Total Parenteral Nutrition Flashcards

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.