Ch. 13
filtered exhaust system
A Containment Secondary Engineering Control area for HD CSPs vents air to the
when CSPs are prepared in a batch for multiple patients
A master formulation record must be followed
60gtts/mL
A microdrip IV drop set typically used for pediatric patients provides
4 liters
A patient is receiving peripheral parenteral nutrition at 130 mL/hr. How many liters will need to be sent for a 24-hour supply?
125 mL/hr
A patient on TPN needs to get a total of 3 liters per day to meet their nutritional needs. At what rate will the TPN need to run to achieve the nutritional goals?
19:00
A patient was started on a 500 mL bag of D5NS at 9 am running at 50 mL/hr. When will the next bag be hung?
the pharmacy technician inside the DCA, using aseptic technique
A vial-and-bag system is assembled by
Horizontal Laminar Airflow Workbench (LAFW)
All of the following Primary Engineering Controls can be used to compound hazardous drugs, EXCEPT:
3 1-L bottles
An IV order is received for 0.9% Normal Saline at an infusion rate of 125 mL/hour. How many 1-L bottles must be prepared for use over the next 24 hours?
Lactated Ringers (LR)
An example of an isotonic solution that is often used after blood loss in surgery is
7.4
Blood plasma is slightly alkaline with a pH value of
2% sodium hypochlorite
Chemical deactivation of a hazardous drug (HD) should be done with what agent?
Trissel's Stability of Compounded Formulations
Chemical incompatibility data on two or more medications added to an IV solution is best found in
neonatal IVs
For what kind of CSP would it be necessary to have a technician provide the "third-line check" for the compounding calculations?
true statements about frozen IV antibiotics
Frozen IV antibiotics are considered a premixed manufactured product; Frozen IV antibiotic expiration dates will vary with drug and storage conditions; Frozen IV antibiotics produce less wastage than with CSPs
vertical airflow
HEPA-filtered air that projects downward onto the DCA to offer additional protection for both the compounding technician and the environment when aseptically compounding hazardous chemicals; examples of vertical airflow hoods include biological safety cabinets (BSCs) and the compounding aseptic contaminant isolator (CACI)
small-volume parenteral (SVP) solutions
IV solutions of generally 25 to 250mL, typically administered as an IV piggyback (infusing into the LVP)
large-volume parenteral (LVP) solutions
IV solutions of more than 250mL that may contain medications, nutrients, or electrolytes
parenteral intravenous fat emulsions (IVFEs)
IV solutions that include a fatty nutritious additive
Use a vented needle and swirl gently to dissolve powdered medication.
In sterile compounding, what step is required when working with a lyophilized powder in a vial that is not needed when working with a drug solution in a vial?
after donning gloves in the buffer room
In the steps of sterile compounding with aseptic technique, when do you clean the primary engineering control?
working in a nuclear pharmacy requirements
It requires a lead-shielded, sealed biological safety cabinet for all compounding; Hazardous irradiated products are commonly prepared off-site; NPT training programs are offered by the American Pharmacy Association
overfill
Manufacturers of base IV bag solutions will often ________ each bag to accommodate for the fact that the IV may be stored for long periods in uncontrolled conditions.
determined by the manufacturer's product package insert
Once activated, a vial-and-bag system's expiration date is
use of PPE and HDs
PPE must be used to repackage a hazardous oral agent into unit-dose bubble packaging; PPE must be used for both non-sterile and sterile HD compounding; PPE must be worn when receiving HDs from a wholesaler
roles expected of the IV compounding technician
Prepare a 24-hour supply of every CSP for each patient in the hospital; Wipe down IV bags prior to entering buffer area; Complete a quality check of each CSP by doing a visual check.
water to be drawn out of cells.
The administration of a hypertonic solution will cause
28 days
The contents of an opened MDV stored under proper conditions would typically have a BUD of
Total Parenteral Nutrition Solution
The insertion of a central venous catheter (usually into the subclavian vein) is needed for a(n)
0.45% Sodium Chloride 1000 mL
The label for a large volume parenteral contains the following information:KCl 20mEq in ½NS at a rate of 100 mL/hr. Which large volume parenteral solution will you select from stock to make the LVP?
alkaline
The pH of blood is considered to be slightly
identify the earliest reversible biologic effects of HDs in every worker
The primary goal of medical surveillance of HD workers is to
A trained HD worker in proper attire with spill kit.
There has been a spill of a hazardous drug outside of the Class IIB Biological Safety Cabinet. Who cleans it up and with what equipment?
administration time
What information may be on the label of a small volume parenteral, such as IV piggyback, or IV push medications that does not usually appear on that of a large volume parenteral?
infusion rate
What information on the CSP's label directs the nurse on how fast or slow to give the infusion?
Detect health changes in HD workers early
What is the purpose of medical surveillance that is required by USP <800> standards?
200mL/hr
What is the rate in mL/hr for a patient receiving an IV infusion of 100 mL over 30 minutes?
labeled with appropriate, brightly colored labels
What is the usual storage strategy for HDs in the pharmacy?
Wipe the rubber top with sterile 70% isopropyl alcohol.
When working with a vial in the DCA, what should you do next after you have flipped the plastic cap of the vial?
hazardous waste container
Where should the empty vials that held hazardous drugs be placed for disposal?
around the glass neck of an ampule
Where will a pharmacy technician find a break ring when compounding sterile products?
double gloving and eye protection
Which additional PPE is (are) required when working with hazardous drugs as compared to non-hazardous CSPs?
amino acids
Which additive to a TPN solution provides the components our bodies need for protein synthesis?
non-permeable sterile gown
Which is the appropriate type of gown to wear when working with hazardous compounds?
Class II-A1
Which of the following C-PEC BSCs should no longer be used in the hospital or infusion pharmacy for HD CSPs because it has the least shielding and most recirculated air?
specialized doses available for chemotherapy
Which of the following is NOT a benefit of vial-and-bag systems for the hospital pharmacy?
Workers handling radiopharmaceuticals must wear a radiation badge.
Which of the following statements concerning radioactive pharmaceuticals is TRUE?
NIOSH
Which organization categorizes the risk for exposure to hazardous agents?
chemotherapy compounding mat
Which supplemental engineering control is placed on the Direct Compounding Area to soak up potential fluid spills?
To allow air into the vial to prevent suction from keeping the liquid from flowing
Why does a milking technique need to be used when removing liquid from a vial?
10%
With regards to addition of an additive to an IV solution, the rule of thumb is that fluid should be withdrawn from the base solution if the additive volume is greater than what percent of the total calculated final volume?
compounding record
You are checking the inventory of batch compounded bags of pitocin in normal saline and notice that instead of normal saline the pitocin is in dextrose 5%. The pharmacist wants to know who did not follow the directions for compounding the pitocin. What document identifies the compounder and pharmacist who double checked the LVP?
master formulation record
You are making ceftazidime 1 g in normal saline IVPB. Where do you find the information on beyond use dating for this CSP?
Getting powder particles on your hands and lips while breaking in half a hazardous drug form.
You work in a retail pharmacy that does not do sterile compounding. Which of the following actions do you need to be aware of and avoid to prevent risk of hazardous-drug exposure?
batch
a 24-hour supply of every CSP for each patient in a unit, wing, or the hospital
hazardous communication standard (HCS)
a US government regulation designed to ensure that the hazards of all chemicals produced or imported are evaluated and that details regarding their hazards are transmitted to employers and employees
central venous catheter (CVC)
a catheter placed into a large vein deep in the body, often used for TPN solutions; also called a central line
lactated ringer's solution
a common specially formulated mix of minerals and electrolytes (includes sodium chloride, sodium lactate, potassium chloride, and calcium chloride) used often for fluid restoration after blood loss from injury, surgery, or burns
spill kit
a container of supplies, warning signage, and related materials used to contain the spill of an HD
closed-system transfer devices (or CSTDs)
a drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of HD or vapor concentrations outside of the system; these devices protect the worker from exposure to hazardous drugs
National Institute for Occupational Safety and Health (NIOSH)
a federal agency that establishes policies to protect workers from exposure to hazardous agents
filter needle
a needle that is equipped with a 5-micron (or finer) filter within its core to catch any microscopic glass shards and impurities to prevent them from entering the CSP
3-in-1 solution
a parenteral nutrition solution that contains dextrose, amino acids, and lipids in one bottle
2-in-1 solution
a parenteral solution that contains a formulation of dextrose and amino acids with the lipid emulsion administered via piggyback in a separate bag
hypertonic solution
a parenteral solution with a greater number of particles than the number of particles found in blood
hypotonic solution
a parenteral solution with a lower number of particles than the number of particles found in blood
isotonic solution
a parenteral solution with an equal number of particles as blood cells; 0.9% normal saline is isotonic
compounding record
a printout for a specific patient, including the amounts or weights of all ingredients with national drug code calculations and instructions for compounding; used by the technician to document a compounded medication for a patient
Master Formulation Record
a recipe for a compound preparation that lists the name, strength, dosage form, ingredients and their quantities, mixing instructions, and beyond use dating; many recipes are available from the Professional Compounding Centers of America (PCCA)
break ring
a scored area on the neck of an ampule that marks the site where a technician will break the glass to access the ampules contents
ampule
a small hermetically sealed sterile container made of glass
vented needle
a special needle with a hole in the lumen that allows fluid to be injected into a vial while simultaneously allowing the air, or positive pressure, from the vial to escape.
nuclear pharmacy
a specialized practice that compounds and dispenses sterile radioactive Pharmaceuticals
Compounding Aseptic Containment Isolator (CACI)
a specific type of CAI that is designed for the compounding of sterile HDs. This is designed to provide worker protection from exposure to undesirable levels of airborne drugs throughout the compounding and material transfer processes and to provide an aseptic environment with unidirectional airflow for compounding sterile preparations
normal saline (NS)
a sterile solution containing a concentration of 0.9% sodium chloride in water
filter straw
a syringe attached similar to a filter needle, only instead of a needle, this is a thin tube with a filter
vial-and-bag system
a type of SVP in which a specially designed vial and diluent IVPB bag screw or snap together and are activated by the nurse just before patient administration of the medication
containment primary engineering control (C-PEC)
a ventilated device designed and operated to minimize workerand environmental exposures to HDs by controlling emissions of airborne contaminants through the following: the full or partial enclosure of a potential contaminant source; the use of airflow capture velocities to trap and remove airborne contaminants near their point of generation; the use of air pressure relationships that define the direction of airflow into the cabinet; and the use of HEPA filtration on all potentially contaminated exhaust streams
total parenteral nutrition (TPN)
an IV infusion therapy that supplies a patient with all the nutrition needed by the body
peripheral IV line
an IV line that is connected to a catheter inserted in a peripheral vein in a limb rather than a main blood vein leading to the heart
engineering controls
an adjunct control (e.g. CSTD) that may be used concurrently with primary and secondary engineering controls; offer additional levels of protection and may facilitate enhanced occupational protection, especially when handling HDs outside of primary and secondary engineering controls such as for nursing during administration
Positron Emission Tomography (PET)
an imaging test that uses a radioactive drug as a tracer to help reveal the function of tissues and organs
coring
an inadvertent introduction of a small piece of the rubber closure into the solution while removing medication from a vial
hazardous drug (HD)
any drug identified by at least one of the following six criteria: carcinogenicity; teratogenicity or developmental toxicity; reproductive toxicity in humans; organ toxicity at low doses in humans or animals; genotoxicity; new drugs that mimic existing hazardous drugs in structure or toxicity
antineoplastic
cancer fighting; drug therapies generally apply toxic agents to kill or inhibit the cancer cells which are faster-growing than normal healthy cells
medical surveillance
collected and interpreted data on workers who handle HDs to detect any changes in their health status due to potential exposure
multiple-dose vials (MDVs)
containers of sterile medication (water or saline) with preservatives; used to reconstitute medication powders
single-dose vials (SDVs)
containers of sterile medication for parenteral administration (e.g., injection or infusion) that are designed for use with a single patient as a single injection/infusion; this container does not contain a preservative
USP Chapter <800>
covers additional training, equipment, supplies, procedures, medical surveillance, and cleanup regulations for hazardous compounding; these guidelines for hazardous drugs stress the importance not only of protecting the patients but of protecting yourself as a compounding technician from the toxicity of hazardous drugs
electrolyte solutions
dissolved mineral salts in fluid
Safety Data Sheets (SDSs)
formerly Material Safety Data Sheet (MSDS); a document that contains important technical information on the hazards of chemicals used in compounding and procedures for the treatment of accidental ingestion or exposure
decontamination
inactivation, neutralization, or removal of HDs, usually by chemical means
tonicity
is the directional flow pattern of water in cells based on concentrations and osmotic pressure within their environments
containment quality control
measured steps to ensure the containment of HDs
chemotherapy gloves
medical gloves that meet the ASTM Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs
nuclear pharmacy technician (NPT)
one who has received specialized training to prepare radioactive Pharmaceuticals
scoop method
placement of the needle tip into the inside of the cap and scooping it up before putting pressure on the cap to secure it
radiopharmaceuticals
radioactive compounded drugs like irradiated iodine that are created in a nuclear compounding facility
negative pressure
refers to air pressure that is lower than adjacent rooms because air is suctioned out into and external filtered exhaust system to protect the compounding personnel from the hazardous agents
vial
sealed glass or plastic sterile container with a rubber seal and hard plastic cap
biological safety cabinets (BSCs)
shielded, enclosed, or sealed PECs (with HEPA filtering and exhausting) that work to contain hazardous substances from the personnel and rest of the facility; come in classes (I, II, III - with some subclasses)
peripheral parenteral nutrition (PPN)
short-term parenteral nutrition with carbohydrates and/or lipids
trace hazardous waste
small amounts of HDs remaining on used HD vials, ampules, IV bags, needles, and syringes
preservatives
substances added in multiple-dose containers to inhibit microbial growth and promote a longer shelf-life
iso-osmotic
term that describes a solution that should have the same number of particles per unit volume and the same osmotic pressure as blood; similar to isotonic
chemical compatibility
the ability of two or more base components to combine in solution or with other solutions (such as another IV solution or blood serum) without resulting in physical or chemical property changes to any of them
priming
the act of running fluid through IV tubing to flush out small particles and expel air from the tubing before medication administration
overfill
the amount of solution manufacturers add to make up for the loss of water due to evaporation through plastic
osmolarity
the concentration of all molecules in a volume of fluid
pH value
the degree of acidity or alkalinity of a solution; less than 7 is acidic and more than 7 is alkaline; the pH of blood is 7.4
osmosis
the natural flow of molecules in a solution through semi-permeable cell walls
drop factor
the number of drops that an IV tubing delivers to provide one mL; this number may be used by nurses to calculate the IV flow rate when using certain types of primary IV tubing; also called drop set or drip set
osmotic pressure
the pressure required to maintain equilibrium, with no net movement of solvent
containment secondary engineering control (C-SEC)
the room with fixed walls in which the C-PEC is placed; it incorporates specific design and operational parameters required to contain the potential hazard within the compounding room
infusion rate
the speed of administration of IV fluids and/or medication, commonly expressed in mL per hour
chemotherapy compounding
this mat is placed on the work surface before each session to catch toxic contaminants
deactivation
treatment of an HD with another chemical, heat, ultraviolet light, or other agent to create a less hazardous agent DEA number (an identification number assigned by The Drug Enforcement Administration (DEA)) to identify someone authorized to handle or prescribe controlled substances within the United States
automated compounding device (ACD)
used in large hospitals and in many infusion compounding pharmacies for home care; generally comes with 12 to 24 fluid ports within it that each have sterile containers of the commonly needed nutritional additives for the TPN bags
double gloving
wearing two sets of gloves at once for HD sterile compounding