2. Lecture Objectives
• Define and describe the different types of admixture solutions
• Describe different routes/methods of parenteral drug administration
• define common terminology associated with parenteral drug administration
• describe the basic principles of aseptic technique
• demonstrate appropriate aseptic technique used in the preparation of IV
admixtures
• describe the advantages and limitations of a pharmacy-based IV admixture service
• describe the specialized equipment and supplies used in an IV admixture service,
including TPN and chemotherapy
•
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describe the techniques and technology that may be used to increase efficiency
and productivity of an IV admixture service
3. Admixture
Preparations
Sterile IV solutions that are prepared by using
one or more medications or electrolytes and will
be administered via the parenteral route
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Irrigation Ophthalmic Intrathecal
Solutions Solutions Solutions
4. Intravenous Admixture Preparations
• Compounding sterile admixture medication has
originally started to prepare sterile intravenous,
intrathecal, ophthalmic, and irrigating solutions
that were not available commercially
• 40% of hospital inpatients receive IV
preparations including replacing fluids and
electrolytes, provide nutrition and administer
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medication.
• It can be administered in the hospital or to
patients at home.
5. Pharmacist’s Roles in Admixture Pharmacists
Monitor
Parenteral Parenteral
Drugs Solutions
Experts
Administer
Parenteral
Compound Solutions
Preparations
parenteral
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Solutions
Stability Compatibility
6. Pharmacist’s Responsibilities in
Admixture Preparations
The pharmacy must maintain a clean area out
Contamination of the direct flow of traffic with a vertical or
horizontal laminar air flow hood to prepare IV
admixtures
Pharmacy education should prepare
pharmacrists to deal with problems of physical,
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chemical, and therapeutic incompatibilities
Compatibility and to design suitable alternatives
7. Pharmacist’s Responsibilities in
Admixture Preparations
Stability Drug stability information must be readily
accessible to the pharmacist in order to
determine optimum conditions for drug
storage prior and after preparation
Keeping a drug at ideal storage conditions
will help to establish a reasonable expiration
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date for the product.
Inspection method to test product sterility
and overall integrity must be instated
8. Advantages of Admixture
Prepared by Pharmacists
Errors
Errors are reduced if a pharmacy based
admixture program is instated
When pharmacists prepare admixture
preparations errors become less frequent.
The use of standardized dosing charts,
including precalculated drug doses and
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dilutions contained in admixture area reduce
the chance of error significalntly
9. Advantages of Admixture
Prepared by Pharmacists
Quality Pharmacists should design and enforce
admixture preparation system that ensures
quality of the prepared preparations
This system should include policies and
procedures that can be applied in centralized
and decentralized settings
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This system will provide a mechanism to
monitored quality to the prepared
preparations
10. Advantages of Admixture
Prepared by Pharmacists
Individual-
ization Admixture preparations have the advantage
of being prepared for each individual patient
and administered according to certain
directions tailored for the individual patient.
Admixture preparations ensures the
application of total pharmaceutical care as
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the pharmacist prepares, administers , and
monitor the patient therapy
11. Admixture Pharmacy System
Process
Check the solution
against original order
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Label against original
prescription
• Dose
Determine • Diluent
• Rate of Administration
12. Establishing an Admixture
Pharmacy System
Preparation
Area
Admixture Storage
Systems Area
SYSTEM
COMPONENT
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Policies and
Personnel
Procedures
13. Preparation Area Description
Washable floor
covered with vinyl Restricted Area
or epoxy
Refrigirator
Laminar Flow Hoods
Vertical Adequate Light
Horizontal
Preparation Tools
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No Smoking Adequate Counter
No Food Space
No Drink
14. Policies and Procedures
Stability
Labeling
Aseptic and
Techniques Checking
Compat- Quality
IV
ibility Assurance
Profiling
Auxiliary
Preparation should be according to a policies Labels
and procedures manual
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Detailed information of preparation, labeling, storage, and
expiring date determination should be accessible
15. Policies and Procedures
Stability Place
Environmental
Conditions
Environmental
Conditions
Diluents
Used
Stability is affected by
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Other Drugs
Stability and Sterility determine expiration date
16. Policies and Procedures
Physical
Precipitation
Inactivation
Compat-
ibility
Chemical
Deterioration
Types of incompatibilities
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Therapeutic
Interaction
that lead to Increase
the effect
or show
toxic
effects
17. Policies and Procedures
Aseptic
Techniques
IV
Profiling
A sterile parenteral dosage form is free from
living microorganisms, particulate matter, and
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pyrogens.
Review preparation against patient’s current profile
18. Policies and Procedures
Labeling
and
Checking
Patient Name Bottle Sequence Environmental
Number Conditions Name and
amount of each
drug
Name and volume
of admixture
Labels should reflect the information provided
in the prescription
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Preparer initials
Auxiliary Labels
Preparation and Date and times of
Flow Rate
Expiration dates Administration
19. Policies and Procedures
Quality
Assurance
System to check aseptic environments and the
pharmacist’s access to both patient’s profile
and final product provide more stringent
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quality control over parenteral therapy
Admixtures of drugs not available commercially can be
prepared using the powder form.
The resulting solution should be filtered before addition to
IV bag
20. Policies and Procedures
Note Strength Activate before
Protect from light
use
Auxiliary
Required to avoid fatal errors Labels
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Caution:
For epidural use
Chemotherapy Do Not Refrigirate
only
Agent
21. IV Room Equipment
Laminar
Flow
Refrigerator
HEPA
Filteration References
Slows microbial
Vertical or growth
Horizontal
Handbook of
Injectable Drugs
Needle means
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Check every 6 contamination
months
Compatibility and
compounding
charts
23. IV Room Personnel
Training
Organized
Regular Job
Description
Specialization
Intense
Who will do what
Distribution
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Module Based
24. IV Room Storage Area
The
prepared
Mixture
Refrigirator
IV Room Admixture Systems
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Systems require little involvement of actual
compounding, it helps with general needs not
special orders