Podcast Beta
Questions and Answers
What is one of the primary risks associated with exposure to cytotoxic agents?
What is the primary function of a LAF cytotoxic cabinet?
Why is it important to keep doors and windows closed in the preparation area?
Which of the following is a recommended safety measure when reconstituting cytotoxic products?
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What protective gear is commonly used to prevent inhalation when handling cytotoxic agents?
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What is the primary responsibility of trained personnel in TPN preparation?
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What should be included in the TPN work sheet?
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Why is the identification and collection of materials crucial in the TPN preparation process?
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What temperature should TPN be stored at to prevent degradation?
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What is a key characteristic of cytotoxic drugs used in treatment?
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What is necessary for the pharmacist to provide a cytotoxic reconstitution service?
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What should be considered for pricing TPN?
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Which of the following is an appropriate type of packaging for TPN during transfer?
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What is the primary purpose of IV admixtures?
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What is an essential step before preparing an IV solution?
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Which of the following correctly describes TPN?
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What is the purpose of labeling an IV solution?
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What must a pharmacist ensure regarding the stability of TPN components?
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What is the required environment for preparing TPN?
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What should be checked during the final inspection before supplying an IV admixture?
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What information should be included on the additional label for an IV solution?
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Study Notes
Aseptic Dispensing
- The preparation and supply of sterile medical products, requiring manipulation before administration.
- IV admixtures or IV additive solutions are sterile products created by adding one or more drugs to IV solutions/fluids.
- The additive is the drug added to the IV solution.
- IV fluids are large-volume parenterals administered by intravenous infusion, used for:
- Correcting electrolyte imbalances
- Correcting body fluid disturbances (fluid replacement)
- Serving as vehicles for other drug substances.
Examples of IV Fluids
- Dextrose 5%, 10% Injection
- NaCl Injection: 0.9%, 0.45%
Preparation Steps for IV Admixtures
- Receipt of physician’s order, pharmacists work from this order sheet.
- Label preparation, containing information about:
- Patient identification and location
- Physician's name
- Drugs and quantities
- Date of compounding
- Expiry date
- Pharmacist name
- Additional label preparation if necessary, positioned upside down for easier access when the container is hung from a pole on the patient's bed.
- IV solution preparation always in LFH (Laminar Flow Hood), using sterile needles, syringes, etc.
- After adding the drug, a new seal is crimped onto the container. The seal color should be different to indicate that a drug has been added.
- Final inspection by the pharmacist before supplying, checking labels, solution clarity, and calculations.
TPN / Hyperalimentation
- IV administration of sufficient nutrients above usual basal requirements to achieve:
- Tissue synthesis
- Positive nitrogen balance
- Anabolism
- Used for patients unable to receive enteral feeding.
- TPN is also known as hyperalimentation.
- TPN is part of total patient care, involving simple procedures for preparation.
- Requires appropriate facilities and equipment like LFHs providing controlled environmental conditions.
- Pharmacists must understand preparation methods, stability and compatibility, facilities, and equipment.
TPN: Stability and Compatibility
- TPN consists of various ingredients, creating a complex pharmaceutical system.
- There is a possibility of interactions and incompatibilities between the components, increasing the risk of toxicity to patients.
- Pharmacists need a thorough understanding of stability and compatibility issues and should consult available literature before preparing TPN.
TPN: Facility and Environment
- TPN preparation requires an aseptic environment, therefore LFHs are used.
TPN: Personnel and Training
- Trained personnel should carry out aseptic preparation of TPN.
- They should understand patient requirements and product usage.
TPN: Documentation
- A worksheet should be designed for TPN dispensing and maintained.
- The worksheet contains information about:
- Materials
- Patient name
- Label details
- Manufacturing procedures are developed jointly by production and quality control staff.
TPN: Receiving Requests
- Upon receiving a request for TPN, feasibility and stability are checked within normal clinical limits of the requested combinations.
- Information is then transferred to the dispensing worksheet.
TPN: Collection of Materials and Preparation
- The first step is the identification and collection of all necessary materials.
- The pharmacist checks these against the worksheet and signs it.
- With multiple TPNs, care is taken to avoid mixing source materials, labels, etc.
- Materials are placed well within the LFH, organized to facilitate systematic steps and minimize disruption of airflow.
TPN: Labeling
- The label should contain information about:
- Patient name/number
- Ward
- Product constituents
- Batch no.
- Expiry date
- Storage conditions
TPN: Charging of Compounding Services
- TPN compounding services are costly for the pharmacy department, as amino acids and lipids themselves are expensive.
- Pricing of TPN requires identification of materials cost, labor costs, etc.
- All factors must be considered before deciding on in-house manufacturing or obtaining products from other hospitals or manufacturers.
TPN: Storage
- TPN is stored at 2-6 °C to protect it from microbiological and chemical degradation.
TPN: Packaging
- The quality of packaging systems should comply with QC standards and maintain product temperature during transfers.
- Insulated polystyrene containers are the most useful.
Cytotoxic Dispensing
- Cytotoxic drugs kill cells, used in cancer treatment to destroy tumor and neoplastic cells.
- Most cytotoxic injectables are available in powdered form and require reconstitution.
- Pharmacists can provide cytotoxic reconstitution services due to their knowledge in Pharmaceutics, Pharmacology, Pharmaceutical Chemistry, and Pharmacokinetics.
Cytotoxic Dispensing: Knowledge Requirements
- Understanding the pharmacological action of cytotoxic drugs and their stability in solution.
Cytotoxic Dispensing: Area of Skills Needed for Pharmacists
- Safe handling
- Preparation areas
- Techniques and precautions
Cytotoxic Dispensing: Safe Handling of Cytotoxic Agents
- Cytotoxic agents are non-selective and can destroy healthy tissue.
- Precautions are necessary for personnel handling them.
- Exposure to cytotoxic agents may cause:
- Irritation of mucous membranes, eyes, skin
- Light-headedness, nausea, headache
- Allergic reactions
- Risk of malignancy, teratogenesis, leukemia, infertility
- Following proper precautions and procedures eliminates possible direct exposure, inhalation of aerosolized drugs, or ingestion.
Areas for Preparation
- LAF cytotoxic cabinets are used for preparation, providing:
- Product protection
- Worker protection
- Cytotoxic cabinets are reserved only for cytotoxic drugs.
- The ventilation of the area should be adequate, but doors and windows should be closed to prevent drafts (entry of external air).
- The working area should be non-porous for easy cleaning.
- Equipment and drugs should be arranged in an orderly manner to avoid accidents, with neutralizing solutions close at hand.
- Horizontal LAF cabinets should never be used.
Techniques and Precautions for Cytotoxic Drug Dispensing
- Prior to dispensing, the product is reconstituted while maintaining its sterility and ensuring maximum protection for the operator.
- Eating, smoking, and drinking are prohibited in the work area.
- Suitable protective clothing and gloves are worn to protect the skin.
- Latex gloves are commonly used.
- Surgical face masks prevent inhalation.
- Goggles protect the eyes and should be washed after use.
- Reconstitution is carried out on a solid surface that is easily cleaned.
- A broad-edged tray is suitable when the LFH surface is perforated.
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Description
This quiz focuses on aseptic dispensing techniques, particularly the preparation of sterile IV admixtures. Participants will learn about the steps involved in compounding IV solutions, the importance of labeling, and examples of commonly used IV fluids. Test your knowledge on how to ensure safety and accuracy in the preparation of these medical products.
