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Chapter 15: Parenterals  Physician’s assistant

 Nurse
Parenterals are administered at:
Parenteral  Hospitals
 The term parenteral derived from the Greek words:  Clinics
para (outside) and enteron, (intestine)  Extended care facilities
 denotes routes of administration other than oral route
 refers to the injectable routes administration Antirheumatic injectables
 sterile Brand Name: Enbrel
Generic name: Etanercept
Parenteral Injections
Manufacture: Immunex
 pyrogen free preparations
Form: Injectable
 intended to be administered parenterally.
Recommended initial dose: 25mg (1 vial) twice a week injected
subcutaneously
Based on the route of administration, sterile products are
classified into:
Botulinum toxin
1. Parenteral preparations
Brand name: Botox
2. Ophthalmic preparations - for the eye
Generic name: Clostridium botulinum ( type A neurotoxin
3. Otic preparations - for the ear
complex)
4. Nasal preparations - for the nose & throat
Form: Powder for solution for injection
5. Irrigating solutions - for washing wounds or abraded
mucous membrane
Botulinum toxin
Brand name: Myobloc
Parenteral Routes of Administration
Generic name: Botulinum toxin Type B
1. Intra-articular – joints
Form: Injection, solution [single-dose vial]: 5000 units/mL (0.5 mL, 1
2. Intraspinal – spinal column
mL, 2 mL) [contains albumin 0.05%]
3. Intra-arterial – arteries
4. Intravenous – veins
Intravenous Route (IV)
5. Intradermal – shin
 Advantage:
6. Intrasynovial – joint fluid
 May be a life-saving procedure because of the
7. Intrathecal – spinal fluid
placement of the drug directly into the circulation
8. Intracardiac – heart
and the prompt actions which ensues.
9. Intramuscular – muscles
 Disadvantage:
10. Subcutaneous – under the skin
 Once the drug administered, it cannot be
retrieved.
 In the case of adverse reaction to the drug, for
instance, the drug cannot be easily removed from
the circulation.
 Precautions:
 Strict aseptic precautions must be taken at all
times to avoid risk of infection.
 The syringes and needles used must be sterilized
and to the point of entrance must be disinfected
to reduce chance of carrying bacteria from the
skin into the blood via the needle
 Flow Rates:
 Generally, the flow rates of IV are expressed in
mL/hour,
 Range from 42 to 150 mL/hour.
 Lower rates are used for keep-open (KO, KVO)
 Great care must be taken to prevent overdosing
or underdosing.
 Example:
 Metoprolol (beta blocker)
– 3 bolus injections of 5 mg each at about
2 minute intervals
– oral dosing (100 mg/day)
 NOTE:
 Not only are the injectable solutions sterile,
syringes, needles must also be disinfected to
Parenterals are administered by: reduce the chance of carrying bacteria
 Physician

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 A backflow of blood into the administration set or Example: WalkMed PCA
syringe indicates proper placement of the needle 4. Ability to provide constant and uniform analgesia
in the vein 5. Can prevent pharmacokinetics and
 Intravenous drugs ordinarily must be aqueous pharmacodynamic differences between patients from
solution interfering with the effectiveness of analgesia
 They must mix with the circulating blood and not 6. Also permits patients to medicate themselves when
precipitate from solution. Such an event can lead there is breakthrough pain
to pulmonary micropillary occlusion and blockage 7. Minimizes various side effects
of blood flow. 8. PCA devices can be used for IV, SC or epidural
administration
9. These devices are either, demand dosing (fixed dose of
drug is injected intermittently) or constant-rate infusion
 Intravenous fat emulsions plus demand dosing
 Intralipid, 10,20,30%
 Clintec Intramuscular (IM)
 Liposyn 11,10, 20%  Intramuscular injections of drugs provide effects that
 Abott Liposyn 111, 10,20,30% are less rapid, but generally of greater duration than
 as a source of calories and essential fatty acids for those obtained from intravenous administration
patients requiring parenteral nutrition for extended  IM are performed deep into the skeletal muscles.
period, usually more than 5 days.  The point of injection should be as far as possible from
 The product contains up to: 30% soybean oil major nerves and blood vessels.
emulsified with eggyolk phospholipids in a vehicle  Injuries to patients from IM injection usually are related
of glycerin in water injection to the point at which the needle entered and where
the medication was deposited.
Different lengths of needles  Such injuries include:
1. Paralysis resulting from neural damage
2. Abscesses
3. Cysts
4. Embolism
5. Hematoma
6. Sloughing of the skin
7. Scar formation
 Adult – upper outer quadrant of the gluteus
maximus
 Infants– gluteal area is small, composed
primarily fats not muscle, so not
Hazard of Intravenous Injection recommended
 The possibility of thrombus formation  Infants and Young children – deltoid, muscles
– induced by the touching of the wall of the of the upper arm or the midlateral muscles of
vein by the catheter or needle. the thigh
 Thrombus  Volume of Administration:
– is a blood clot formed within the blood vessel  limited :
(or heart) due usually to a slowing of the – 5 mL in the gluteal region
circulation or to an alteration of the blood or – 2 mL in the deltoid of the arm
vessel wall.  Injection is 2 to 3 inches deep
 Once such a blot circulates, it becomes an Embolus  20 to 22 gauge needle.
– carried by the blood stream until it lodges in a  To avoid staining: it must be injected only into
blood vessel, obstructing it, and resulting in the muscle mass of the upper outer quadrant
blockage or occlusion referred to as an of the buttock.
Embolism.  The skin is displaced laterally, then needle inserted and
syringe aspirated, and injection performed slowly &
Example: Automated IV delivery system - Self administration smoothly. The needle is then withdrawn and the skin
analgesics release. This creates a “Z” pattern that blocks
Advantages: infiltration of medication into subcutaneous tissue.
1. Patient Controlled Analgesia (PCA) used to control  The Z-Track Injection technique is useful for IM injections
pain of medications that stain upper tissue.
2. Allows greater degree of ambulation and  Examples:
independence  Iron dextran injection –irritate tissues
3. Typical PCA contains analgesic drug, syringe and  Diazepam (Valium) – by sealing in the lower
programmable electromechanical unit, which might muscle
be compact enough to be worn on a belt or carried in
a pocket Subcutaneous Route (SC)

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 May be utilized for  The choice of catheter depends on several factors
 the injection of small amounts of medication 1. Length of time of the infusion
or 2. Purpose of the infusion
of drugs beneath the surface of the skin of the 3. Condition and availability of the veins
1. upper arm  Types of Catheter
2. the anterior surface of the thigh, and the 1. Plain plastic
3. lower portion of the abdomen. 2. Catheter over needle or outside needle
 The site of injection is usually rotated when injections 3. Catheter inside needle
are frequently given, as with daily insulin injection.  Official Types of Injections
 The maximum amount of drug given SC is about 1.3 mL 1. Drug Injection
 Amounts greater than 2 mL will most likely cause painful  Liquid preparations that are drug
pressure substances or solutions thereof
 Syringes: up to 3 mL capacities  Ex.: Insulin Injection, USP
 Utilizing needles: 24 to 26 gauges 2. Drug for Injection
 SC insulin needles:  Dry solids that, upon the addition of
 gauge between 25 to 30 suitable vehicles, yield solutions
 needle length between 5-16 to 5-8 inch. conforming in all respects to the
 Upon insertion, if blood appears in the syringe, a new requirement for Injections
site should be selected.  Ex.: Cefamandole Sodium for Injection
 Irritating drugs and those in thick suspension may 3. Drug Injectable Emulsion
produce  Liquid preparations of drug substances
 induration, sloughing, or abscess and may be dissolved or dispersed in a suitable
painful. Such preparations are not suitable for emulsion medium
subcutaneous injection  Ex.: Propofol
4. Drug Injectable Suspension
 Liquid preparations of solids suspended in
Intradermal Route a suitable liquid medium
 Substances may be effectively injected into the corium,  Ex.: Methylprednisolone Acetate
the more vascular layer of the skin just beneath the Suspension
epidermis. 5. Drug Injectable Suspension
 These substances include:  Dry solids that, upon the preparations
 diagnostic determinations, desensitization, or conforming in all respects to the
immunization. requirements for Injectable Suspensions
 Usual site: anterior surface of the forearm.  Ex.: Imipenem, Cilastatin for Injection
 Needle: Suspension, USP
 A short (3-8 inch) and narrow gauge (23 to
26). a. INSULIN INJECTION, USP
 is inserted horizontally into the skin with the b. PROPOFOL
bevel facing upward. The injection is made c. METHYLPREDNISOLONE ACETATE
when the bevel just disappears into the SUSPENSION
corium.
 Volume: Usually about 0.1 mL Injections
 Generally, if a drug is unstable in solution, it may be
Specialized Access prepared as a dry powder intended for reconstitution
 Devices that provide continued access and reduce with the proper solvent at the time of administration
pain associated with administration (Repeated  If the drug is unstable in water, the solvent may be
injections over time) replaced in part or totally by a solvent in which the
 Several catheters of central venous are used for a drug is insoluble
variety of parenteral medications.  If the drug is insoluble in water, an injection may be
 Example: cancer chemotherapy, long term antibiotic, prepared as an aqueous suspension or as solution in a
therapy,TPN solutions suitable nonaqueous solvent, such as a vegetable oil
 The use of indwelling plastic catheters reduces the  If an aqueous solution is desired, a water soluble salt
need for multiple punctures during intravenous therapy. form of the insoluble drug is frequently prepared
 Composed of  Aqueous or blood miscible solutions may be injected
 polyvinyl chloride directly into the blood stream
 Teflon  Blood immiscible liquids, such asoleaginous injections
 Polyethylene and suspensions can interrupt the normal flow of blood,
these should be radiopaque to ensure that they are and their use is generally restricted to other than
visible on radiographs. intravenous administration
 Usually, these must be removed within 48 hours after  Often times long action is desired to reduce the
insertion. frequency of injections.

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 These long acting injections are called respiratory or 4. Bacteriostatic Water for Injection, USP
depot preparations  is sterile water for injection
 Following differences with other preparations containing one or more suitable anti-
1. Solvents or vehicles used must meet special microbial agents.
purity and other standards assuring their safety  it is packaged in pre-filled syringes or
by injection in vials containing not more than 30
2. The use of added substances, as buffers, mL of the water. Label must state,
stabilizers, and antimicrobial preservatives, fall “Not for Use in Newborns”.
under specific guidelines of use and are  Ex.: benzyl alcohol - not good for
restricted in certain parenteral products. The neonates and the toxicity of the
use coloring agents is strictly prohibited. bacteriostat.
3. Parenteral products are always sterilized and 5. Sodium Chloride Injection, USP
meet sterility standards and must be pyrogen  a sterile isotonic solution of sodium
free. chloride in Water for Injection.
4. Parenteral solutions must meet compendial  It contains no anti-microbial agents
standard for particulate matter. 6. Bacteriostatic Sodium Chloride Injection
5. Parenteral products are packaged in special  is a sterile isotonic solution of sodium
hermetic containers of specific and highly chloride in Water for Injection. It
quality. contains one or more suitable
6. Each container of an injection is filled to a antimicrobial agents which must be
volume in slight excess of the labeled “size” or specified in the label.
volume to be withdrawn. This overfill permits  Sodium chloride concentration is
the ease of withdrawal and administration of 0.9% to render isotonic solution. It is
the labeled volumes also used to flush a catheter or IV
7. Parenteral products must be prepared in line to maintain its patency.. “Not for
environmentally controlled areas, under strict Use in Newborns”.
sanitation standards, and by personnel 7. Ringer’s Injection, USP
especially trained and clothed to maintain  is a sterile solution of sodium chloride,
the sanitation standards. potassium chloride, and calcium
8. There are restrictions over the volume of chloride in water for injection.
injection permitted in multiple-dose containers  It is used as electrolyte replenisher
and also a limitation over the types of and a systemic alkalizer.
containers (single-dose or multiple- dose)  Lactated R = Na lactate
which may be used for certain Injections.
9. Specific powders intended for solution or Characteristics Of Components used in Compounding
suspension immediately prior to injection are 1. Therapeutically effective when used as the active
frequently packaged as lyophilized or freeze- ingredients
dried powders to permit ease of solution or 2. Provide maximum safety
suspension upon the addition of the solvent or 3. Function efficiently (when used as excipient)
vehicle. 4. Free from contamination
 Solvents and Vehicles for Injections 5. Physically and chemically stable even after thermal
1. Water for Injection, USP sterilization
 This water is purified by distillation or 6. Produce little or no tissue irritation at site of
by reverse osmosis. administration
 Water for Injection is not required to
be sterilized, it must be pyrogen free. Nonaqueous Vehicles Selected Vehicles must be:
2. Purified water, USP 1. Nonirritating
 may not contain other substances 2. Non toxic in the amounts administered
 meets standard for the presence of 3. Nonsensitizing
total solids 4. It must not exert a pharmacologic activity
3. Sterile Water for Injection, USP 5. May not adversely affect the activity of the medicinal
 is water for injection which has been agent
sterilized and packaged in single-
dose containers of not greater than Other Considerations Of Selecting Nonaqueous Solvents
IL size 1. Physical and chemical stability
 as water for Injection, it must be 2. Its viscosity (syringeability) and its fluidity
pyrogen free and may not contain 3. Its boiling point (it should be high to permit heat
an anti-microbial agent or other sterilization)
added substance. 4. Its miscibility with body fluids
5. Its low vapor pressure to avoid problems during heat
sterilization

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6. Constant purity or ease of purification & Antioxidants
standardization  Oxidation is one of the pathways of degradation which
Examples of Nonaqueous Solvents can be accelerated during thermal sterilization.
1. Fixed vegetable oils  To protect a therapeutic agent susceptible to this
2. Glycerin reaction, antioxidants are required.
3. Polyethylene glycols  Ex.: Sulfur dioxide - 0.2%
4. Propylene glycol  Classification of Antioxidants used in Sterile products:
5. Ethyl oleate 1. Reducing agents - antioxidants which functions
6. Isopropyl myristate by being preferentially oxidized
7. Methylacetamide Ex.: ascorbic acid, sodium bisulfate,
8. Alcohol metabisulfite, thiourea, sodium formaldehyde,
sulfoxylate
Nonaqueous Vehicles… 2. Blocking agents - antioxidants which block an
Examples of Fixed Oils Commonly Used in Injections oxidative chain reaction in which they are not
1. Corn Oil usually consumed
2. Cottonseed seed Oil Ex.: ascorbic acid esters, butyl hydroxytoluene
3. Peanut Oil (BHT), tocopherols
4. Sesame Oil 3. Synergists - compounds increase the
5. Castor Oil and Olive Oil (occasion) effectiveness of antioxidants, particularly those
blocking oxidative reactions
SOLVENTS AND VEHICLE FOR INJECTIONS Ex.: ascorbic acid, citraconic acid,
Water for Injection phosphoric acid, citric acid, tartaric acid
 solvent 4. Chelating agents - those that complex with
 purified by distillation or by reverse osmosis catalysts which otherwise would accelerate the
 stored in tight container with temperature below or oxidative reaction
above the range of microbial growth Ex.: ethylenediaminetetraacetic acid salts
 must be pyrogen free 5. Inert gases like nitrogen and carbon dioxide
have been used to displace oxygen from a
Added Substances solution and reduce the possibility of oxidative
 Additives are essential for almost every product to changes in the formulation
enhance its stability. They must exhibit the following
characteristics: Buffers
1. Perform its function throughout the useful life of  added to maintain the required pH for many products;
the product a change in pH may cause significant alterations in the
2. Must be non-toxic and non-irritating rate of degradation reactions.
3. Must not exert any adverse effect on the product  Changes in pH may occur during storage as a result of:
4. Must be compatible in all components of the 1. Dissolving of glass constituents in the product
formulation 2. Release of constituents from rubber closures or
5. Must not interfere with: plastic components in contact with the product
a. Therapeutic efficacy 3. Dissolving of gases and vapors from the air
b. Assay of the active therapeutic space in the container or by diffusion through
compound the rubber or plastic component.
4. Reactions within the product
Such substances include:  The principal buffer systems used to stabilize pH are the
1. Solubilizers 1. Acetates
2. Chelating agents 2. Citrates
3. Anti-microbial agents 3. Phosphates
4. Hydrolysis Inhibitors  Tonicity Contributors
5. Antioxidants  Compounds contributing to the isotonicity of a
6. Buffers product reduce the pain of injection in areas
7. Tonicity contributors with nerve endings
8. Antifoaming agents  Buffers may serve as tonicity contributors as well
as as stabilizers for the___?___
Antifungal/Antibacterial
 must be present in adequate concentration at the time Containers
of use to prevent the multiplication of microorganism.  Containers for sterile products are made of glass or
 Ex.: agents containing mercury and the cationic, plastic.
surface active compounds - 0.01%; for agents like  Glass is still preferred for injectable products.
chlorobutanol, cresol, and phenol - 0.5%  Glass is composed principally of the:
 silicon dioxide tetrahedron

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 modified physicochemically by such oxides as  2 MAIN DIVISIONS OF STERILIZATION
those of sodium, potassium, calcium, 1. Physical Processes of Sterilization
magnesium, aluminum, boron and iron. A. Thermal Method
 Two general types of glass i. Microorganisms are killed by heat
1. soda-lime by what is thought to be
2. borosilicate coagulation of the protein of a
 Based on its chemical resistance, glass compounds are living cell. The lethal
classified into 4 types: effectiveness of heat is
1. Type I - highly resistant borosilicate glass dependent on:
2. Type II - treated soda-lime glass  The degree of heat
3. Type III - soda lime glass  The exposure period
4. NP (nonparenteral) - general purpose soda-  The moisture present
lime glass ii. Steam sterilization is conducted
***Glass containers like ampule cartridges and vials in an autoclave and employs
may be manufactured from glass tubings or blow steam under pressure
molding. iii. The usual steam pressures, the
 Rubber closures are used to seal the openings of temperatures obtainable under
catridges, vials and bottles, providing a material soft these pressures, and the
and elastic enough to permit entry and withdrawal of a approximate length of time
hypodermic needle without loss of the integrity of the required after the system reaches
sealed container. Accessories used in conjunction with the indicated temperatures are
closures are aluminum caps with or without flif-off seals. as follows:
 10 pounds pressure
Examples of Some Injections in Oil (115.50C), for 30 min.
 15 pounds pressure
(121.50C), for 20 min.
 20 pounds pressure
(126.50C), for 15 min.
iv. Dry-Heat Sterilization usually
carried out in sterilizing ovens
specifically designed for this
purpose. The ovens may be
heated either gas or electricity
and generally thermostatically
controlled. It is conducted at
temperatures of 1600C to 1700C
for periods not less than 2 hours.
B. Nonthermal Methods
i. Ultraviolet light
- is commonly employed to aid in the
METHODS OF STERILIZATION
reduction of airborne contamination and
Sterilization
to attempt to sterilize surfaces within the
 defined as the complete destruction or elimination of
processing environment. The germicidal
microbial life
light produced by mercury vapor lamps is
 The choice of the most effective sterilization procedure
emitted at a wavelength of 2537
is dependent on:
Angstrom units (253.7 millimicrons)
1. Compatibility of the process with the
- The lethal mechanism of UV light works
preparation; (sterilization process must not have
when this energy is absorbed by orbital
significant adverse effect upon the preparation)
electrons within the molecules of the
2. The successful validation of the process (the
microorganisms or of their essential
parameters must prove to be lethal to the most
metabolites causing excitation and
resistant spores of microorganism normally
alteration of activity. Thus the organism
encountered)
dies or is unable to reproduce.
 5 general methods:
ii. Ionizing Radiations - are highly
1. Steam distillation
radiations emitted from
2. Dry-heat sterilization
radioactive isotopes such as
3. Sterilization by filtration
cobalt-60 (gamma rays) or
4. Gas sterilization
produced by mechanical
5. Sterilization by ionizing radiation
acceleration of electrons to very
high velocities and energies
(cathode rays, beta rays).
Ionizing radiations destroy

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microorganisms by stopping for many of the febrile reactions which occur in
reproduction as a result of lethal patients following injections.
mutations.  Are lipid substances associated with a carrier molecule
iii. Filtration which is usually a polysaccharide but may be a protein.
- This is a nonthermal method for the
sterilization of select solutions by 2 Official Tests for Detecting and Measuring Pyrogens
removing microorganisms from the 1. Bacterial Endotoxins Test
solution while permitting the passage of – Using Limulus Amebocyte Lysate (LAL) which
all the desired components of the has been obtained from aqueous extracts of
solution and imparting no undesirable the circulating amebocytes of the horseshoe
components from the filter. crab, Limulus polyphemus, and which has
- They are available in pore sizes from 14 to been prepared & characterized for use as an
0.025 um. LAL reagent for gel-clot formation
- The size of the smallest particle visible to – The procedure include incubation for a
the naked eye is about 40 um, a red preselected time of reacting endotoxins and
blood cell is about 6.5 um, the smallest control solutions with LAL Reagent and
bacteria, about 0.2 um, and a polio virus, reading of the spectrophotometer light
about 0.025 um absorbance at suitable wavelength
2. Chemical Processes of Sterilization 2. Pyrogen Test
A. Gas Sterilization – The test involves measuring the rise in
– Ethylene oxide believed to exert temperature of rabbits following the
its lethal effect upon intravenous injection of a test solution and is
microorganisms by alkylating designed for products that can be tolerated
essential metabolites, affecting by the test rabbit in a dose not to exceed 10
particularly the reproductive mL per Kg injected intravenously within a
process. Ethylene dioxide period of not more than 10 minutes
sterilization is the acceptable – If no rabbit shows an individual rise in
practical method for sterilizing temperature 0.60C or more above its
plastic. Other gases used are respective control temperature, and if the
beta propiolactone, sum of the 3 individual maximum temperature
formaldehyde & sulfur dioxide rises does not exceed 1.400 C, the product
B. Surface Disinfection meets the requirements for the absence of
– Disinfectants do not sterilize a pyrogens.
surface. However, as adjuncts
to thoroughly cleaning of Depyrogenation Method are as follows:
surfaces, disinfectants properly 1. Adequate washing with detergent treatment followed
used may be expected to by dry heat sterilization is recommended for glasswares
provide an aseptic condition of and equipment. Optimum temperature is 2500C for 45
the surfaces involved minutes.
2. Distillation is the most reliable method of eliminating
Validation of Sterility pyrogens from water. Pyrogenic substances are not
 Regardless of the method of sterilization employed, volatile and thus will remain in the distilland.
Pharmacutical preparations must undergo sterility tests 3. Removal of pyrogens by select adsorbents has limited
to confirm the absence of microorganisms. use because of the concurrent phenomenon of
 A biologic indicator is characterized preparation of adsorption of solute ions of molecules. It is of interest in
specific microorganisms resistant to a particular the production of antibiotics where heavy pyrogen
sterilization process contamination results from fermentation.

2 main forms PRODUCTION of a sterile preparation


1. Spores are added to a carrier, as a strip of filter paper,  consists of the following steps:
packaged to maintain physical integrity while allowing the 1. Compounding
sterilization effect. - Processing of sterile preparations follow
2. The spores are added to representative units of the product normal manufacturing procedures which
being sterilized, with sterilization assessed based on these must be done in aseptic condition. All
samples equipment and materials used whenever
In moist heat (steam) - Bacillus stearothermophilus possible must be sterile
In dry heat - Bacillus subtilis 2. Filtration
In ionizing radiation - Bacillus pumilus, stearothermophilus, subtilis - Membrane filters are used for clarification
when a highly polished solution is desired.
Pyrogens and Pyrogen Testing The process removes particulates matter
 Pyrogens are fever producing organic substances down to at least 3 microns in size.
arising from microbial contamination and responsible Sterilization by filtration is achieved when

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viable microorganisms and spores of 3. Erythromycin Lactobionate for Injection
approximately 0.3 microns are removed. 4. Oxytetracycline Hydrochloride Injection
Membranes with porosity ratings of 0.22 5. Nafcillin Sodium for Injection
or 0.45 microns are usually specified for 6. Hydrocortisone Sodium Succinate for Injection
sterile filtration. 7. Cyclophosphamide for Injection
3. Filling 8. Hyaluronidase for Injection
- Bulk preparations are subdivided into unit 9. Mitomycin for Injection
dose containers during filling. This process 10. Penicillin G Potassium for Injection
forces a measured volume of the 11. Vinblastine Sulfate for Injection
preparation through the orifices of a
delivery tube designed to enter the Containers…
constricted opening of a container by 1. Mix-O-Vial - that incorporates the cover as part of the
means of gravity, vacuum or with the aid plunger. Once mixed, the small circle of plastic that
of a pressure pump. covers the injection site is removed. This reduces the
4. Sealing touch contamination
- Sealing will retain the contents of a sterile 2. Add-Vantage System IVPH - is other example of ready-
product and will assure a tamper-proof to-mix sterile IV product designed for intermittent IV
presentation administration of potent drugs that do not have long
5. Sterilization term stability in solution. Two components:
a. A flexible plastic IV container partially filled
Containers with diluents
 should be sealed in an aseptic area adjacent to the b. Glass vial of powdered or liquid drug
filling machine. Ampuls are sealed by heating with a  The vials containing the medication and the
high temperature gas-oxygen flame to form piggybacks (50-250 mL of Dextrose 5% in Water
1. Tip-seals: those made by melting sufficient Injection) or Normal Saline Solution are specially
glass at the tip of the ampul neck to form a designed to be used together.
bead of glass and close the opening  The ADD-Vantage System can be used within 30
2. Pull-seals: those made by heating the neck of days from the date that the diluent container was
a rotating ampul below the lip, then pulling removed from the overwrap.
away the tip to form a small, twisted capillary 3. Monovial Safety Guard
just prior to being melted closed. - This is new system integrated device
(drug transfer mechanism) with a
A leakers test protective shield surrounding the
 is a useful method for evaluating the efficiency of the attached transfer needle. The
sealing process. reconstitution and transfer of the drug
 the test consists of immersing completely the sterile into an infusion bag is accomplished
sealed ampuls in an aqueous dye bath (0.5 to 1.0% of safely, quickly, and necessitates fewer
methylene blue) within a vacuum chamber. materials. The needle is inserted into the
 ss negative pressure of 27 inches Hg or more is created, port of the infusion bag and then the
a tiny drop of dye solution can penetrate an opening transfer set is pushed down toward the
of an incompletely sealed ampul. vial until a “Click” is heard. With Monovial
 the colored ampuls are sorted out during washing and upright, the infusion bag is squeeze
100% inspection that follows after. several times to transfer liquid into the
Monovial. The Monovial is then shaken to
Examples of Sterile Drugs prepared and packaged without the reconstitute the drug. It is then inverted,
presence of phamaceutical additives as buffers, preservatives, the minibag is squeezed and release to
stabilizers, tonicity agents, and other substances transfer the drug back into the infusion
1. Sterile Ampicillin Sodium bag. This process is repeated until the
2. Sterile Ceftazidime Sodium vial is empty
3. Sterile Kanamycin Sulfate - Packaging, Labeling, and Storage of
4. Sterile Penicillin G Banzathine Injections - Containers for injections,
5. Sterile Tobramycin Sulfate including closures, must not interact
6. Sterile Ceftizoxime Sodium physically and chemically with the
7. Sterile Cefuroxime Sodium preparation
8. Sterile Nafcillin Sodium - Single-dose container - A single dose
9. Sterile Streptomycin Sulfate container is a hermetic container holding
a quantity of sterile drug intended for
Examples of Sterile Drugs prepared and packaged with the parenteral administration as a single
presence of phamaceutical additives as buffers, preservatives, dose, and which when opened cannot
stabilizers, tonicity agents, and other substances be re-sealed with assurance that sterility
1. Cephradine for Injection has been maintained.
2. Dactinomycin for Injection

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- Multiple-dose container - A multiple-dose 15. Isoproterenol HCl Injection - Adrenergic
container is a hermetic container that (bronchodilator)
permits withdrawal of successive portions 16. Ketorolac Tromethamine Injection - NSAID
of thecontents without changing the 17. Lidocaine HCl Injection - Cardiac depressant as an
strengths, quality, or purity of the antiarrhythmic
remaining portion. 18. Magnesium Sulfate Injection -
- Note: Recall type I,II,III containers Anticonvulsant/Electrolyte
19. Meperidine HCl Injection - Narcotic analgesic
The Labels on containers of parenteral products must state: 20. Metoclopramide Monohydrochloride Injection-
1. The name of the preparation Gastrointestinal stimulant
2. For liquid preparation, the percentage content of the 21. Midazolam HCl - Short acting benzodiazepine CNS
drug or amount of the drug; for dry preparation - the depressant
amount of the active ingredient present and the 22. Morphine Sulfate injection - Narcotic analgesic
volume of liquid to be added to the dry preparation to 23. Naloxone HCl Injection - Narcotic antagonist
prepare a solution or suspensions. 24. Nalbuphine HCl Injection - Narcotic Agonist-Antagonist
3. The route of administration Analgesic
4. Statement of storage conditions and expiration 25. Oxytocin Injection- Oxytoxic
5. The name of the manufacturer and distributor 26. Phenytoin Sodium Injection - Anticonvulsant
6. The identifying lot number 27. Phytonadione Injection - Vitamin K (prothrombogenic)
28. Procaine Penicillin G Injection - Anti-infective
General Precautions required with the use of microwave ovens 29. Prochlorperazine Edisylate Injection - Antidopaminergic
for thawing frozen premixed products include 30. Propranolol HCl Injection - Beta adrenergic receptor
1. Being aware that the possibility of radiation leakage blocking agent
does exist. However, manufacturers of microwave 31. Sodium Bicarbonate Injection- Electrolyte
ovens are required by law to comply with federal 32. Sumatriptan Succinate injection - treat acute migraine
standards attacks
2. Safeguarding pharmacy personnel who are exposed to 33. Verapamil HCl Injection - Calcium channel blocking
these ovens, especially those with cardiac agent
pacemakers.
3. The possible leaching of rubbers material when the INSULIN
rubber material on the container is exposed to 1. Insulin Injection (regular)
microwave heating.  Insulin Injection is a sterile aqueous solution of
4. A possible explosion that may result from the increase in insulin. It is prepared from beef or pork pancreas
internal pressure as a result of placing a closed or or both or through biosynthetic means (Human
sealed container into the microwave oven. Insulin). With apH of 2.8 to 3.5. Insulin Injection is
5. Developing protocols to ensure that the final solution prepared to contain 100 or 500 USP Insulin Units in
temperature does not exceed room temperature each mL.
Expiration: Not to be later than 24 months
Examples of some Injections Usually Package and Administered after the date of distribution.
in Small Volume Preservative: Glycerin (1.4 to 1.8) for stability,
1. Butorphanol Tartrate Injection - Narcotic Agonist- Phenol or Cresol (0.1 to 0.25%)
Antagonist Analgesic Storage: Cold place, preferably the
2. Chlorpromazine HCl Injection - Antipsychotic drug with refrigerator
antiemtic 2. Human Insulin
3. Cimetidine HCl Injection - Histamine H2 antagonist  It is produced by utilizing a special nondisease-
4. Dalteparin Sodium Injection- Prophylaxis against deep forming laboratory strain of Escherichia coli and
vein thrombosis recombinant DNA technology.
5. Dexamethasone Sodium Phosphate Injection -  Two formulations:
Glucocorticoids A. Neutral Regular Human Insulin (Humulin R) -
6. Digoxin Injection – Cardiotonic consists of Zinc-insulin crystals in solution. It has
7. Dihydroergotamine Mesylate Injection - Alpha- a rapid onset of action and relatively short
adrenergic blocking agent duration of action (6 to 8 hours)
8. Diphenhydramine HCl Injection - An ethanolamine, non B. NPH Human Insulin (Humulin N) - is a turbid
selective antihistamine preparation that is intermediate acting, with a
9. Furosemide Injection - Loop diuretic slower onset of action and longer duration of
10. Granisetron HCl Injection - Prevention of nausea & action (slightly less than 24 hours) than regular
vomiting insulin
11. Heparin Sodium Injection - Anticoagulant (IV or SubQ) 3. Lispro Insulin Solution
12. Hydromorphone HCl Injection - Narcotic analgesic  Insulin solution consists of Zinc-insulin lispro
13. Ibutilide Fumarate Injection - An antiarrhythmic drug crystals dissolved in a clear aqueous fluid. It is
14. Iron Dextran Injection- Hematinic agent created when the amino acids at positions 28
and 29 on the Insulin B-chain are reversed

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 Compared to regular insulin, however, peak 7. Extended Insulin Zinc Suspension
serum levels of lispro insulin occur earlier,  Is a sterile suspension of zinc insulin crystals in
(within 0.5 to 1.5 hours) are higher, and are an aqueous medium buffered to between pH
shorter acting ( 6 to 8 hours) 7.2 and 7.5 with sodium acetate.
 Lispro insulin are administered fifteen minutes  Present also are 0.7% sodium chloride for
before meals has decreased the risk of tonicity & 0.1% methylparaben as
hypoglycemic episodes and improve preservatives
postprandial glucose excursions when  Dosage: The usual dosage range is 10 to 80
compared to conventional regular insulin. USP Units
 Storage: Refrigerator; room temperature - 28  Expiration: 24 months after the immediate
days container was filled
 Note: If accidentally frozen, it should not be 8. Prompt Insulin Zinc Suspension
used  The sterile suspension of insulin in Prompt Insulin
4. Isophane Insulin Suspension (NPH Insulin) Zinc Suspension is modified by the addition of
 Is a sterile suspension, in an aqueous vehicle Zinc chloride so that the solid phase of the
buffered with dibasic sodium phosphate to suspension is amorphous
between pH 7.1 and 7.4, of insulin prepared  The suspension is available in 100 USP Insulin
from zinc-insulin crystals modified by the Units per mL in vials of 10 mL
addition of protamine so that the solid phase  Expiration: not more 24 months
of the suspension consists of crystals 9. Insulin Infusion Pumps
composed of insulin, zinc, and protamine.  Insulin infusion pumps allow the patients to
 Protamine is prepared from the sperm or the achieve and maintain blood glucose at near-
mature testes of fish belonging to the genus normal levels on a constant basis.
Oncorhynchus.  The main objective of pump therapy is the
 Expiration date: 24 months strict control of the blood glucose level
 Dosage: dosage range subcutaneously is 10 between 70 to 140 mg/dL
to 80 USP Units  These systems utilize microcomputers to
 NPH used in some product names stands for regulate the flow of insulin from a syringe
“Neutral Protamine Hagedorn”; the pH is 7.2 attached to a catheter (usually 18 gauge)
and developed by Hagedorn. The term connected to a 27 to 28 gauge needle
“isophane” is based on the Greek: iso and inserted in the patient.
phane, meaning “equal” and “appearance”  The insulin may be delivered SubQ, IV, IP
and refers to equivalent balance between  Patients who used infusion pumps for the
the protamine and insulin. continuous subcutaneous administration of
5. Isophane Insulin Suspension and Insulin Injection insulin may develop hard nodules at the site
 A premixed formulation of of isophane insulin of injection
suspension and Insulin injection. 10. Humalog Mix
 2 Formulations:  Manufactured premix insulin consisting lispro
A. Humulin 70/30 - combination that and neutral protamine lispro (NPL) in afixed
consists of 70% isophane insulin ratio
suspension and 30% insulin injection  Humalol Mix 50/50 consists of 50% insulin NPL
B. Humulin 50/50 - combination that suspension and 50% insulin lispro injection
consists of 50% isophane insulin  Humalog Mix 75/25 contains 75% insulin NPL
suspension and 50% insulin injection suspension and 25% insulin lispro injection
 They contain zinc of 0.01 to 0.04 mg/100 units.  It is estimated that these premixed
Neutral in pH and phosphate buffered combinations are used by more than 40% of
 Preservatives: m-cresol and phenol diabetes patients who inject insulin twice daily
6. Insulin Zinc Suspension 11. Insulin Glargine
 modified by the addition of zinc chloride so  It is a long acting (up to 24 hours) basal insulin
that the suspended particles consists of a preparation intended for once daily
mixture of crystalline and amorphous insulin subcutaneous administration at bedtime in
 in a ratio of approximately 7 parts of crystals the treatment of type 1 diabetes mellitus in
to 3 parts of amorphous material. adult and children
 Buffered to pH 7.2 to 7.5 with sodium acetate:  In can be used by adults with type 2 diabetes
0.7% sodium chloride for tonicity; 0.10% who require long-acting insulin
methylparaben as preservatives  It is created when the amino acids at position
 Expiration: 24 months after the immediate 21a of human insulin are placed by glycine
container was filled. and 2 arginines are added to the C terminus
 Storage: Refrigerator with freezing being of the B chain
avoided

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Types of Insulin: Approximate effect/action * several days, simple solutions
providing adequate amounts of
Characteristics Onset Peak Duration water, dextrose and small amounts
sodium and potassium generally
suffice.
5 - 30
Short/Fast-Acting (clear) 1 - 3 hrs 4 - 8 hrs – Total Nutrient Admixtures also may
mins
be given (TNA) include all substrate
4 - 12 16 - 24 necessary for nutritional support (
Intermediate-Acting (milky) 1 - 2 hrs carbohydrates, protein, fat,
hrs hrs
electrolytes, trace elements and
Premixed (Short & 2 - 12 16 - 24 others).
1/2 hr
Intermediate) hrs hrs – These admixtures are very useful for
patients undergoing chemotherapy,
8 - 24 28 - 36 and for gastrointestinal patients, and
Long-Acting (milky) 4 hrs
Ins ulin Activity Prof iles and Comp at ib ility hrs hrs anorexic patients
Insulin Preparat ions Onset (hr) Peak (hr) Duration (hr) Compatible 2. Utilized as Replacement therapy in patients who
mixed with
Rapid acting
have suffered a heavy loss of fluid and
Insulin I nj (reg ular) 0.5 to 1 8 to 12 all Lente Prompt electrolytes.
Insulin Z inc 1 to 1.5 5 to 10 12 to 16
 Replacement Therapy
Suspension(semilente)
– given to the patient in which there is
Lispro Ins ulin Sol’n 0.25 0.5 to 1.5 6 to 8 Ultralente, NPH
Intermediate heavy loss of water and electrolytes, as in
Isophane Insulin 1 to 1.5 4 to 12 24 regular severe diarrhea or vomiting, greater than
Suspension (NPH) usual amounts of these materials may be
Insulin Zinc Suspension(lente) 1to 2.5 7 to 15 24 regular, semilente initially administered and maintenance
Long acting
therapy provided. Patients with Crohn’s
PZI (Protamine Zinc Insulin) 4 to 8 14 to 24 36 regular
Extended Insulin Zinc 4 to 8 10 to 30 >36 regular, semilente
disease, AIDS, burn patients, or those
Isophane Ins ulin Suspensio n experiencing trauma are candidates for
Premixed 50% and Insulin Inj 50% replacement therapy.
insulin Isophane Ins ulin Susp. 0.5 2 to 12 18 to 24 regular, NPH  Water Requirement
70% and Insulin Inj, 30%
– The daily water requirement is that
amount needed to replace normal and
expected losses. Normal requirement
Examples of Some Injections Administered in Large Volume by IV t hat may be Administered
adult -25 to 40 mL/kg of body weight or
in Volumes of 1 Liter or More, Alone, or With Other Drugs Added
an average of about 2,000 mL per square
Injection Usual Content Category/Comments
meter of body surface area
– Estimate guidelines in normal daily
Amino Acid Injection 3.5,5,5.5,7,8.5,10% crystalline amino
acids with or without varying
Fluid /Nutrient replenishe r requirement for water
concentrations of electrolytes or glycerin 1. <10 kg: 100 mL/kg/day
Dextrose Injection,USP 2.5,5,10,20% dextrose, other strengths Fluid/Nutrient replenishe r
2. 10-20kg: 1000 mL plus 50 mL/kg/day
Dextrose and sodium Dextrose varying from 2.5 to 10% and F luid/Nutrient/Electrolyte
chloride Injection,USP sodium chloride from 0.11 (19 mEq Na) electrolyte for weight over 10 kg
to 0.9% (154 mEq sodium)
Mannitol Injection, USP 5,10,15,20 and 25% mannitol Diagnostic aid in renal 3. >20 kg to maximum of 80 kg: 1500
f unction determinatio ns;
diuret ic. Fluid/Nut rient mL Plus 20 mL/kg/day for weight
Ringers’ Injection, USP 147 mEq sodium, 4 mEq potassium Fluid/electrolyte over 20 kg
calcium, and 156 mEq chloride/ liter
Lactated Ringer’s 2.7 mEq calcium, 4 mEq potassium, Systemic alkalinizer; Injectio n,
 Electrolyte Requirement
USP 130 mEq sodium and 28 mEq
lactate per liter replenisher
f luid and electro lyte
1. Potassium
Sodium Chloride 0.9% sodium Chloride Fluid and electrolyte Injection,  important for cardiac and skeletal
USP replenisher, isotonic
vehicle muscle function. The usual daily intake
Large Volume Parenterals (LVPs) is about 100 mEq and the usual daily
 These solutions are usually administered by IV infusion to loss is about 40 mEq
replenish body fluids, electrolytes, or to provide  Potassium can be lost through:
nutrition. They are usually administered in volumes of excessive perspiration, repeated enemas,
100 mL to liter amounts and more per day by slow trauma (such as severe burns), uncontrolled
intravenous infusion with or without controlled-rate diarrhea, diseases of intestinal tract, surgical
infusion systems operations and others
 USES:  Low potassium levels - Hypokalemia,
1. Employed as Maintenance therapy for the can lead to death
patient entering or recovering from surgery, or for  Symptoms of potassium loss :weak
the patient who is unconscious and unable to pulse, faint heart sounds, falling blood
obtain fluids, electrolytes, and nutrition orally. pressures & generalized weakness
 Maintenance Therapy  Excess potassium is not good either :
– given to the patient being Hyperkalemia can cause kidney
maintained on parenteral fluids only failure

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 Symptoms : diarrhea, irritability, muscle  Niacin – 40 mg
cramps, and pain  Vitamin B2 – 3.6 to 4.93 mg
2. Sodium  Vitamin B1 – 3 to 3.35 mg
 is vital to maintain normal extracellular  Vitamin B6 – 4 to 4.86 mg
fluids.  Pantothenic Acid – 15 mg
 Average daily intake of sodium:  Folic Acid – 400 mcg
 135 to 170 mEq (8 to 10 g of Sodium  Vitamin B12 – 5 mcg
chloride)  Biotin – 60 mcg
 Sodium loss/deficit: 3 to 5 g sodium  Amino Acids: Essential Amino Acids
chloride (51 to 85 mEq of sodium) is 1. L - Isoleucine……………..590 mg
administered daily 2. L - Leucine ……………….770 mg
 Symptoms: excessive sweating, 3. L - Lysine acetate………..870 mg
fatigue, muscle weakness, convulsions (free base…………….620 mg)
 Symptoms (excess): Dry, sticky mucous 4. L - Methionine ……………450 mg
membranes, flushed skin, elevated 5. L - Threonine ……………..340 mg
body temperature, lack of tears, and 6. L - Tryptophan ……………130 mg
thirst 7. L - Valine ………………….560 mg
3. Chloride 8. L - Phenylalanine ………..480 mg
 the principal anion of the extracellular  Nonessential Amino Acids
fluid usually paired with sodium. 1. L - Alanine ……………..600 mg
 Chloride is also important for muscle 2. L - Arginine …………….810 mg
contraction, balancing the fluid levels 3. L - Histidine …………….240 mg
inside and outside the cells & 4. L - Proline ………………950 mg
maintaining the acid-base balance of 5. L - Serine ……………….500 mg
the extracellular fluid. 6. Aminoacetic acid ………1.19 g
 Caloric Requirements :
– Basic caloric requirements Enteral Nutrition
may be estimated by body  Enteral nutrition products may be administered orally,
weight; in the fasting state, via nasogastric tube, via feeding gastronomy, or via
the average daily loss of needle-catheter jejunostomy.
body proteins is  These products are formulated to contain vitamins,
approximately 80g/day for minerals, carbohydrates, proteins, fats and caloric
a 70 kg man. requirements to meet specific needs of the patient.
– Daily ingestion of at least  The formula diets may be monomeric or oligomeric
100 g of glucose reduces (amino acids or peptides and simple carbohydrates) or
this loss by half. polymeric (more complex protein and carbohydrates
– Generally patients requiring sources.
parenteral fluids are given  Ex.:
5% dextrose to reduce Protein - ProMod Powder, Propac Powder
caloric deficit Carbohydrates - Moducal Powder
* Parenteral hyperalimentation Fat - Lipomul Liquid
 This is the infusion of large amounts of basic nutrients Fewer calories- Ensure HN, Sustacal, & Osmolite HN
sufficient to achieve active tissue synthesis and growth.
It is employed with a long term intravenous feeding of Intravenous Infusion Devices
protein solutions containing high concentration of  Advances in infusion technology and computer
dextrose (approximately 20%), electrolytes, vitamins, technology have resulted in devices with extremely
and sometimes insulin. sophisticated drug-delivery capabilities
 Ex.: Multiple-rate programming, pump or controller
Components of Parenteral Nutrition Solutions operation)
 Electrolytes
1. Sodium…………. 25 mEq Special Considerations Associated with Parenteral Therapy
2. Potassium ……... 20 mEq  Adsorption Of Drugs - Some drugs are adsorbed onto
3. Magnesium ……..5 mEq the inner lining of IV containers and tubing or
4. Calcium …….……5 mEq administration sets.
5. Chloride ……….. 30 mEq  Ex.:
6. Acetate …..…… 25 mEq 1. Chorpromazine HCl
7. Phosphate ……..18 mM 2. Insulin
 Vitamins 3. Promethazine HCl
 Vitamin A – 3300 I.U. 4. Trifluoperazine HCl
 Vitamin D – 200 I.U. 5. Thioridazine HCl
 Vitamin E – 10 I.U. 6. Diazepam
 Vitamin C – 100 mg 7. Promazine HCl

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8. Thiopental sodium  The implanted pellets, which might contain 100 times
9. Warfarin sodium the amount of drug.
Ex.: (desoxycorticosterone, estradiol, testosterone)
Another Example: given other routes are release slowly into general
Nitroglycerin circulation
 should always be prepared in glass containers, and is  Pellets were formulated with no binders, diluents, or
adsorbed (40 to 80% of total dose) to polyvinylchloride excipients, to permit total dissolution and absorption of
(PVC), a plastic commonly used in administration the pellets.
components and some infusion containers, therefore, it Ex.: Levonorgestrel
should be packaged with special non-PVC tubing to
avoid loss <5% of the drug into the tubing during Levonorgestrel Implants
administration.  These are a set of six flexible, closed capsules of a
dimethylsiloxane/methylvinylsiloxane copolymer, each
Selected Infusion Devices Used in Parenteral Nutrition Support containing 36 mg of the progestin levonorgestrel
1. Volumetric Infusion Pumps - AVI 2000 #200: Flo-Gard  These are found in an insertion fit to facilitate surgical
8100; IMED subdermal implantation through a 2 mm incision in the
2. Multiple-rate Programmable Pumps – CADD-TPN mid-portion of the upper arm about 8 to 10 cm above
3. Volumetric Infusion Pumps - Provider one; Quest 521 the elbow crease.
Intelligent  These are implanted in a fan like pattern, about 150
4. Multiple-solution Programmable Pumps - Gemini PC –2; apart, for a total of 750. Removal after the end of the
Life Care 5000 Plum;Omni-Flow 4000 5th year.
5. Others- Breeze Lifecare 175, Coleague 3, Horozon Nxt,  The dose of levonergestrel is about 85 mcg/day by 9
Sabratek 600 months and to about 35 mcg/day by 18 months, with a
NOTE: All these devices have their own features like: safety further decline thereafter to about 30 mcg/day.
alarm, flow rate error, alarm for air in line, door open, low
battery, occlusion, malfunction, invalid rates and others Irrigation and Dialysis Solutions
 Solutions for irrigation of body tissues and dor dialysis
Handling/Disposal of Chemotherapeuticc Agents for Cancer resemble parenteral solutions in that they are subject to
 In theory, “correct and perfect preparation and the same stringent standards.
handling techniques will prevent drug particles or  These solutions are not injected into the vein, but
droplets from escaping from their containers while they employed outside of the circulatory system.
are being manipulated”.
 Basic Steps in handling Chemotherapeutic Agents Irrigation Solutions
1. Utilizing vertical laminar flow hoods (or  Irrigation solutions are intended to bathe or wash
bacteriological gloves boxes) for the wounds, surgical incisions, or body tissues.
preparation and reconstitution of cytotoxic  Ex.:
drugs. 1. Acetic acid Irrigation, USP - This solution is
2. Wearing protective gloves and mask during employed topically to the bladder as a 0.25%
product preparation solution for irrigation. It is administered to wash
3. Handling and disposing of cytotoxic drugs blood and surgical debris away while
centrally utilizing specially designed waste maintaining suitable conditions for the tissue.
containers and incineration. 2. Neomycin and Polymixin B Sulfate Solution for
4. Periodic monitoring of personnel involved with Irrigation, USP - Employed as a topical
handling admixtures of cytotoxic drugs (CBC, antibacterial in the continuous irrigation of the
blood chemistry screen, differential cell count) bladder.
5. Informing personnel handling cytotoxic drugs 3. Ringer’s Irrigation, USP - It is used topically as an
that a potential risk to their health exists. irrigation and must be labeled “not for
6. Instituting specialized labeling of containers to injection”. The solution is sterile and pyrogen
ensure proper handling and disposal of the free.
cytotoxic agent. 4. Sodium Chloride Irrigation, USP - This solution is
employed topically to wash wounds and into
Other Injectable Products body cavities where absorption into the blood is
Pellets or Implants not likely. The solution also employed rectally as
 are sterile, small, usually cylindrical-shaped solid objects an enema for simple evacuation and also for
 about 3.2 mm in diameter and 8 mm in length, colonic flush.
 prepared by compression and intended to be 5. Sterile Water for Irrigation, USP - The label
implanted subcutaneously for the purpose of providing designations “for irrigation only” and “not for
the continuous release of medication over prolonged injection” must appear prominently on the label.
period of time The water must not contain any antimicrobial or
 The pellets - implanted under the skin (thigh or other added agent.
abdomen) with special injector or by surgical incision -
used for potent hormones.

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Dialysis Solutions
 May be defined as a process whereby substances may
be separated from one another in solution by taking
advantage of their differing diffusibility through
membranes

Peritoneal Dialysis
 Solutions allowed to flow into the peritoneal cavity, are
used to remove toxic substances normally excreted by
the kidney
 The solutions are made to be hypertonic (with dextrose)
to plasma to avoid absorption of water from the dialysis
solution into the circulation

Hemodialysis
 Is employed to remove toxins from the blood. In this
method, the arterial blood is shunted through a
polyethylene catheter through an artificial dialyzing
membrane bathed in an electrolyte solution. Following
the dialysis, the blood is returned to the body
circulation through a vein.

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