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162 Cards in this Set
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administered by continuous infusion (CI) and are used to replenish fluids and/or electrolytes and can be used for TPNs? |
large volume parenterals |
|
administered in volumes 100 ml to 1000 ml and maybe more for TPN? |
large volume parenterals |
|
IV bags, glass bottles, TPN solutions, dialysis fluids are examples of? |
large volume parenterals (LVPs) |
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LVP sizes? |
250, 500, 1000 mL |
|
used as primary fluid or base for mixture? |
LVPs |
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most commonly sterile water, various NaCl strengths, D5W, lactated Ringers? |
LVPs |
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used for drugs unstable in plastic IV bags due to leaching/absorption? |
glass bottles for IV infusion |
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hermetic container that when opened cannot be resealed with assurance that sterility has been maintained? |
single dose container |
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hermetic container that permits withdrawal of successive portions of contents without changing drug in any way? |
multiple-dose container |
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can sterile water alone be given IV? |
no, too hypotonic |
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max package volume for sterile water? |
1000 mL |
|
sterile water that contains one or more antimicrobial agents? |
bacteriostatic water |
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used in preparation of small volume injectables and container must have names and proportions of antimicrobial agents on it? |
bacteriostatic water |
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why can't bacteriostatic water be used in neonates? |
risk of toxicity with benzyl alcohol |
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why should preservative containing diluents be avoided in injections intended for the CNS? |
can cause significant spinal cord damage, CNS toxicity, potential seizures |
|
0.9% NaCl in mEq/L and mOsmol/L? |
154, 308 |
|
used as sterile vehicle, flush, or fluid replacement? |
sodium chloride injection |
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hypotonic form of sodium chloride injection? |
0.45% NaCl |
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bacteriostatic water for injection (BSWI) precautions? |
large volume use, neonates, CNS injections |
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packaged in multiple dose containers of 30 mL or less? |
bacteriostatic sodium chloride injection |
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often used with other pharmaceutical ingredients (and combined with D5W) to increase solution osmolarity? |
0.45% NaCl |
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D5W osmolarity? |
252 mOsmol/L? |
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dextrose comes in what concentrations? |
5, 10, 50% |
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administered IV for caloric value and for fluid replenishment? |
dextrose injection |
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use caution in diabetics, critically ill, chronically malnourished, alcoholics, and those with electrolyte abnormalities with? |
dextrose |
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sterile solution of sodium chloride, potassium chloride, and calcium chloride in water for injection? |
Ringer's injection |
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what is key for the concentrations of things in Ringer's injection? |
similar to that found in physiological fluids |
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Ringer's injection osmolarity? |
310 mOsmol/L |
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may be used as a vehicle or IV for electrolyte/fluid replacement? |
Ringer's injection |
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cannot be given in combination with ceftriaxone to neonates (or anyone if in same line)? why? |
Ringer's injection, because calcium and ceftriaxone precipitate |
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sterile solution of sodium chloride, potassium chloride, calcium chloride, and sodium lactate in water for injection? |
lactated Ringer's |
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lactated Ringer's osmolarity? |
273 mOsmol/L |
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IV as an electrolyte/fluid replenisher and as a systemic alkalizer? |
lactated Ringer's |
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ethyl alcohol, propylene glycol, glycerin, polyethylene glycols, and fixed vegetable oils are all what in terms of injections? |
non-aqueous vehicles |
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why use non-aqueous vehicles? |
when solubility or stability problems arise in pure aqueous vehicle |
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must be used in minimum amount necessary and must not exert pharmacologic activity or effect activity of medicinal agents? |
non-aqueous vehicles |
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what pharmaceutical ingredient is not allowed for IV? |
colorants |
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what pharmaceutical ingredients must be contained in multiple dose containers unless the drug itself is bacteriostatic? |
antimicrobial preservatives |
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buffers, solubilizers, perservatives and antioxidants are all types of? |
pharmaceutical ingredients |
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destruction of all living organisms and their spores or their complete removal from the parenteral preparation? |
sterilization |
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sterilization methods? |
steam, dry heat, filtration, gas sterilization, sterilization by ionizing radiation |
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what is the sterilization method choice based on? |
drug stability under sterilization conditions |
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what, historically, is the concern regarding plastic IV bags? |
PVC and DEHP |
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why do IV bags often come with plastic overwrap? |
to prevent loss of liquid through IV bag over time |
|
used to supply fluids, electrolytes, and calories to pt recovering from surgery? |
maintenance therapy |
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what is a consideration to be had for long term maintenance therapy? |
need to meet higher caloric content |
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used for pt who have suffered heavy loss of fluids and electrolytes? |
replacement therapy |
|
usually replacement therapy transitions to? |
maintenance therapy |
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daily water requirement? |
25-40 ml/kg body weight |
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what to consider when giving fluid? |
overload (give less), hypotension or dehydration (give more) |
|
IV fluids containing sodium or salts aka? |
crystalloids (like NS and LR) |
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IV fluids containing dispersion of large molecular weight molecules aka? |
colloids (albumin, hetastarch, dextran) |
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IV fluids that distribute in same way as total body water? |
dextrose-containing fluids |
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remains in extracellular fluid (3/4 interstitial, 1/4 intravascular)? |
crystalloids |
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used for plasma volume expansion and stays intravascular? |
colloids |
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2/3 intracellular, 1/3 extracellular distribution with? |
dextrose-containing fluids |
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patients with life threatening low Na levels get? |
3% NaCl infusions |
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serum sodium concentration change that would cause osmotic demyelination? |
more than 12 mEq/L/day |
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target for rise in sodium serum in life threatening cases? |
4-6 mEq/L/hour |
|
electrolyte needed for normal cardiac and skeletal muscle function? |
potassium |
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max infusion rate for potassium and what conditions? |
20-40 mEq/hr with central line and cardiac monitoring |
|
max infusion rate for magnesium? |
1 gram per hour |
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max infusion rate for calcium gluconate and calcium chloride? |
1-2 grams gluconate 1 gram chloride |
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max infusion rate for phosphate? |
7 mmol/hr |
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which two electrolytes are replaced sort of indirectly as components of other electrolyte replacement additions? |
phosphate and chloride |
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hyperchloremia can lead to? |
acidosis |
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patient caloric need is detrmined by? |
BMR, activity, increased metabolism due to stress of trauma or disease |
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simplest energy expenditure calculation? |
25 kcal/kg/day |
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protein maintenance requirement? |
0.8 - 1 gram/kg/day |
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daily lipid requirement? |
>8% (usually 15-30%) of total kcal/day |
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remaining calorie requirements usually met with? |
dextrose |
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three macronutrients? |
dextrose, amino acids, lipids |
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single solution containing all three macronutrients? |
TNA (total nutrient admixture) |
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preferred route of administration for TPN? |
central line |
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PPN limitations? |
<900 mOsm/L dextrose <10% amino acids <5% |
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2 in 1 PN? |
dextrose and amino acids |
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3 in 1 PN? |
dextrose, amino acids, lipids (TNAs) |
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often come in pre-made bags? |
dextrose and amino acids |
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used to balance chloride salts in conditions of acidosis? |
acetate salts |
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micronutrients in PN? |
electrolytes, vitamins, trace elements |
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too much, re-feeding syndrome, GI atrophy, catheter infections, clots, extravasation are all risks associated with? |
PPNs |
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the process in which substances can be separated based on differing diffusabilities through membranes? |
dialysis |
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maintains fluid balance, removes toxic waste products, maintains normal electrolyte balance, removes drugs and metabolites (wanted or unwanted)? |
dialysis |
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uses principles of osmosis and diffusion, osmotic and chemical equilibrium, allows movement of water, urea/toxins, and electrolytes? |
peritoneal dialysis |
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dialysis with higher risk for infection? |
peritoneal dialysis |
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uses artificial kidney to remove waste/chemicals from the blood? |
hemodialysis |
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what blood is shunted by way of a dialysis fistula/graft or catheter to the dialyzing membrane of the dialysis machine? |
arterial |
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dialysis electrolyte solution is called? |
dialysate |
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dialysis used for pt who are critically ill, runs slower and for a longer time, and can add replacement fluids as well as maintain normal electrolyte concentrations? |
continuous renal replacement therapy (CRRT) |
|
dialysis that only lasts a few hours? |
intermittent hemodialysis |
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dialysis solutions are (hypertonic or hypotonic)? why? |
hypertonic, to avoid absorption of water from the dialysis solution into the circulation |
|
can contain electrolyte or have electrolyte added? |
dialysis solutions |
|
used for bathing or washing wounds, surgical incisions or body tissues (such as the bladder)? |
irrigation solutions |
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used for uncomplicated wounds? |
isotonic normal saline |
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irrigation solutions that contain drug products? |
antiseptics |
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sterile fluids intended for direct contact with internal body fluids or tissues? |
parenteral solutions |
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SVPs, LVPs, irrigation fluids, dialysis solutions, biologics are all? |
sterile fluids |
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parenteral means (?) but indicates? |
outside of the intestine, injectable dosage forms |
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common routes of parenteral administration? |
IV, IM, SC |
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most injectables are administered by? |
health care professionals |
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why is parenteral admin used? |
rapid, uncooperative or unconscious patients, pt unable to take oral meds, low bioavailability drugs, longer acting for compliance reasons |
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which drug admin gives most rapid onset of action? |
IV |
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provides optimal blood/plasma drug levels? |
IV |
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can an IV drug be removed once administered? how? |
not easily, antidote |
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must be sterile, no particulates, no risk of precip in solution and in blood, proper placement, watch for clots are all? |
IV precautions |
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can emulsions/suspensions be used IV? |
yes but they must be proven safe for IV use |
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drug is drawn up into a syringe and administered directly into the vein or port? |
IV push |
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one time or intermittent infusion method, drug solution added to SVP (minibag), attached at Y-site, rate often controlled by infusion pump? |
Y-site or piggyback |
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aka drip, used for large volume solutions, many drugs possible, rates in mL/hr, infused via infusion pump, compatibility issues are common? |
continuous infusions |
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used to control the rate of IV infusion? |
infusion pumps |
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can have both continuous and/or intermittent (bolus) dose of analgesic administered by pt. at pre-set intervals with lockout? |
PCA pumps (patient controlled analgesia) |
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longer lasting, less rapid effect, gradually releases drug into circulation, used for admin of aqueous or oleaginous solutions or suspensions, can be painful, erratic absorption rates (especially with obesity or low muscle mass) in? |
IM |
|
sites for IM admin? |
upper outer quadrant of gluteus maximus deltoid muscle of upper arm midlateral muscle of the thigh |
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best IM admin site for adults? |
butt (hard to reach in obese) |
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best IM admin site for infants and young children? |
deltoid or thigh |
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IM muscle injection angle? |
90 degrees |
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max volume for gluteal IM? |
5 ml |
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max volume for deltoid IM? |
2 ml |
|
vaccines, immunoglobulins, sedatives/antipsychotics, vitamin/electrolytes, biologics, hormones given which way? |
IM |
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used for small volumes of medication in solution or suspension? |
SC |
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rotating sites of injection is optimal in? |
SC |
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used when longer duration of action is desired because tissue is very slowly perfused and very slow absorption? |
SC |
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SC volume? |
<1.3 ml preferred but up to 2 ml ok |
|
angle for SC? |
45 to 90 |
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used for chronic administration of drugs like insulin and opioids? |
SC infusion pumps |
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for SC administration, volume needs to be low, what does this mean for drugs? |
more concentrated |
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SC infusion pump size? |
smaller than IV pumps |
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pump site of SC infusion pump can be dirty and become occluded resulting in? |
accidental underdosing |
|
biologics, hormones, anticoagulants, some vaccines, analgesics, many others are administered via? |
SC |
|
type of injection depends on? |
physical-chemical properties of the drug substance and the intended use of the medication |
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5 types of injectable materials? |
injection, for injection, injectable emulsion, injectable suspension, for injectable suspension |
|
liquid preparations that are solutions of drug substances? |
injection |
|
dry solids that, upon addition of diluent, yield solutions? |
for injection |
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liquid preparation of drug dissolved/dispersed in a suitable medium? |
injectable emulsion |
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liquid preparation of solid drug suspended in suitable medium? |
injectable suspension |
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dry solid that, upon addition of suitable medium, yields a preparation meeting requirement for an injectable suspension? |
for injectable suspension |
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must meet special purity and other standards assuring their safety by injection? |
solvents or vehicles |
|
what about coloring agents for injections? |
strictly prohibited |
|
must be sterilized, meet compendial standards for particulate matter, prepared in controlled areas, packaged in hermetic containers, filled to slight excess are all? |
requirements for preparing products for injection |
|
volume of injection permitted in multiple-dose containers is? |
under restrictions |
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how are sterile powders packaged? |
lyophilized or freeze-dried |
|
what to follow for proper IV compounding procedure? |
USP 797 |
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most injectables fall into this category? |
small volume parenterals |
|
used for piggyback or Y-site administration? |
small volume parenterals |
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may be admixed in the pharmacy, or may be part of ready-to-use system? |
small volume parenterals |
|
ampules, vials, prefilled syringes, minibags are all? |
small volume parenterals |
|
minibag volumes? |
50 or 100 ml |
|
available in any of the 5 forms of official injectables? |
vials and mix-o-vials |
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some must be further diluted in large or small volume IV bags? |
vials and mix-o-vials |
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some can be directly administered to patient without further dilution? |
vials and mix-o-vials |
|
what must always be done in regards to ampules? |
always start with filter needle to get drug out of ampule then switch to regular needle for dilution |
|
do the bubbles in prefilled syringes need to be expelled? |
no |
|
used for direct administration by patient or caregiver? |
prefilled syringe |
|
administers single dose, easy for self admin, usually SC route? |
auto injector systems |
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often contain multiple doses (single too), some need to be primed, can have adjustable dose or preset single dose, usually administered SC? |
prefilled pens for injection |
|
most common minibag solutions? |
NS and D5W |
|
rarely given by themselves? |
minibags |
|
can be attached to vials using ADD-Vantage systems? |
minibags |
|
powders that contain water that can be released when manipulated or stored in low humidity? |
efflorescent powders |
|
adsorb moisture from the air? |
hydroscopic powders
|
|
hydroscopic powders that adsorb so much moisture they transform into liquid? |
deliquescent powders |
|
agglomerates of smaller particles that behave as larger particles? |
granules |