What is the pH

range of a Dextrose injection?

(D-Glucose)

3.5 - 6.5

 For a Dextrose injection of 2.5%, give its osmolarity (mOsm/L).

126

For a Dextrose injection of 5%,

give its osmolarity (mOsm/L).

252

For a Dextrose injection of 10%,

give its osmolarity (mOsm/L).

505

For a Dextrose injection of 20%,

give its osmolarity (mOsm/L).

1010

For a Dextrose injection of >20%,

give its osmolarity (mOsm/L).

>1010

For a Sodium Chloride injection of 0.45%, give its osmolarity (mOsm/L).

155

For a Sodium Chloride injection of 0.9%, give its osmolarity (mOsm/L).

310

For a Sodium Chloride injection of 3%, give its osmolarity (mOsm/L).

1030

For a Sodium Chloride injection, what is its pH range? 

4.5-7.0

For a Ringer's injection,

what is its pH range? 

5.0-7.5

For a Ringer's injection,

what is its osmolarity (mOsm/L)?

310

For a Ringer's injection of NaCl, what is its concentration (%)?

0.86

For a Ringer's injection of KCl,

what is its concentration (%)?

0.03

For a Ringer's injection of CaCl₂,

what is its concentration (%)?

0.033

For a Lactated Ringer's (Hartmann's)

injection of CaCl₂, what is its concentration (%)?

0.02

For a Lactated Ringer's (Hartmann's)

injection of KCl, what is its concentration (%)?

0.03

For a Lactated Ringer's (Hartmann's)

injection of NaCl, what is its concentration (%)?

0.6

For a Lactated Ringer's (Hartmann's)

injection of Sodium Lactate, what is its concentration (%)?

0.3

For a Lactated Ringer's (Hartmann's)

injection, what is its pH range?

6.0-7.5

For a Lactated Ringer's (Hartmann's)

injection, what is its

osmolarity (mOsm/L)?

273

For a Lipid Emulsion

injection [Intralipid (Clintec) and Liposyn (Abbott)], what is its

osmolarity (mOsm/L)?

260-284

For a Lipid Emulsion

injection [Intralipid (Clintec) and Liposyn (Abbott)], what is

its pH range?

5.5-9

For a Lipid Emulsion

injection [Intralipid (Clintec) and Liposyn (Abbott)], what is

its concentration (%)?

10 and 20

What is an example of

an injectible emulsion?

Diprivan (propofol)

What is an example of

an injectible suspension?

Isophane Insulin Suspension (NPH)

What is an example of

an injectible reconsitutable solid?

Cefepine HCl (stable for 24 hrs. at room temperature)

What is an example of a sterile solid to be reconstituted before admixture or injection, which is produced by the aseptic crystallization technique?

Claforan Sterile

(cefotaxime for injection, USP)

What are some examples of prefilled syringes that are convenience parenterals that

can be useful in the ER?

Tubex (Wyeth)

Carpuject (Winthrop)

Bristoject (Lyphomed)

Abboject (Abbott)

What is an example of a prefilled syringe that is a convenience parenteral for home use? 

Enbrel (etanercept), a TNF alpha blocker, self administered SC

In inspection and certification of a laminar flow hood, what is used to check for the passage of particles throught the HEPA filter?

Dioctyl phthalate (DOP) smoke test

What is an example of a pH-related chemical incompatibility

in an acidic media?

Ampicillin sodium degrades faster in D5W (acidic) than in NS.

What is an example of a pH-related chemical incompatibility

in a basic media?

Doxorubicin HCl can turn from red to purple when mixed with 

 an alkaline drug.

What is an example of a sodium salt of a weak acid added to an acidic medium precipitating as the (unionized) free acid?

Cefazolin sodium can precipitate at a pH below 4.5.

What is an example of a HCl salt of a weak base drug added to an alkaline medium precipitating as the (unionized) free base?

Metoclopramide HCl inj. (pH 3-6.5) and

Cephalothin Na inj. (pH 6-8.5)

What are examples of precipitation formed by poorly soluble salts?

Divalent cations (Ba⁺⁺, Mg⁺⁺, Ca⁺⁺, and Fe⁺⁺) in the presence of bicarbonate, citrate, sulfate (sulfite), and phosphate salts.

What is a very important example of precipitation formed by poorly soluble salts?

Calcium-Phosphate incompatibility.

Can occur in LVP or in-line.

Has been associated with deaths.

What are some examples of destabilization of colloidal products for parenteral use?

IV fat emulsions.

Liposomes.

Amphotericin B.

(can occur because of temperature extremes or incompatibilities)

What is an example of leaching from a plastic parenteral container?

Phthalates (a plasticizer,

like DEHP) leaching from PVC.  Several formulations of lipophilic drugs can leach phthalate.  Surfactants in the product usually leach DEHP.

What is the most frequently used solvent in the large-scale manufacturer of injections?

Water for Injection, USP

• purified by distillation or reverse osmosis
• meets same stds. for presence of total solids as does Purified Water, USP           (< 1mg/100 ml)
• no added substances
• not sterile
• must be pyrogen free

What are some characteristics of Sterile Water for Injection, USP?

• packaged in single-dose containers < 1 L
• must be pyrogen free
• < 0.25 USP endotoxin units/mL
• no antimicrobial agents or additives
• slightly more total solids than Water for Inj., USP
• used as solvent, vehicle, or diluent for already sterilized and packaged injectable medications.
• no IV use (no tonicity)
• used for reconstitution of multiple antibiotics

What are some characteristics of Bacteriostatic Water for

Injection, USP?

• sterile water for inj. with one or more antimicrobial agents
• packaged in prefilled syringes or in vials < 30mL of the water
• properly labeled with all agents
• used in preparation of small volumes of injectable preparations.
• bacteriostatic agent used for multiple-dose vials
• with antimicrobial agents, must use only a small volume when administered
• if > 5 mL of solvent needed, sterile water for inj. is preferred
• label required to state "NOT FOR USE IN NEONATES" (benzyl alcohol toxicity "gasping syndrome", leads to multiorgan failure -> death ).

What are some characteristics of Sodium Chloride Inj., USP?

• a sterile isotonic solution of NaCl in water for inj.
• no antimicrobial agents
• approx. 154 mEq each of Na⁺ and Cl^- ions/L
• used frequently as a catheter or IV flush to maintain patency
• usually, 2 mL is used to flush the line after each use, or every 8 hrs. if line is not used

What are some characteristics of Bacteriostatic NaCl Inj., USP?

• sterile, isotonic soln. in water for inj.
• one or more antimicrobial agents (must be on label)
• soln. not packaged in containers > 30 mL
• also used to flush a catheter or IV line to maintain its patency
• "NOT FOR USE IN NEONATES" warning because of benzyl alcohol poisoning

What are some characteristics of Ringer's Inj., USP?

• sterile solution of NaCl, KCl, and CaCl₂ in water for injection
• similar to concentration of these agents in physiologic fluids
• vehicle for other drugs or used alone as an electrolyte replenisher and plasma volume expander

What are some characteristics of Lactated Ringer's Inj., USP?

• contains different quantities of the three salts in Ringer's inj.
• contains sodium lactate
• electrolyte replenisher
• systemic alkalizer