Pharmaceutical Injections Quiz

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Questions and Answers

What is the pH range of Compound Sodium Chloride Injection?

5-7.5 (correct)

6-8

4-7

3.5-6.5

What is the maximum percentage of potassium chloride allowed in Ringer injection?

0.02%

0.025%

0.0315% (correct)

0.0285%

Which statement is correct regarding the solubility of potassium chloride?

Freely soluble in alcohol

Insoluble in water

Only soluble in boiling water

More soluble in warm water (correct)

Which of the following conditions contraindicates the use of potassium chloride?

Dehydration Signup and view all the answers

What is the main use of calcium chloride?

Calcium replacement Signup and view all the answers

Which form does potassium chloride NOT occur in?

Brown liquid Signup and view all the answers

What is the maximum allowed percentage of sodium chloride in Sodium Chloride and Dextrose Injection?

0.9% Signup and view all the answers

What is the characteristic of calcium chloride that requires caution during injection?

Irritating to the veins Signup and view all the answers

What is the primary purpose of replacement therapy?

To restore the volume and composition of body fluids to normal Signup and view all the answers

Why is volume contraction considered life-threatening?

It impairs the circulation and decreases blood volume Signup and view all the answers

What is the recommended infusion rate for sodium chloride solution in severe cases of volume depletion?

100 mL per minute Signup and view all the answers

What is the difference between isotonic and hypertonic sodium chloride solutions?

Hypertonic solutions are used when there is excess sodium loss, while isotonic solutions are not Signup and view all the answers

Which of the following is NOT a use of sodium chloride?

Treatment of viral infections Signup and view all the answers

What is the pH range for sodium chloride injection?

4.5-7.0 Signup and view all the answers

What is the composition of sodium chloride hypertonic injection?

Contains 1.52-1.68% sodium chloride Signup and view all the answers

What type of sodium solutions are administered for maintenance therapy in patients unable to take fluids orally?

Hypotonic solutions Signup and view all the answers

Which of the following is NOT an official preparation of calcium replacement?

Calcium acetate Signup and view all the answers

What is a potential consequence of overtreatment with magnesium sulfate?

Respiratory paralysis Signup and view all the answers

Which pH range is optimal for most metabolic reactions in the body?

7.38 - 7.42 Signup and view all the answers

What describes the term 'acidemia'?

Abnormal decrease in blood pH Signup and view all the answers

What role do the bicarbonate/carbonic acid buffer system serve?

Buffering changes in blood pH Signup and view all the answers

What is the primary classification of potassium bicarbonate?

Electrolyte replenisher Signup and view all the answers

What is the most effective single system for buffering carbonic acid in red blood cells?

Hemoglobin buffer Signup and view all the answers

What is the primary function of sodium biphosphate?

Urinary acidifier Signup and view all the answers

Which condition does NOT lead to acidemia?

Chronic hyperventilation Signup and view all the answers

What is an important consideration when administering magnesium sulfate?

It is contraindicated in patients with renal insufficiency. Signup and view all the answers

Which statement describes the action of sodium citrate in the body?

Restores bicarbonate reserve during chronic acidosis Signup and view all the answers

What is a characteristic of potassium citrate?

White granular powder that is deliquescent Signup and view all the answers

What is the minimum percentage of dextrose that should be included in maintenance solutions?

5% Signup and view all the answers

Which of the following is NOT a component of the general electrolyte composition in maintenance solutions?

Calcium Signup and view all the answers

What pharmacological category does ammonium chloride fall into regarding its effects?

Diuretic, expectorant, and electrolyte replenisher Signup and view all the answers

What is a key characteristic of the solution for rapid initial replacement in electrolyte therapy?

Electrolyte concentrations resembling ECF Signup and view all the answers

What type of solutions are commonly required when patients have severe electrolytic deficits?

Electrolyte combination therapies Signup and view all the answers

Which solution is typically used for fluid maintenance therapy in patients unable to take fluids orally?

Standard glucose & saline solution Signup and view all the answers

Which of the following solutions contains sodium lactate?

Lactated Ringer's injection Signup and view all the answers

Which of the following properties is true about sodium citrate?

It is a component of the Krebs cycle Signup and view all the answers

Which of the following scenarios indicates a need for replacement therapy?

Prolonged fever Signup and view all the answers

What reaction does carbonic anhydrase catalyze in erythrocytes?

H2O + CO2 to H2CO3 Signup and view all the answers

What happens during the chloride shift in erythrocytes?

Bicarbonate ion diffuses out and chloride ion diffuses in. Signup and view all the answers

What is the typical ratio of bicarbonate to carbonic acid in the plasma at pH 7.4?

27/1.35 meq/l Signup and view all the answers

Which condition is classified as metabolic acidosis?

Diabetic acidosis Signup and view all the answers

Which buffer system is effective in maintaining physiological pH alongside bicarbonate?

Phosphate buffer system Signup and view all the answers

What occurs to the bicarbonate ions in the lungs?

They are converted back to carbon dioxide and water. Signup and view all the answers

What is the typical pH range of urine corresponding to the phosphate buffer system in the kidneys?

4.5-4.8 Signup and view all the answers

What compensates for the increased concentration of H2CO3 in erythrocytes?

Hemoglobin Signup and view all the answers

Study Notes

Inorganic Pharmaceutical Chemistry - Replacement Therapy

Replacement therapy aims to restore the volume and composition of body fluids to normal levels.
Volume contraction is life-threatening due to impaired circulation, decreased blood volume, and compromised microcirculation.
When volume depletion is life-threatening, prompt infusion of isotonic sodium chloride solutions is necessary.
In severe cases, intravenous therapy at 100 mL per minute for the first 1000 mL may be needed for treatment of conditions like cholera.

Sodium Replacement

Sodium Chloride (NaCl; MW 58.44) occurs as colorless cubic crystals or white crystalline powder, having a saline taste.
It's freely soluble in water, more soluble in boiling water, soluble in glycerin, and slightly soluble in alcohol.
Sodium chloride is used in replacement therapy, isotonic solution production, and as a flavor enhancer.

Uses of Isotonic, Hypotonic, and Hypertonic Solutions

Isotonic solutions are used as wet dressings and for irrigating body cavities or tissues.
Hypotonic solutions are used for maintenance therapy when patients can't take fluids or nutrients orally for a few days.
Hypertonic injections are used for severe sodium loss and should be administered slowly, in small volumes (200–400 mL).

Official Preparations of Sodium Replacement

Sodium Chloride Injection, solution, and tablets.
Bacteriostatic sodium chloride injection.
Dextrose and sodium chloride injection and tablets.
Mannitol and sodium chloride injection.
Fructose and sodium chloride injection.
Ringer's injection.
Lactate Ringer's injection.

Sodium Chloride Injection

A sterile isotonic solution of sodium chloride in water for injection.
Contains not less than 0.85% and not more than 0.95% w/v of sodium chloride.
Contains no antimicrobial agents.
A clear, colorless solution with a pH between 4.5–7.0.

Sodium Chloride Hypertonic Injection

A sterile solution of sodium chloride in water for injection.
Contains not less than 1.52% and not more than 1.68% w/v of sodium chloride.
Contains no antimicrobial agents.
A clear, colorless solution with a pH between 5.0–7.5.

Compound Sodium Chloride Injection (Ringer Injection)

It contains:
- Not less than 0.82% and not more than 0.9% w/v of sodium chloride.
- Not less than 0.0285% and not more than 0.0315% w/v of potassium chloride.
- Not less than 0.03% and not more than 0.036% w/v of calcium chloride in water for injection.
Contains no antimicrobial agents.
A clear, colorless solution with a pH between 5–7.5.

Sodium Chloride and Dextrose Injection

A sterile solution of sodium chloride and dextrose in water for injection.
A clear, colorless, or faintly straw-colored solution with a pH between 3.5–6.5.
Contains 0.9% sodium chloride and 5% dextrose.

Potassium Replacement

Potassium Chloride (KCl; M.Wt. 74.56) occurs as colorless, elongated prismatic or cubical crystals, or as white granular powder.
Odorless, has a saline taste, and is stable in air.
Freely soluble in water and even more soluble in boiling water, with a neutral solution to litmus. Insoluble in alcohol.
Uses: Oral potassium replacement (solution needs dilution), familial periodic paralysis, Meniere's syndrome, digitalis intoxication antidote. Can be used as an adjunct in myasthenia gravis treatment.

Contraindications for Potassium Replacement

Impaired renal function with oliguria (diminished urine output).
Acute dehydration.
Hyperpotassemic conditions like myotonia congenita, adynamia episodica hereditaria (periodic weakness or paralysis of skeletal muscle).
Potassium-sparing drugs.

Official Preparations of Potassium Replacement

Potassium chloride injection and tablets.
Ringer's injection.
Lactate Ringer's injection.
Lactate potassium saline injection.
Potassium gluconate elixir and tablets.

Calcium Replacement

Calcium Chloride (CaCl₂·2H₂O; M.Wt. 147.02) occurs as white, hard, odorless fragments or granules.
Freely soluble in water, alcohol, and boiling alcohol; very soluble in boiling water.
Irritating to veins, so inject slowly.
Used as a calcium source in electrolyte replacement and maintenance solutions.

Official Preparations of Calcium Replacement

Calcium chloride (in Ringer's and Lactate Ringer's injection).
Calcium gluconate injection and tablets.
Calcium lactate tablets.
Dibasic calcium phosphate.
Tribasic calcium phosphate.

Parenteral Magnesium Administration

Magnesium Sulfate (MgSO₄·7H₂O; M.Wt. 246.47).
Used as a central nervous system depressant for treating eclampsia (convulsions and coma) and magnesium deficiency in alcoholics.
Overtreatment can cause respiratory paralysis and cardiac depression.
IV injection of calcium salts is used to counteract magnesium intoxication. Should not be administered to patients with renal insufficiency.
Used as an anticonvulsant and cathartic.

Physiological Acid-Base Balance

pH disturbances in the body are clinically significant.
Acidemia and alkalemia refer to abnormal decreases/increases in blood pH, respectively.
Acidosis and alkalosis are clinical states that could cause acidemia or alkalemia.
Extent of pH change depends on compensation, which varies in different clinical cases.
Acids, such as carbonic (from CO2) and lactic (from anaerobic metabolism), are constantly produced during metabolism.

Buffer Systems

The body uses buffer systems to maintain a narrow pH range (7.38–7.42).
Bicarbonate/carbonic acid (HCO₃⁻/H₂CO₃) is present in plasma and kidneys.
Monohydrogen/dihydrogen phosphate (HPO₄²⁻/H₂PO₄) is found in cells and kidneys.
Red blood cells (RBCs) have a hemoglobin buffer system which is highly effective in buffering carbonic acid produced during metabolism.
During metabolic processes, CO2 diffuses from cells and into plasma, reacting with water to form carbonic acid. This increased carbonic acid is buffered by plasma proteins. Many CO2 enters erythrocytes, where it forms H2CO3, with the help of carbonic anhydrase, and combines with Hb.

Kidney's Role in Acid-Base Balance

Sodium salts of mineral or organic acids are removed from the plasma through glomerular filtration.
Tubular fluid reacts with carbonic acid (formed by carbonic anhydrase) in the tubular cells, and this reaction is sometimes called Na⁺–H⁺ exchange.
NaHCO₃ returns to the plasma (removed in lungs as CO2), and the protons enter the tubular fluid, forming acids from the original anion sodium salts, such as H₂PO₄⁻, lactate, etc.

Types and Causes of Acidosis and Alkalosis

Metabolic acidosis: Primary bicarbonate ion deficit and causes include diabetic acidosis, renal failure, diarrhea. Compensatory mechanisms include hyperventilation and increased acid excretion.
Respiratory acidosis: Excess carbonic acid and causes include cardiac disease, lung conditions, drowning. Compensatory mechanisms include increased CO2 excretion, increased acid excretion, and increased NH₃ formation.
Metabolic alkalosis: Excess HCO₃⁻ and causes include administration of excessive alkali, vomiting, and potassium ion. Compensatory mechanisms include CO₂ retention, decreased Na⁺–H⁺ exchange, decreased NH₃ formation, and HCO₃⁻ reabsorption.
Respiratory alkalosis: Primary H₂CO₃ deficit and causes include fever, hysteria, anoxia, and salicylate poisoning. Compensatory mechanisms include CO₂ retention, decreased Na⁺–H⁺ exchange, decreased NH₃ formation, and HCO₃⁻ reabsorption.

Electrolytes used in Acid-Base Balance

Sodium acetate is metabolized to CO₂ and then to bicarbonate, used as an effective buffer in metabolic acidosis. Effective in treating metabolic acidosis from cholera and uremia.
Potassium acetate: Alkalinity increases as the solution sits, is stored in closed containers. It's soluble in water but insoluble in alcohol.
Sodium bicarbonate is an alkalizer used to combat gastric hyperacidity and systemic acidosis, often available as an injection or tablet form.
Potassium bicarbonate is a colorless, transparent, monoclinic prism, or a white granular powder; odorless and stable in air.
Sodium biphosphate is a urinary acidifier.
Sodium citrate is used as an anticoagulant, chelating serum calcium, and as a buffer. It has a diuretic effect due to increased body salt concentration. Potentially useful in cases of chronic acidosis.
Potassium citrate is a white granular powder, odorless and cooling, freely soluble in water and almost insoluble in alcohol.

Electrolyte Combination Therapy

In short-term therapy (e.g., post-surgery), standard glucose and saline infusions may suffice, but severe or protracted electrolyte deficits may require solutions containing additional electrolytes.
Combinations are usually not feasible from the standpoint of patient-specific needs or cost/sterility.
Combination products can be categorized into fluid maintenance and electrolyte replacement solutions.
Maintenance therapy is intended to supply normal water and electrolyte requirements intravenously for patients unable to take it orally, minimizing metabolites associated with starvation. Solutions contain at least 5% dextrose and electrolytes like Na, K, Cl, HCO3 (or equivalent amounts of lactate or acetate), Mg, and P for overall maintenance.

Replacement Therapy Situations

Prolonged fever.
Severe vomiting.
Diarrhea.
Rapid initial replacement solutions have electrolyte concentrations resembling extracellular fluid.

Official Electrolyte Infusion Combinations

Ringer's injection contains potassium chloride, sodium chloride, and calcium chloride dihydrate, equivalent to Na, K, Ca, and Cl.
Lactated Ringer's injection contains sodium chloride, sodium lactate (equivalent), potassium chloride, and calcium chloride dihydrate; usually available as injections.

Oral Electrolyte Solutions

Oral electrolyte solutions are available, such as Lytren or Pedialyte, for electrolyte and fluid maintenance when oral intake isn't possible or insufficient (e.g., diarrhea).

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Description

Test your knowledge on pharmaceutical injections, including sodium chloride, potassium chloride, and calcium chloride. This quiz covers solubility, injection characteristics, contraindications, and more. Challenge yourself to see how well you understand these essential medical compounds.