Dispensing and Compounding

Lecture 1
1/7/19

Steps to Solving Compounding Problems

Products (The names of the drug are in alphabetical order by generic name)
The product section tells you the size of the vials and how they come IM or IV and the volume that is needed to be used

Injection for 1g IM QD of Ceftriaxone Sodium for 7 days

 Assume you have a 1g vial and a 2g vial

Intramuscular Injection (IM): Look at chart for vial size + volume of diluent added to obtain a specific concentration

1 gram + 3.6 mL = 250 mg/mL and 1gram + 2.1 mL = 350 mg/mL

2g grams + 7.2 mL =250mg/mL and 2 grams +4.3 mL = 350 mg/mL

Note: You would need TWO injections as the muscle can only take 3 mL’s of the 1 gram in 3.6 mL solution, but you only need ONE injection of the 1 gram in
2.1 mL solution

Intravenous Injection (IV): Intermittent infusion of Ceftriaxone 1g IV q12 for 7 days

250mg + 2.4mL =2.5 mL

500mg + 4.8 mL = 5.0 mL

1gram + 9.6 mL = 10 mL

2 grams + 19.2 mL = 20 mL
Solution Choice (Compatibility)
Look at solution compatibility, C = compatible and I = incompatible (yes or no) look on the chart

0.9% NaCl and D5W are the two must typically used out of these two NaCl is most often used

 D5W = Dextrose 5% in water (Diabetic Patients) increased glucose levels

If patients have multiple condition that rule out both solutions Lactated Ringer can be given, or the patient may have to reduce the amount of sodium in their diet
so that the medication can be administered safely.

Administration
The KEY question is (How long is it infused over?) 15 minutes 30 minutes an hour, two hours?

Vancomycin – Causes Red Man’s Syndrome and because of this it MUST be infused over AT LEAST 1 hour and can be found under the administration section

Go with the upper limit due to thrombophlebitis (inflammation of the veins) 15-30 minutes but you should lean toward 30 minutes the faster the medication is
infused the higher the risk of inflammation of the veins

Recommendation: Lay a warm compress or decrease the infusion rate to treat thrombophlebitis 30 minutes to an hour or dilute the solution to decrease the
concentration of the medication

 Warm Compress
 Decrease the infusion rate
 Increase the Volume

Stability (Expiration Date)

1,500 mg in 100mL = 15mg per mL

 At room temperature 3 days and refrigerated 10 days

Full Example Problem (4-Step Plan)

Step 1: In the product section how does this come? – It comes as 1g and 2g in the pharmacy typically and the 1-gram vial is chosen

1-gram vial and come as a powder, you must add a solution to it (2.1 mL)

Step 2: What solution will be used? Look under solution compatibility and know that 80% of the time 0.9 % NaCl is used is it compatible? Now you have 350
mg per mL but the order calls for 750mg

mL
750 mg X =2.14 mL one injeciton
350 mg
Step 3: Administration – This IM injection will be given at a dose of 750mg IM QD for 3 days and each dose contains 2.14 mL of solution

Step 4: Stability – 350/mL is only good for 24 hours if not refrigerated

Note: For each injection that you give the muscle can ONLY take 3mL’s (no more than 3mL’s)

You want to choose the volume of diluent that will give you the greater concentration the greater the concentration the less mL’s are needed for the injection
REMEMBER a muscle can only take 3 mL’s

An increase in concentration leads to a decrease in the number of mL’s needed for the injection
Practice Problems

1. The concentration wanted for an infusion is 750mg and you have a 1-gram vial how many mL’s would you use?
750 mg 10 mL
X =7.5 mL needed for injeciton
x 1,000 mg
2. What if you had only 2-gram vials in the pharmacy and the order still called for 750mg for the injection how many
ML’s would you use?
Note: You have 2 grams in 20 mL (2-gram vial + 19.2 mL)

750 mg 20 mL
X =7.5 mL
x 2,000 mg

3. If you had an order for 1.5-gram injection IM QD and you have a 2-gram vial. If your odder calls for 1.5 grams solve
for the number of mL’s needed for the injection
You would take the 2-gram vial and add 4.2 mL (of some solution) to make it 350mg/mL

mL
1,500 mg X =4.28 mL needed for theinjeciton at least TWO injecitons need ¿ be given
350 mg
4. You have an order for 1.5 grams IV q12 for 7 days you have in your pharmacy 2-gram vials
How much will you add to it? 19.2 mL will be added, and this will yield 2-grams in 20 mL’s which is the SAME as 100mg/mL
The order calls for 1500mg and there is 2-grams in 20mL how many mL’s would you need?

mL
1 ,5 00 mg X =15 mL for the infusionthere are 5 mL ¿ ¿ the20 mL solution which can go ¿ the nect bag
100 mg
Dispensing and Compounding

Lecture 2

1/9/19

Flushes
Ceftriaxone 1-gram IV QD (BID) 8am and 8pm

 A flush is 10mL once you use it you can not use it again

 There is blood in the line use 0.9% (NaCl Flushes 3mL) to clear the line and then infuse the drug and flush again with 0.9% NaCl (White and Clear) –
Are applied before and after the infusion for a total of 6mL

 Hep-Lock infusion of 1mL 100 units per mL Heparin (Yellow) – Are applied after the infusion is done DO NOT give pediatric patients 100units/mL use
10units/mL it is done after each infusion

In this case you would give 3mL NaCl then Ceftriaxone 3mL NaCl and Hep-Lock (1mL)

Y-Site Infusion
Two injections into one vein Ceftriaxone and Propofol and must be compatible and this section tells you if other drugs can be run into at the same time

Must be the same solution

C = compatible and I = Incompatible

Rocephin 625mg IV Q12h x 10 days

1. How much Rocephin will be needed?

You have in the pharmacy 1gram and 2 grams (Use a 2-gram vial) as you get more injections out of the bottle. The powder must be reconstituted.

2-gram vials you use 19.2 mL = 2g in 20mL which is the same as 100mg/mL

625mg x 20mL/2,000mg = 6.25 mL for each bag of 100mL remove the volume that you calculated

20 mL
625 mg X =6.25 mL
2,000 mg

6.25mL at two bags per day gives you 12.5 mL per day x 10 days =125 mL

Each vial holds 20 mL so 125mL x 1 vials/20mL =6.25 vials so you would need 7 vials

1. 6.25 mL per bag X 2 bags=12.5 mL

2. 12.5 mL X 10 days=125 mL for the whole order

1 vial
3. X 125 mL=6.25 vials ( 7 vials )
20 mL
2. What solution will be used?

Solution compatibility 0.9% NaCl is compatible

3. What size bag will be used? (Go to products section)

Choose the 100mL to prevent thrombophlebitis the 50mL may be too concentrated so 100 mL will further dilute the solution

A piggyback is an IV infusion that is intermittently infused

4. How many flushes will be needed?

3mL before and 3 mL after twice a day for 12mL per day for 10 days = 120mL

Hep-Lock 1mL after infusion for 2 infusions for 2mL per day for 10 days = 20mL

5. How long will if be infused over?

Choose the 30-minute infusion to mitigate the risk of thrombophlebitis

6. Expiration Date

Gram per 100ml is concentration

625mg in 100ml = 6.25 mg/mL (Less than 100mg/mL) 3 days for room temperature and refrigerated 10 days ALWAYS CHOOSE REFRIGERATION