Total Parenteral Nutrition Flashcards

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Questions and Answers

What is the microbial growth-promoting soybean-based product added to?

A compounding preparation

What defines medium-risk level Compounded Sterile Preparations (CSPS)?

Mixed in nuclear pharmacies

Prepared from sterile ingredients

Stored for up to 30 hours at room temperature (correct)

Prepared using complex manipulations (correct)

Which of the following is an example of high-risk level CSPS?

Patient-controlled analgesia

TPN

Aseptic non-touch technique

Radioactive products used in cancer treatment (correct)

What role do pharmacy technicians play in quality assurance?

Participating in quality assurance and medication error prevention programs. Signup and view all the answers

What are the guidelines provided by USP 797 and 800?

Guidelines regarding procedures and practices to prevent patient harm or death. Signup and view all the answers

Nonsterility is the most common type of medication error.

True Signup and view all the answers

What does quality assurance programs provide?

Means to ensure product and service quality meet standards Signup and view all the answers

What is the definition of bulk repackaging?

Repackaging medications into a single dose. Signup and view all the answers

What are some common reasons pharmacies repack from bulk medications?

To save on costs Signup and view all the answers

What is the beyond-use date (BUD) for a repackaged drug?

The earliest of the repackaged date or manufacturer's date Signup and view all the answers

Which ingredient is NOT a part of a nonsterile compound?

Preservatives Signup and view all the answers

What are excipients?

Inert ingredients used to promote effectiveness Signup and view all the answers

When measuring using a Class A balance, __________ should be used to adjust the weights.

tweezers Signup and view all the answers

Molded tablets disintegrate easily upon exposure to moisture.

True Signup and view all the answers

What does TPN stand for?

Total Parenteral Nutrition Signup and view all the answers

What is the general daily caloric requirement for adult patients on TPN?

2500 to 3000 Signup and view all the answers

What are the primary goals of TPN? (Select all that apply)

Maintain nutritional balance Signup and view all the answers

TPN solutions are made up of?

Macronutrients and micronutrients Signup and view all the answers

What are the two ways of preparing TPN?

Automated compounder machines Signup and view all the answers

What guidelines must technicians follow prior to TPN administration?

Aseptic preparation to avoid contamination and destabilization Signup and view all the answers

What can cause TPN to destabilize? (Select all that apply)

Aggregation Signup and view all the answers

What should be done when preparing micronutrients for TPN?

Draw each micronutrient individually and follow manufacturer instructions Signup and view all the answers

What special considerations should be taken when preparing TPN?

Use aseptic technique Signup and view all the answers

What type of technique must TPN solutions be prepared using?

Aseptic technique Signup and view all the answers

What are the energy sources for TPN solutions?

Macronutrients such as carbohydrates, fats, and proteins Signup and view all the answers

What do TPN solutions for long-term therapy contain?

Electrolytes such as potassium, sodium, magnesium, and phosphorous Signup and view all the answers

What are some classes of IV chemotherapeutic agents? (Select all that apply)

Alkylating agents Signup and view all the answers

What should be used to handle hazardous drugs properly?

Biological safety cabinets (BSC) or compounding aseptic containment isolators (CACI) Signup and view all the answers

Chemotherapeutic agents are only toxic to cancerous cells.

False Signup and view all the answers

What do regulations regarding investigational drugs focus on?

Eligible patients, adverse effects monitoring, documentation, and waste disposal Signup and view all the answers

What are the responsibilities of pharmacy technicians in home IV infusion therapy?

Preparing sterile IV admixtures, gathering equipment and supplies, maintaining progress notes, billing, cleaning, and quality control Signup and view all the answers

What are critical components of quality assurance practices? (Select all that apply)

Training for all personnel Signup and view all the answers

What does quality control involve?

Maintaining the quality of products and services to meet standards Signup and view all the answers

Match the following types of infusion pumps with their uses:

Volumetric pumps = High-potency drugs Peristaltic pumps = Enteral feeding Syringe pumps = Small doses of high-potency drugs PCA pumps = Patient-controlled pain relief Ambulatory pumps = Lightweight delivery of IV therapy Signup and view all the answers

Study Notes

Total Parenteral Nutrition (TPN) Overview

TPN is used to deliver essential nutrients directly into the bloodstream for patients unable to eat or absorb nutrients via the digestive tract.
Daily caloric requirement for adults on TPN typically ranges from 2,500 to 3,000 calories.

Primary Goals of TPN

Replace nutritional deficits in patients.
Promote wound healing and recovery.
Increase weight or limit weight loss.
Prevent malnutrition and ensure nutritional balance.

Composition and Preparation of TPN

TPN solutions consist of macronutrients (carbohydrates, fats, proteins) for energy and micronutrients for additional health benefits.
Can be prepared via gravity method or automated compounder machines.

Aseptic Preparation Guidelines

Strict aseptic techniques must be followed to prevent contamination.
Guidelines include performing calculations in designated areas, decontaminating preparation zones, and mixing in a controlled environment.

Destabilization of TPN Solutions

TPN can become unstable due to:
- Creaming: Fat particles rising to the top.
- Cracking: Separation of oil and water phases.
- Coalescence: Smaller fat particles merging into larger ones.
- Aggregation: Fat particles clumping together.

Micronutrient Preparation

Draw each micronutrient separately and consult manufacturer guidelines for compatibility.
Vials should be prepared for pharmacist verification to avoid incompatibility issues.

Special Considerations for TPN Administration

TPN must be refrigerated immediately after preparation and infused or discarded within 24 hours.
Use appropriate filters based on lipid content (1.2 micron for TPN with lipids, 0.2 micron for TPN without).
Monitor patient vital signs and lab values every 4 to 6 hours.

Chemotherapy and Hazardous Drug Handling

Chemotherapeutic agents are toxic to both cancerous and healthy cells; common symptoms of exposure include skin rashes and gastrointestinal effects.
Proper handling includes using Biological Safety Cabinets (BSC) and Personal Protective Equipment (PPE).

Safe Waste Disposal Protocols

Chemotherapy waste must be disposed of in specially marked containers.
Use of needle-free devices to minimize risks during hazardous drug administration.

Patient Education on Home Infusion Therapy

Patients must understand IV catheter insertion, use of PICCs and CVCs, and medication flushing techniques (SASH method).
Awareness of complications related to PICCs should be emphasized.

Types of IV Therapy in Home Settings

Treatments can include chemotherapy infusion via specific arteries, pain management techniques, and anti-infective therapies.

Infusion Pump Types

Volumetric pumps deliver precise drug volumes, while peristaltic pumps are used for enteral feeding.
PCA pumps allow patient-controlled pain relief, enabling patients to self-administer medication.

Pharmacy Technicians' Role in IV Therapy

Responsibilities include preparing sterile mixtures, maintaining equipment, documenting patient progress, and ensuring quality control.

Quality Assurance and Medication Error Prevention

The importance of quality assurance (QA) and control is emphasized to prevent medication errors in sterile compounding.
Patient rights in medication management include ensuring the right patient, medication, strength, route, and time.

Education Resources for Pharmacy Technicians

Stay updated with pharmacy practice through professional organizations and educational institutions.### Compounding Categories
Category 1: Compounds with a maximum BUD of 12 hours or less at room temperature or 24 hours or less refrigerated.
Category 2: Compounds with a maximum BUD of greater than 12 hours at room temperature or greater than 24 hours refrigerated.

Compounding Areas

Category 1: Can be compounded in a segregated compounding area (SCA) without a buffer and ante room.
Category 2: Must be compounded in a facility with a separate walled ante room (ISO class 8) and buffer room (ISO class 7) areas.

Pharmacy Technician Responsibilities

Participating in quality assurance and medication error prevention programs.
Bulk repackaging and nonsterile compounding.

Bulk Repackaging

Involves repackaging medications into a single dose.
Reasons for repackaging: medications not available for purchase as single doses, cost savings, faster dispensing, reduced error, and stocking medications.

Good Manufacturing Practices (GMP)

US FDA guidelines that guarantee safe and effective products for consumers.
Examples of GMP guidelines: checking drugs by a registered pharmacist, equipment maintenance, beyond-use date, packaging, and logging.

Equipment and Techniques

Automated packaging machines, pill-counting trays, and spatulas.
Aseptic technique recommended for bulk repackaging.
Wear laboratory coat, keep hair pulled back, perform handwashing, and wear face mask and gloves.

Expiration and Beyond-Use Dates

Beyond-use date (BUD) is one year from the repackaging date or the manufacturer's expiration date, whichever is earlier.

Compounding

Allows the preparation of medication for a specific patient.
Reasons for compounding: medication no longer manufactured, patient allergy, special drug strength, or patient compliance.

Nonsterile Compounding

Preparation of patient-specific medication doses without a clean room.
Three parts to a nonsterile compound: active ingredient, inactive ingredient(s), and vehicle or diluent.

Compounding Area and Equipment

USP 795 guidelines for setting up compounding areas.
Personal protective equipment, measuring devices, mixing equipment, and weighing equipment.

Weighing and Measuring Substances

Techniques for using Class A and Class II balances.
Leveling the balance, adding weighing papers, and zeroing out the balance.

Solubility and Dosage Forms

Concepts of solubility: particle size, dissolution rate, and viscosity.
Buffers: solutions that resist pH changes.

Molded Tablets and Capsules

Steps to compound molded tablets: preparing powder mixture, moistening, and pressing into a cavity plate.
Benefits of capsules: masking taste and easier to swallow.

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Description

Test your knowledge on total parenteral nutrition (TPN) with these flashcards. Learn about daily caloric requirements, primary goals, and more essential concepts related to TPN. Perfect for healthcare students and professionals.