Medication reconstitution
and administration guide
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1
Objectives
• Medication error and its cause
• Medication that should not be
crushed
• Medication stability
• Dose and dosage
• Calculate the desired dose from the
original dosage form
• Percentage weight-in-volume (w/v)
calculation
• Alligation
• Calculation of Intravenous Drip Rates
• Calculation of Flow Rate for an Infusion
Pump
• Reconstitution of commonly used
medication
• Administration, dilution
• Storage
Medication error
At the end
• Medication error and
of this
its cause
session,
the trainee • Medication that
should not be crushed
will be able
to
• Medication stability
understand
What is medication error
 A medication error is any preventable
event that may cause or lead to
inappropriate medication use or patient
harm while the medication is in the
control of the health care professional,
patient, or consumer.
 Such events may be related to
professional practice, procedures, and
systems.
medication error
Medication error may occur when
1.
2.
3.
4.
5.
6.
7.
8.
prescribing
order communication
product labeling
packaging
compounding
dispensing
Administration
monitoring, and use
medication error
• Common administration errors include
–
–
–
–
–
–
wrong patient
wrong route
wrong dosage form
wrong time
wrong dose or rate
and wrong drug
medication error
• Administration errors those are more
specific to i.v. Administration includes the
wrong rate or incompatibility at the Y-site
of the infusion.
• When appropriate, independent double
checks for high-alert medications should
be completed before administration by
completing independent calculations and
checking the patient's allergies
Factors that may influence medication errors
• Factors associated with health care
professionals
 Lack of therapeutic training
 Inadequate drug knowledge and experience
 Inadequate knowledge of the patient
 Inadequate perception of risk
 Overworked or fatigued health care professionals
 Physical and emotional health issues
 Poor communication between a health care
professional and with patients
Factors associated with patients
• Patient characteristics (e.g.,
personality, literacy and language
barriers)
• The complexity of the clinical case,
including multiple health conditions,
polypharmacy, and high-risk
medications
Factors associated with the work environment
 Workload and time pressures
 Distractions and interruptions (by both
primary care staff and patients)
 Lack of standardized protocols and
procedures
 Insufficient resources
 Issues with the physical work
environment (e.g., lighting, temperature
and ventilation)
Factors associated with medicines
 Naming of medicines
 Labeling and packaging
 Factors associated with tasks
 Repetitive systems for ordering,
processing, and authorization
 Patient monitoring (dependent on
practice, patient, other health care
settings, prescriber)
Factors associated with computerized information systems
 Difficult processes for generating first
prescriptions (e.g. Drug pick lists, default
dose regimens and missed alerts)
 Difficult processes for generating correct
repeat prescriptions
 Lack of accuracy of patient records
 Inadequate design that allows for human
error
Oral Medications That Should
Not Be Crushed or Altered
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Case
• Xy is 5 years male patient his body weight is 22 KG
currently diagnosed as partial seizures with a
complex system, and carbamazepine 100 mg PO tid
was ordered, but his mother bought
carbamazepine 200mg tablet SR, from the
pharmacy.
• How do you administer this drug for your patient?
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Answer
• Carbamazepine is in the form of SR
• Its not recommended to crush SR tablet
• So inform that to change to film coated or
immediate release carbamazepine.
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Why we crush medication
• For Patients on nasogastric tubes
• For pediatrics patient ,dosage not
found at pharmacy
• For patients having difficulty of
swallowing capsules or tablets
• To mix medication with food or drink
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medications which should not be
crushed
1.
Extended-Release Products
• Extended-release means the pill is formulated so that the
drug is released slowly over time
• Common Abbreviations for Extended-Release Products
– CD-- Controlled dose
– CR-- Controlled release
– CRT-- Controlled release tablet
– SR ---Sustained release
– ER --Extended-Release
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• Note: check on blister or package of the
drug before administration and if you found
one of the above labels or signs, DON’T
crush or dissolve in any solvent.
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2.Medications Which Irritate the GI
• Tablets that are irritating to the stomach
may be enteric-coated which delays the
release of the drug until the time when it
reaches the small intestine.
• Enteric-coated aspirin is an example of this.
So if you found enteric-coated label don't
crush.
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3. Foul-Tasting Medication
• Some drugs are quite unpleasant to taste so
the manufacturer coats the tablet in a sugar
coating to increase its palatability.
• By crushing the tablet, this sugar coating is
lost and the patient tastes the unpleasant
tasting medication. eg CPZ
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4.Sublingual Medication
• Medication intended for use under the
tongue should not be crushed.
• Sublingual medications should indicate on
the package that they are intended for
sublingual use.
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5.Effervescent Tablets
• These are tablets that, when dropped
into a liquid, quickly dissolve to yield a
solution. Many effervescent tablets,
when crushed, lose their ability to
quickly dissolve.
• NOTE: put the whole tablet in a glass
of water and wait until it completes
bubbling.
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Mnemonic:
• Seniors erroneously crush enteric-coated laxatives
• Seniors: abbreviation for the seniors is: SR (sustained
released)
• Erroneously: ER (extended release)
• Crush: CR (controlled release)
• Enteric-coated: EC
• Laxatives: LA (long acting)
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Crushing Pills
• If you know a medication can be safely
crushed, there are three safe ways to go
about it:
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 Pill crusher:
The easiest way to crush pills is to use a pill
crusher.
The gadget works by reducing the pill into a fine,
powdery substance to be mixed with food or a
beverage.
Using a pill crusher is simple and requires little
physical effort.
Plus, the process is very time efficient, as most
pills are relatively small and take mere seconds to
crush.
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Pill splitter
If the pill is large that cannot be
crushed, a pill splitter may be the
solution.
 A pill splitter allows to safely cut a pill in
two, making it easier to swallow.
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Mortar and pestle
 An old-fashioned mortar and pestle is that heavy
bowl and thick stick often used to make guacamole.
 You can use it to safely grind and mash pills into
powder form.
 This method requires a little more time and physical
effort than a pill crusher,
 however, In addition, it's not very user-friendly for
people with arthritis or other joint conditions of the
hands and wrists because application of pressure is
needed to twist and turn the pestle.
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Avoid This Method
 Crushing medication by placing pills inside a plastic bag and
bludgeoning them with a hammer or other heavy object, may
result in different problems
 It can make holes in the bag and you could lose some of the
medication, which throws off dosing.
 The crushed-up medication can collect in the corners of the
bag, making it difficult to get every bit of medication out.
 It may leave chunky pill fragments, rather than a smooth
powder.
 It's more time-consuming than any other method.
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Medication stability
• Group discussion
• While you are at the pediatric ward for one of
your patient NPH insulin and ciprofloxacin eye
drop were ordered, and you start administering
medications for your patient,
• How do you store this medications and for
how long both insulin and ciprofloxacin are
stable after once opened?
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• NPH insulin is stable for 28 days at room
temperature after once opened, so
refrigerating only increase pain at injection
site
• Ciprofloxacin eye drop is stable for one
month after opening the droppers
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Medication stability
 Drug stability means the ability of the
pharmaceutical dosage form to maintain the
Physical
chemical
therapeutic and microbial properties during
the time of storage and usage by the patient.
 It is measured by the rate of changes that take
place in the pharmaceutical dosage forms.
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Medication stability
• Shelf-life of a drug product is defined as the time at which
the average drug characteristic (e.g. Potency) remains within an
approved specification after manufacture (FDA, 1987).
• Shelf life is the time required for 10%of the drug to disappear; it
is the time at which decreased to 90% of its initial concentration
from the original.
• Expiry date: means that drug cannot be used after this
date because the concentration of the drug is decreased and
become lower than therapeutic concentration.
• Besides, some products of drug degradation are toxic and harmful
to patients.
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Medication stability
• After the opening of the drug container, the
expiry date will be shorter as a result of the
decreased concentration of drugs during
usage and the effects of external factors.
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Medication stability
Example:
Eye drops: can be used for one month after opening the droppers
Syrups and suspension of antibiotics: can be used for one
week by storage at room temperature and for two weeks by storage in
4C˚.
Tablets and capsules remain stable in the package but after
removal, the expiry date will change no more than 12 month
Ampoules: must be used immediately
vials (multi-dose) are stable for some hour (depends on drug type)
for the presence of preservatives.
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Aseptic Technique
Use aseptic technique when preparing and
administering IV medications, flush/locking
solutions, and other parenteral solutions
administered by direct IV injection
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Aseptic Technique
The aseptic technique includes:
Hand hygiene before and after preparation and
administration of the medication or solution
Disinfection of the medication access diaphragm on a vial or
the neck of an ampule before accessing the medication or
solution
Disinfection of the IV access port, needleless connector, or
another vascular access device (VAD) prior to administration
of the medication or solution
The use of personal protective equipment (PPE) if contact
and exposure to blood or bodily fluids are possible when
administering the medication or solution
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calculation used for medication
reconstitution and administration
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Objectives
Dose and dosage
Calculate the desired dose from the original dosage form
Percentage weight-in-volume (w/v) calculation
Alligation
Calculation of Intravenous Drip Rates
Calculation of Flow Rate for an Infusion Pump
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Dose and dosage
• dose refers to a specified amount of
medication taken at one time.
• dosage is the prescribed administration of
a specific amount, number, and frequency
of doses over a specific period of time.
• Drug dosage calculations are required
when the amount of medication
ordered (or desired) is different from
what is available on hand for the nurse
to administer
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General formula for calculating dose
• 𝑅𝑒𝑞𝑢𝑖𝑟𝑒𝑑 =
𝐴𝑚𝑜𝑢𝑛𝑡 𝐷𝑒𝑠𝑖𝑟𝑒𝑑
𝑥Quantity
Amount on Hand
• Example1: metoprolol, 50mg PO, is ordered.
Metoprolol is available as 100mg per tablet. How
many tablets would the nurse administer?
• Answer
42
General formula for calculating dose
Example2: Amoxicillin is available as Amoxicillin 250mg/5ml. Amoxicillin
320mg TID is ordered. How much should the nurse administer to the
patient?
 Solution

Amount desire = 320mg

Amount on hand= 250mg

Quantity =5

320
𝑥5
250

This means there is 320mg of amoxicillin in 6.4ml of suspension
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= 6.4ml
43
Question
• Enoxaparin is available as enoxaparin 40mg/0.4ml, enoxaparin 0.5mg/kg
per day divided in two is ordered and if the KG of the child is 6.4 kg. How
much should the nurse administer to the patient?
• Answer
 Let determine daily dose 0.5x6.4 = 3.2mg of enoxaparin is needed,
divided in two dose 3.2/2= 1.6mg

𝟏.𝟔
𝒙𝟎. 𝟒
𝟒𝟎
= 𝟎. 𝟎𝟏𝟔 ml but 0.016ml is unpractical dose no measuring device and can’t measured accurately

So we have to dilute in SWFI 4.6ml to make 5ml then

0.2ml
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𝟏.𝟔
𝒙𝟓
𝟒𝟎
= 𝟎. 𝟐 ml
44
2.1 Percentage weight-in-volume (w/v)
• Percent weight per volume is defined as the grams of
solute in 100 milliliters of solution.
• The calculation provides information about the
concentration of the solution.
• A percentage expresses the number of parts of a
particular substance per 100 total parts.
• The solute is a substance present in the solution in an
amount less than that of the solvent.
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Example
• Magnesium Sulfate is available as Magnesium Sulfate
50%W/V in 20 ml vial. Physician order 2 g Magnesium
Sulfate. How much should the nurse administer to the
patient?
• Answer
• 50%WV means 50/100 = 0.5g in 1 ml so 20 ml contain
20x0.5 = 10 g
• So to get 2g administer 4ml
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2.2 Alligation
• Alligation is a way to solve problems associated with
mixing preparations of two different strengths of the
same ingredient to obtain strength in between the
starting preparation.
• The problems could also be solved using algebra, but
using the alligation method is often easier.
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Lower strength (l)
H-D
Total
Desired strength (d)
Higher-strength (h)
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D-L
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Alligation
• Example1: physician order 10% DW 1000 ml to be
given over 2 hours for your patient, but you have DW
5% and 40 % dextrose. How you prepare 10% DW
from both solutions.
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Alligation
5
40-10 = 30
10
40
To solve for the volume 5%
To solve for the volume 40%
total 30+5= 35
10-5 = 5
1000𝑥30
35
= 857.1ml
1000𝑥5
35
= 142.9𝑚𝑙
So to make 1000ml of 10% DW just mix 857.l ml of 5% DW and 142.9ml of 40% DW
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Alligation
• Question: Infuse 500ml fluids of ½(half) NS0.9% and
½(half) 10%DW over 1 hour. How do you prepare the
fluid?
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Alligation
• Answer
• DNS (dextrose in normal saline contain 5% dextrose
and 0.9% sodium chloride), so we can solve by
alligation methods
5
30
10
40
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total 30+5 = 35
5
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•
•
•
•
For DNS 500𝑥30
=428.6ml
35
For 40% 500𝑥5
= 71.4ml
35
There fore to make 500ml of half NS and half DW10%
Mix 428.6 ml of DNS and 71.4ml of 40% dextrose
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2.3 Calculation of Intravenous Drip Rates
 In these types of calculations, for a given volume, period,
and drop factor (gtts/mL), the required IV flow rate in drops
per minute (gtts/min) is calculated
 Note: Since a fraction of a drop is not possible to give to a
patient, it is usual to round the answers to the nearest
whole number.
 Formula:
𝑽𝒐𝒍𝒖𝒎𝒆 (𝒎𝑳)
𝒙𝑫𝒓𝒐𝒑 𝑭𝒂𝒄𝒕𝒐𝒓 (𝒈𝒕𝒕𝒔/𝒎𝑳)
𝑻𝒊𝒎𝒆 (𝒎𝒊𝒏)
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= 𝒀 (𝑭𝒍𝒐𝒘 𝑹𝒂𝒕𝒆 𝒊𝒏 𝒈𝒕𝒕𝒔/𝒎𝒊𝒏)
54
Example
Calculate the IV flow rate for 250mLof 0.5% dextrose
to be administered over 180 minutes.
The infusion set has a drop factor of 30gtts/mL.
Step 1: Determine your givens. Volume: 250 mL
Time: 180 min
Drop factor: 30 gtts/mL
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Step 2: Use the formula to calculate the IV flow rate.
No unit Conversions are required.
Remember to round the final answer to the nearest whole number.
𝑉𝑜𝑙𝑢𝑚𝑒 (𝑚𝐿)
𝑥𝐷𝑟𝑜𝑝
𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛)
250𝑚𝑙
180 𝑚𝑖𝑛
gtts/min.
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𝐹𝑎𝑐𝑡𝑜𝑟 (𝑔𝑡𝑡𝑠/𝑚𝐿) = 𝑌 (𝐹𝑙𝑜𝑤 𝑅𝑎𝑡𝑒 𝑖𝑛 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛)
𝑥 30𝑔𝑡𝑡/𝑚𝑙 = 41.66𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 Therefore, the IV flow rate is 42
56
2.4Calculation of Flow Rate for an Infusion Pump
Infusion pumps do not have a calibrated drop factor.
The flow rate depends on the volume of fluid
ordered and the time of infusion
Formula:
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𝑉𝑜𝑙𝑢𝑚𝑒 (𝑚𝐿)
𝑇𝑖𝑚𝑒 (ℎ)
= Y (Flow Rate in mL/h)
57
Example 1: 1200 mL D5W IV is ordered to infuse in 10 hours by infusion pump.
Calculate the flow rate in milliliters per hour.
Answer
Step 1: Determine your givens. Volume: 1200 mL
Time: 10 h
Step 2: Since the volume is given in mL and the time is given in hours, the flow rate can be
calculated in one step using the formula.
Step 3: Use the formula to calculate the IV flow rate (gtts/min).
𝟏𝟐𝟎𝟎
=
𝟏𝟎𝒉
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120ml/h
Therefore, the IV flow rate is 120 mL/hr.
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Can we reuse IV BAGS?
 One IV Bag, One IV Tubing, and Only One Time
 Some of the patients who received re-used IV bags
tested positive for infectious diseases
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Adding Medications to Intravenous Fluids
1.
2.
3.
4.
5.
Prepares and administers medications according to “Medication
Guidelines: Steps to Follow for All Medications.”
Determines whether the ordered medication(s) are compatible with the
intravenous solution and with each other
Recaps needles throughout, using a needle-capping device or approved
one-handed technique that has a low risk of contaminating the sterile
needle
Correctly calculates the amount of medication to be instilled into the
intravenous solution.
Removes any protective covers and inspects the bag/bottle for leaks,
tears, or cracks. Inspects the fluid for clarity, color, and presence of any
particulate matter.
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Adding Medications to Intravenous Fluids
6.
7.
8.
9.
10.
11.
12.
13.
Checks the expiration date
Using the appropriate technique draws up the ordered medication
Cleanses the injection port on the bag with an antimicrobial swab.
Removes the cap from the syringe, inserts needle or the needleless vial
access device into the injection port and injects the medication into the
bag, maintaining aseptic technique.
Removes the syringe from injection port; if using a needle, disposes of
syringe and needle
Mixes the intravenous solution and medication by gently turning the bag
from end to end.
Places label on the bag so that it can be read when the bag is hung
Disposes of used equipment, syringe, or needleless access device,
appropriately.
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3.Medication reconstitution, dilution ,
administration ,and storage
• Objectives
Reconstitution of commonly used medication
Administration, dilution
Storage
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Group Discussion
• Question; A 7-year-old patient (24 kg) develops a wound
infection (found to be Staphylococcus aureus). Since this
bacterium is resistant to penicillins, the patient is begun
on vancomycin 15mg/kg per dose TID. His attendant
bought 1000mg of vancomycin from the pharmacy.
1. How you reconstituted and dilute
2. How you infuse, and for how long
3. For how long you will use the vial after
reconstituted
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Vancomycin
• Reconstitution
Reconstitute powder for IV infusion by adding 10 or
20 mL of SWF In to a vial containing 500 mg or 1 g
Further dilute reconstituted solutions containing 500
mg or 1 g with at least 100 mL or at least 200 mL,
(NS, DW
 Administer by IV infusion over ≥1 hour.
 maximum rate of 10 mg/min
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Storage
• vials are stable for 2 weeks at room temperature
• After further dilution solutions are stable when
stored in plastic syringes for24 hours at 4°C and then
subsequently for 2 hours at room temperature
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• Rapid infusion may cause red man syndrome
• Features:
–
–
–
–
–
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flushing or rash on the upper body and neck
muscle spasm of the chest and back
fever
hypotension
itch
66
•
these features develop quickly and usually subside within an hour but may persist for several
hours in some cases.
•
If symptoms of red man syndrome occur:
–
–
–
–
–
–
Cease the infusion
Check the dose and infusion rate
Wait for symptoms to resolve
Further dilute the infusion if possible
Resume the infusion at a reduced rate
Document the adverse reaction in the patient notes and update their Allergies
and Adverse Drug Reaction details
– Infuse subsequent doses over 90 – 120 minutes and consider administration of
an antihistamine before future doses
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Ceftriaxone
• Reconstitution and dilution
– Reconstitute vials containing 250 mg, 500 mg, 1 g,
or 2 g of ceftriaxone with 2.4, 4.8, 9.6, or 19.2 mL,
respectively, with water for injection to provide
solutions containing approximately 100 mg/mL.
– Then, further dilute in a compatible IV
solution(NS, D5W) to a concentration of 10–40
mg/mL
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Ceftriaxone
• Administration
– IV infuse over 30 minutes
– IM inject deep into large muscle mass
– Never administer with calcium-containing drug
• Storage
– stable for 3 days at 25°C
– Do not refrigerate
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Iv push
• Swelling, redness, pain, or soreness at the injection
site may occur.
• This medication may also infrequently cause loss of
appetite, nausea, vomiting, diarrhea, or headache
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Meropenem
• Reconstitution and dilution
– Reconstitute single-use vials containing 500 mg or 1 g
with 10 or 20 mL, respectively, SWFI to provide a
solution containing approximately 50 mg/mL.
– The vial should be shaken until dissolution occurs and
then allowed to stand until the solution is clear.
– Dilute with NS to provide solution of 2.5–50 mg/mL
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Meropenem
• Administration
– Infants <3 months: Administer as an IV infusion
over 30 minutes
– Infants ≥3 months, Children, Adolescents, and
Adults: Administer IV infusion over 15 to 30
minutes
– IV bolus injection (5 to 20 mL) over 3 to 5 minutes
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Meropenem
• Storage
– Stable for 2 hours at 15– 25°C or 12 hours at 4°C.
– If diluted with NS up to 2 hours at 15–25°C or 18
hours at 4°C
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Phenytoin iv
• Dilution
– May be further diluted in NS to a final
concentration of ≥5 mg/mL; infusion must be
completed within 4 hours after preparation.
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Phenytoin iv
• Administration
– IV: Phenytoin may be administered IV directly into a large vein
through a large gauge needle or IV catheter
– Neonates Administer slowly, usual maximum recommended rate:
0.5 to 1 mg/kg/minute
– Infants, Children, and Adolescents: Administer slowly,
maximum recommended rate: 1 to 3 mg/kg/minute or maximum
rate: 50 mg/minute, whichever is slower
– Following IV administration, NS should be injected through the
same needle or IV catheter to prevent irritation.
– Avoid IM use due to erratic absorption, pain on injection, and
precipitation of drugs at the injection site.
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Phenytoin iv
• Vesicant; ensure proper needle or catheter
placement prior to and during IV infusion.
• Avoid extravasation.
• If extravasation occurs, stop infusion immediately
and disconnect (leave needle/cannula in place);
gently aspirate extravagated solution (do NOT flush
the line); remove needle/cannula; elevate extremity.
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Phenytoin iv
• Storage
– Do not refrigerate
– Use immediately
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Ceftazidime
• Reconstitution and dilution
– Reconstitute vials containing 500 mg, 1 g, or 2 g with 5.3 mL,10,
or 10 mL, respectively, of SWFI to provide solutions containing
approximately 100, 100, or 170 mg/mL, respectively.
– Shake vial after adding the diluent; carbon dioxide is released as
drug dissolves and the solution will become clear within 1– 2
minutes.
– When withdrawing a dose from reconstituted vials, consider
that the solution may contain some carbon dioxide bubbles
which should be expelled from the syringe before injection.
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Ceftazidime
• Administration
– IM: deep IM into large mass muscle.
– IV: over 3 to 5 minutes, or by IV intermittent infusion
over 15 to 30 minutes.
• Storage
– IV solutions that have been further diluted to 1–40
mg/mL in a compatible IV solution are stable for 12
hours at room temperature or 3 days under
refrigeration
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Acyclovir
• Reconstitution and dilution
– Powder for reconstitute Acyclovir 500mg with
SWFI 10ml (final concertation 50mg/ml)
– For infusion dilute to a final concentration of <
7mg/ml in D5W or NS
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Acyclovir
• Administration
– Administer by slow IV infusion over at least one hour
– Do not administer IV push, IM or SC
• Storage
– Store undiluted powder vial at 15-25°C
– Store diluted solutions 20- 25°C and use it within 12
hours
– Do not refrigerate reconstituted or diluted solution it
may precipitate
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Amphotericin B(conventional)
• Reconstitution and dilution
– IV: Add 10 mL of preservative-free SWFI to each vial of
amphotericin B
– Do not use bacteriostatic water; benzyl alcohol, sodium
chloride, or other electrolyte solutions may cause precipitation.
– Further dilute with D5W
– Final concentration should not exceed 0.1 mg/mL for peripheral
administration.
– In patients unable to tolerate a large fluid volume, amphotericin
B at a final concentration not to exceed 0.25 mg/mL in D5W or
D10W may be administered through a central venous catheter
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Amphotericin B(conventional)
• Administration
– IV: Administer by IV infusion over 2 to 6 hours;
– For a patient who experiences chills, fever, hypotension,
nausea, or other nonanaphylactic infusion-related
reactions, premedicate with the following drugs 30 to 60
minutes prior to drug administration
– A nonsteroidal (eg, ibuprofen) ± diphenhydramine or
acetaminophen with diphenhydramine or hydrocortisone.
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Amphotericin B(conventional)
• If the patient experiences rigors during the infusion,
meperidine may be administered.
• Bolus infusion of normal saline immediately
preceding or immediately preceding and following
amphotericin B may reduce drug-induced
nephrotoxicity.
• Risk of nephrotoxicity increases with amphotericin B
doses >1 mg/kg/day
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Amphotericin B(conventional)
• Storage
– Store intact vial under refrigeration
– Reconstituted vial are stable for 24 hour at room
temperature
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Amphotericin B (Lipid complex)
• Reconstitution and dilution
– IV: Shake the vial gently until there is no evidence of any
yellow sediment at the bottom.
– Withdraw the appropriate dose from the vial using an 18gauge needle.
– Remove the 18-gauge needle and attach the provided 5micron filter needle to filter, and dilute the dose with D5W
to a final concentration of 1 mg/mL.
– A final concentration of 2 mg/mL may be used for pediatric
patients and patients with cardiovascular disease
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Amphotericin B (Lipid complex)
• Administration
– Before administration, amphotericin B lipid complex 5
mg/mL concentrated suspension must be diluted.
– Flush line with D5W prior to infusion.
– Gently shake the IV container of diluted drug to
ensure that contents are thoroughly mixed then
administer at a rate of 2.5 mg/kg/hour (over 2 hours).
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Amphotericin B (Lipid complex)
• The manufacturer recommends that an in-line filter
should not be used during the administration of
amphotericin B lipid complex.
• If infusion time exceeds 2 hours, mix the contents by
gently rotating the infusion bag every 2 hours.
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Amphotericin B (Lipid complex)
• Storage
– Intact vials should be stored at 20C to 80 C
– Do not freeze.
– Solution in D5W for infusion are stable for 48 hour
under refrigeration
– And for 6 hour at room temperature.
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Amphotericin B(Liposomal)
• Reconstitution and dilution
– IV: Reconstitute with 12 mL SWFI to a
concentration of 4 mg/mL
– Do not reconstitute with saline or add saline to the
reconstituted solution or mix with other drugs;
– Shake vigorously for at least 30 seconds, until
dispersed into a translucent yellow suspension
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Amphotericin B(Liposomal)
• A 5-micron filter should be on the syringe used to
inject the reconstituted product from the vial into
the diluent.
• AmBisome may be diluted with D5W, to a final
concentration of 1 to 2 mg/Ml
• In infants and small children, a lower concentration
of 0.2 to 0.5 mg/mL may be used to provide
sufficient volume for infusion.
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Amphotericin B(Liposomal)
•
Administration
– IV: Do not use in-line filter less than 1 micron to administer AmBisome.
– Flush line with D5W prior to infusion
– infusion of diluted AmBisome should start within 6 hours of preparation
– Infuse over 2 hours; infusion time may be reduced to 1 hour in patients who
tolerate the treatment.
– If the patient experiences discomfort during infusion, the duration of infusion
may be increased.
– Discontinue if severe respiratory distress occurs.
– For a patient who experiences chills, fever, hypotension, nausea, or other
nonanaphylactic infusion-related reactions, premedicate with the following
drugs, 30 to 60 minutes prior to drug administration: A nonsteroidal (eg,
ibuprofen,) with or without diphenhydramine or acetaminophen with
diphenhydramine or hydrocortisone.
– If the patient experiences rigors during the infusion, meperidine may be
administered.
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Amphotericin B(Liposomal)
• Storage
– Store intact vial at ≤ 25ͦ
– Reconstituted vials are stable at 2o C to 8oC for 24
hour
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