Podcast
Questions and Answers
What infusion method is most suitable for delivering a highly concentrated medication at a small volume?
What infusion method is most suitable for delivering a highly concentrated medication at a small volume?
Which solution is categorized as hypertonic and can cause regulatory shifts in body fluids?
Which solution is categorized as hypertonic and can cause regulatory shifts in body fluids?
What is a risk associated with peripheral IV access that can lead to severe tissue damage?
What is a risk associated with peripheral IV access that can lead to severe tissue damage?
In what scenario would central IV access be preferred over peripheral access?
In what scenario would central IV access be preferred over peripheral access?
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What immediate concern should be monitored for patients receiving continuous infusions of hypertonic solutions?
What immediate concern should be monitored for patients receiving continuous infusions of hypertonic solutions?
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When administering a medication that requires a low osmolarity, which IV access option is most appropriate?
When administering a medication that requires a low osmolarity, which IV access option is most appropriate?
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Which of the following is true regarding prefilled syringes for IV flushing?
Which of the following is true regarding prefilled syringes for IV flushing?
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Which medication should not be administered IV due to specific route restrictions?
Which medication should not be administered IV due to specific route restrictions?
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What infusion method is required for medications that exceed a concentration limit due to their osmolarity?
What infusion method is required for medications that exceed a concentration limit due to their osmolarity?
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What is the primary role of a pharmacist regarding the selection of IV medication routes?
What is the primary role of a pharmacist regarding the selection of IV medication routes?
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Which of the following is an advantage of parenteral administration?
Which of the following is an advantage of parenteral administration?
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Which parenteral route is associated with the highest risk of complications like infections and hypersensitivity reactions?
Which parenteral route is associated with the highest risk of complications like infections and hypersensitivity reactions?
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What is a primary reason that intravenous (IV) administration is preferred for urgent medications?
What is a primary reason that intravenous (IV) administration is preferred for urgent medications?
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What is a key consideration for the administration of intrathecal injections?
What is a key consideration for the administration of intrathecal injections?
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Which of the following drugs should never be administered via IV push?
Which of the following drugs should never be administered via IV push?
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Which parenteral route is most commonly used for vaccines?
Which parenteral route is most commonly used for vaccines?
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What is a potential disadvantage of subcutaneous injections?
What is a potential disadvantage of subcutaneous injections?
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What complication can occur specifically from intramuscular injections?
What complication can occur specifically from intramuscular injections?
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What characteristic defines intra-arterial administration?
What characteristic defines intra-arterial administration?
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Which of the following is a common reason for using total parenteral nutrition (TPN)?
Which of the following is a common reason for using total parenteral nutrition (TPN)?
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Study Notes
Introduction to Parenteral Administration and IV Medication Principles
- Parenteral administration is the delivery of medication outside the digestive tract, typically via injection.
- Objectives include defining parenteral routes, recognizing advantages and disadvantages of parenteral administration, explaining IV push, intermittent, and continuous infusions, differentiating between central and peripheral IV access, understanding hypotonic, hypertonic, and isotonic fluids, and outlining pharmacist considerations for parenteral administration.
Parenteral Definition
- Physiologically, parenteral refers to anything outside the digestive tract.
- Medically, it describes medication delivery not through the digestive tract.
- Typically, parenteral delivery involves injection.
Advantages of Parenteral Administration
- Timing: Immediate physiological response, prolonged drug action (e.g., long-acting injectable antipsychotics), correcting serious fluid and electrolyte imbalances.
- Control: Administered by healthcare professionals for uncooperative, nauseous, or unconscious patients, allowing for easier monitoring and compliance.
- Convenience: Suitable for medications poorly absorbed in the gastrointestinal tract, supplying nutrients when oral intake is impossible (total parenteral nutrition), and providing local effects (e.g., steroid joint injections).
Disadvantages of Parenteral Administration
- Healthcare team: More expensive than oral medications, time-consuming administration, risk of accidental needle sticks, and strict adherence to aseptic procedures (sterility).
- Patient: Difficulty reversing physiological effects, increased risk of complications (infections), incompatibilities, pain/irritation at the injection site, and hypersensitivity reactions.
Parenteral Routes
- Intravenous (IV): Administration directly into a vein, rapid effect, predictable response, less volume limitation.
- Intramuscular (IM): Injection into large muscle; absorption is generally quicker than oral but slower than IV, suitable for sustained-release drugs; up to 5 mL in gluteal area.
- Subcutaneous (SQ/SC): Beneath the skin's surface; quicker than IM but slower than IV, absorption can be erratic, usually up to 2 mL.
- Intra-arterial (IA): Injection into an artery, high concentration of drug to a specific target site with minimal dilution, for analgesia and anesthesia.
- Intra-articular: Injection into a joint space.
- Intrathecal: Injection into lumbar intraspinal sac, bypasses blood-brain barrier, rapid onset (e.g., for analgesia/anesthesia).
- Intradermal: Injection into top layer of skin, used for diagnostic tests (e.g., tuberculin, allergy tests).
IV Push
- Medications are given over a short period (seconds to minutes) via syringe.
- Used for urgent medications (antiemetics, analgesics, cardiac medications).
- Often undiluted for rapid administration.
- Useful for incompatible drugs in large volumes.
Infusions
- Intermittent Infusions: delivered via an IV pump, intermittent start-stop, useful for small volumes of highly concentrated medications; e.g., 15 minutes to 3 hours.
- Continuous Infusions: delivered continuously using an IV pump device; may require close titration; used for correction of dehydration or electrolyte imbalances; examples of use include dextrose and saline.
- Infusion Pumps: varied types exist to include syringe infusion, gravity infusion, and volumetric pumps
Central vs Peripheral IV Access
- Peripheral: Access placed in hand, forearm, or antecubital fossa, limitations on osmolarity, rate of administration, and drug concentration, less expensive, for short-term use.
- Central: Larger veins like the subclavian, internal jugular, or femoral veins, contents rapidly diluted, suitable for larger volumes/faster rates; longer access duration (chemotherapy etc.).
Risks of Peripheral IV Access
- Phlebitis (vein irritation)
- Extravasation/Infiltration (medication entering surrounding tissue).
- Vesicant medications (cause severe tissue damage if infiltrated).
- Thrombosis (blood clot)
- Bleeding/Bruising
Risks of Central IV Access
- Insertion complications (pneumothorax, venous air embolism, arterial injury)
- Infections, central venous obstruction, central vein stenosis.
- Catheter-related venous thrombosis.
Tonicity Review
- Hypotonic: Lower solute concentration than blood, fluid shifts from extracellular to intracellular space.
- Isotonic: Same solute concentration as blood; expands both intracellular and extracellular fluid spaces.
- Hypertonic: High solute concentration than blood, fluid shifts out of cells and into extracellular space.
Hypotonic Solutions
- Water shifting into cells to treat conditions like dehydration, hypernatremia, or diabetic ketoacidosis).
- Risks: rapid movement of water into cells, resulting in hemolysis (red blood cell rupture), hyponatremia, and hypotension.
- Examples: 0.2% and 0.45% saline, 2.5% dextrose in water.
Isotonic Solutions
- Used for rehydration and medication delivery, less risk of fluid overload.
- Examples: 0.9% NaCl, dextrose 5% in water (D5W), Ringer's solution.
Hypertonic Solutions
- Used to correct sodium depletion and water overload, or treat cerebral edema.
- Risks: circulatory overload, osmotic demyelination syndrome, venous irritation.
- Restricted use in most hospitals.
- Examples: D10W, 3% and 5% Saline, and 5% dextrose in Lactated Ringers.
Pharmacist Responsibilities
- Ensuring concentration, pH, and tonicity are appropriate for the route.
- Recalling limitations of peripheral administration (e.g., 3% saline should not be given via peripheral IV).
- Ensuring appropriate volume for the route of administration.
- Prescribing appropriate route or formulation considering patient specific conditions(e.g., allergies, body composition, comorbidities, tolerability).
- Being mindful of maximum concentrations, maximum infusion rates.
- Recommending sterile products for care settings considering any potential adverse effects.
- Choosing the appropriate filtration, syringes, and needle sizes (e.g., 1.2 micron filter).
- Correctly choosing appropriate diluents
Practical Examples and Case Studies
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Example cases that illustrate the choice of appropriate parenteral routes.
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Considerations for choosing the best route of administration based on patient specific conditions.
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Description
This quiz covers the principles of parenteral administration and IV medication delivery. You'll learn about various parenteral routes, the benefits and limitations of this method, and the different types of intravenous infusion techniques. Gain insights into fluid types and pharmacist considerations for effective medication management.
