac{\text{mL}}{\text{hr}}$. The formula derives the rate by dividing total volume by infusion time for consistent delivery.

5. Which filter size is commonly used for lipid-containing parenteral nutrition admixtures: $0.22\ \mu m$ or $1.2\ \mu m$?

   $1.2\ \mu m$. Lipids require larger pores like $1.2\ \mu m$ to pass through without being trapped, unlike smaller filters for aqueous solutions.

6. What does the USP <797> term "immediate-use CSP" mean in terms of preparation and administration timing?

   A CSP prepared for immediate administration with minimal delay. USP <797> defines immediate-use CSPs as those prepared aseptically outside controlled environments for administration starting within 4 hours to reduce microbial contamination risk.

7. What is the key clinical reason bacteriostatic water for injection is generally avoided in neonates?

   Risk of benzyl alcohol toxicity (gasping syndrome). Benzyl alcohol in bacteriostatic water can cause metabolic acidosis and respiratory distress in neonates due to immature liver function.

8. What is the clinical meaning of an IV medication labeled "for IV use only" regarding route of administration?

   It must not be given IM, SC, intrathecal, or epidural. The label restricts administration to IV to prevent adverse effects like tissue irritation or inefficacy associated with other routes.

9. What is the beyond-use date (BUD) after first puncture for a multiple-dose vial unless otherwise specified?

   28 days after initial entry (unless manufacturer states otherwise). The 28-day BUD balances preservative efficacy against contamination risk, aligning with USP <797> guidelines unless shorter stability is indicated by the manufacturer.

10. What is the maximum recommended osmolarity for routine peripheral parenteral nutrition (PPN) to reduce phlebitis risk?

    Approximately $900\ \text{mOsm/L}$ (institution-specific limits may vary). Osmolarity limits for PPN prevent vein irritation and phlebitis, with ~900 mOsm/L as a common threshold based on institutional protocols.

11. Which diluent is preferred to reconstitute most IV antibiotics when both are acceptable: sterile water or bacteriostatic water?

    Sterile water for injection (SWFI). SWFI lacks preservatives like benzyl alcohol, reducing toxicity risks in vulnerable patients compared to bacteriostatic water.

12. What is the primary purpose of using an in-line filter for certain parenteral infusions?

    To remove particulates (and sometimes air/microprecipitates) from the infusion. In-line filters capture contaminants to ensure infusion safety, particularly for solutions prone to particle formation.

13. Calculate mL/hr for an infusion ordered at $10\ \text{mg/hr}$ using a bag concentration of $2\ \text{mg/mL}$.

    $5\ \text{mL/hr}$. Dividing dose rate by concentration ensures the infusion delivers the ordered amount per hour.

14. Calculate the infusion rate in mL/hr for $250\ \text{mL}$ to infuse over $2\ \text{hr}$.

    $125\ \text{mL/hr}$. Dividing volume by time yields the rate, ensuring accurate delivery over the specified period.

15. Which IV access is generally preferred for continuous vesicant infusions: peripheral IV or central venous access?

    Central venous access. Central access reduces extravasation risk by diluting vesicants in larger blood volumes, unlike peripheral veins.

16. What is the USP <797> definition of a "multiple-dose container" for parenteral products?

    Container that allows repeated entries and usually contains a preservative. USP <797> allows multiple-dose containers for repeated access due to preservatives that inhibit microbial growth, extending usability beyond single entry.

17. What is the formula to calculate IV infusion rate in mL/hr from dose rate (mg/hr) and concentration (mg/mL)?

    $\text{mL/hr} = \frac{\text{mg/hr}}{\text{mg/mL}}$. The formula determines volume rate by dividing desired dose rate by solution concentration for therapeutic accuracy.

18. What is the preferred diluent for reconstituting or diluting medications for intrathecal administration?

    Preservative-free 0.9% sodium chloride (or preservative-free SWFI if specified). Preservatives can cause neurotoxicity in the CSF, so preservative-free diluents ensure safety for intrathecal routes.

19. What is the formula for IV drip rate in gtt/min using drop factor (gtt/mL), volume (mL), and time (min)?

    $\text{gtt/min} = \frac{\text{mL} \times \text{gtt/mL}}{\text{min}}$. The formula accounts for drop factor to convert volume over time into countable drops per minute.

20. What is the standard concentration of dextrose in D5W expressed as grams per 100 mL?

    5 g per 100 mL. D5W provides 5% dextrose by weight, equating to 5 grams per 100 mL for caloric support in parenteral nutrition.

21. Which parenteral solution is isotonic and commonly used for IV dilution: 0.9% sodium chloride or 0.45% sodium chloride?

    0.9% sodium chloride (normal saline). 0.9% sodium chloride matches plasma osmolarity at approximately 308 mOsm/L, minimizing cellular damage during infusion unlike hypotonic 0.45%.

22. Calculate gtt/min for $100\ \text{mL}$ over $30\ \text{min}$ with a $15\ \text{gtt/mL}$ set.

    $50\ \text{gtt/min}$. Multiplying volume by drop factor and dividing by minutes provides the precise manual adjustment rate.

23. Identify the correct route for an oil-based depot injection: IV, IM, or intrathecal?

    IM. IM route allows slow absorption of oil-based formulations, providing sustained release unlike rapid IV dispersion.

24. Calculate final concentration in mg/mL when $500\ \text{mg}$ is diluted to a total volume of $250\ \text{mL}$.

    $2\ \text{mg/mL}$. Dividing total drug amount by final volume gives concentration for dosing calculations.

25. What is the major safety concern if a medication intended for epidural use contains preservatives?

    Neurotoxicity; neuraxial products should be preservative-free. Preservatives in neuraxial medications can irritate neural tissues, leading to inflammation or damage in the spinal area.

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