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Parenteral Drug Therapy

Welcome to the parenteral drug therapy category for physicians and pharmacists. This clinical category features links to resources on intravenous (iv) compatibility and administration, infusion / injectable drug monographs and more.

electronic Medicines Compendium (eMC)
Summaries of Product Characteristics (SPCs)

Source: medicines.org.uk
Clinical Resource: Summaries of Product Characteristics (SPCs)
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Last Checked: 22/02/17 Link Error: Report It

 

Pharmacokinetics of drug infusions

This article will describe, rather than derive equations to explain, the pharmacokinetics of i.v. infusions and a basic understanding of simple models of pharmacokinetics and the relationships between parameters is assumed.

Source: oxfordjournals.org
Clinical Resource: Journal Article
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Last Checked: 22/02/17 Link Error: Report It

 

Mixing of medicines prior to administration in clinical practice: medical and non-medical prescribing

Following recommendations from the Commission on Human Medicines, medicines regulations were amended in December 2009 to enable doctors and other prescribers to mix medicines themselves and to direct others to mix medicines.

These changes apply not only to palliative care, but to all clinical areas where the mixing of medicines prior to administration is accepted practice and supported by the employer's policies for delivery of healthcare.

The Commission also agreed parameters, principles and key points on mixing of medicines. The intention is to enable accepted good practice to continue.

Source: gov.uk
Clinical Resource: Guidance
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Last Checked: 22/02/17 Link Error: Report It

 

Mixing of medicines prior to administration in clinical practice — responding to legislative changes

It is common practice for healthcare professionals to mix one or more medicines together before administration to a patient. This is permissible under medicines legislation where one product is a vehicle for the administration of another. However, mixing two licensed medicines where one is not a vehicle for the administration of the other, results in a new, unlicensed product being produced. Prior to recent legislative changes, the law restricted mixing practice to:

  • Doctors and dentists mixing medicines and then administering to a patient
  • Pharmacists mixing medicines to the specification of a doctor or dentist
  • Holders of a manufacturing licence.

The NPC has produced this resource for both organisations and practitioners. It is not intended that this document replaces any generic guidance or professional codes of conduct from the professional regulatory bodies, but should be read in conjunction with them. It provides advice and tools which will help with the implementation of the guidance points.

Source: webarchive.org.uk
Clinical Resource: Guidance
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Last Checked: 22/02/17 Link Error: Report It

 

Stabilis
Stability and compatibility of injectable drugs

Stabilis is a database concerning stability and compatibility of injectable drugs.

It has been compiled in an international language based on pictograms (definitions in 24 languages are provided for all the pictograms in a special dictionary). The database consists of:

  • a series of Monographs
  • summary information on injectable drugs
  • a dictionnary for the translation of the pictograms
  • references
Source: stabilis.org
Clinical Resource: Database
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Last Checked: 22/02/17 Link Error: Report It

 

To mix or not to mix - compatibilities of parenteral drug solutions

Many injectable drugs cannot be mixed together in syringes or infusions. Some cannot be safely diluted in infusion bags. Incompatibility can involve precipitation, ionic reactions, evolution of gas and denaturation of biological molecules. Knowledge of drug compatibility is needed before mixing drugs. Reference texts can provide information, but data are often unavailable for new drugs. If drugs are mixed together, the mixture should be inspected for precipitates, turbidity or changes in colour, however not all incompatibilities are visible.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 22/02/17 Link Error: Report It

 

How can I reduce the risks from mixing injections?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Injectable medicines may be mixed in a variety of contexts: for example, in the same intravenous bag, in a syringe for infusion or rapid injection, or in the same intravenous line.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Parenteral Nutritution (PN) and Drug CompatIbility

The co-infusion of drugs and PN should be avoided. PN solutions are diverse in their composition and compatibilities with drugs can never be guaranteed.

Source: pedmed.org
Clinical Resource: Supplementary Material / Reference
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Last Checked: 22/02/16 Link Error: Report It

 

Q: Are there any risks associated with the use of ceftriaxone in combination with calcium salts?

A. Ceftriaxone (Rocephin), a third generation cephalosporin, is widely used in the treatment of many conditions including acute otitis media, gonorrhea, meningitis, and infections of the skin and lower respiratory tract.

Source: duq.edu
Clinical Resource: Pharmaceutical Information Centre Publication
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Last Checked: 22/02/17 Link Error: Report It

 

Intravenous Dilution Database

Source: globalrph.com
Clinical Resource: Database
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Last Checked: 22/02/17 Link Error: Report It

 

London Health Sciences Centre
Drug Monographs

The following intravenous drug monographs are for medications commonly used in critical care.

Source: lhsc.on.ca
Clinical Resource: Monographs
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Last Checked: 22/02/17 Link Error: Report It

 

Administration of intravenous drugs
Cumbria Partnership NHS Foundation Trust

Source: cumbria.nhs.uk
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

San Diego Patient Safety Council
High-Risk IV Medications Dosing Limits Guidelines of Care

The purpose of this tool kit is to provide evidenced-based recommendations and best practices on setting and managing high-risk IV medications limit settings for adult patients in intensive and acute care units.

Source: hqinstitute.org
Clinical Resource: Toolkit
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Last Checked: 22/02/17 Link Error: Report It

 

Adult Intravenous Medications
Standard and Maximum Allowable Concentrations,
Guidelines for Continuous or Titrated Infusions

Source: med.umkc.edu
Clinical Resource: Table
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Last Checked: 22/02/17 Link Error: Report It

 

Critical Care Intravenous Medications Chart

Source: kentuckyonehealth.org
Clinical Resource: Chart
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Last Checked: 22/02/17 Link Error: Report It

 

UKCPA (United Kingdom Clinical Pharmacy Association Critical Care Group): Minimum Infusion Volumes for Fluid Restricted Critically Ill Patients
4th Edition December 2012

Source: scottishintensivecare.org.uk
Clinical Resource: Document
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Last Checked: 22/02/17 Link Error: Report It

 

Light-Sensitive Injectable Prescription Drugs

In 2009, Hospital Pharmacy published a list of oral medications that require protection from light. This reference does not provide information on injectable drugs and, to our knowledge, there is no comprehensive list of injectable medications that require protection from light published in the United States. Therefore, the purpose of this table is to supplement the previously published list of oral medications by identifying injectable drugs that require protection from light.

Source: thomasland.com
Clinical Resource: Journal Article
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Last Checked: 22/02/17 Link Error: Report It

 

Filtration Medications Guidelines
Filtration Recommendations Table

Source: utmb.edu
Clinical Resource: Table
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Last Checked: 22/02/17 Link Error: Report It

 

A Guide on Intravenous Drug Compatibilities Based on their pH

Mixing incompatible medications is a major intravenous (IV) medication error especially when data on compatibility is not available in commonly used references. The pH of IV medications is very important to consider when tackling compatibility of solutions. Developing a guide reporting the pH of medications, in addition to compatible solutions and light sensitivity, can serve as a unique tool during the preparation of special admixture for a specific patient.

Source: pharmacie-globale.info
Clinical Resource: Review Article
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Last Checked: 03/01/14 Link Error: Report It

 

Thames Valley Y-Site Intravenous Drugs Compatibility Chart
Prepared by the Thames Valley Critical Care Network Pharmacists Group

Source: cardiffpicu.com
Clinical Resource: Chart
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Last Checked: 22/02/17 Link Error: Report It

 

Subcutaneous Drug Infusion Compatibility Guidelines
Gippsland Region Palliative Care Consortium Clinical Practice Group

In palliative care clinical practice, the oral route of administration is the preferred option. However, when the parenteral route is required, the subcutaneous route should be the first option. Drugs may be given as infusions over 24 hours or as bolus doses.

The combination of drugs for subcutaneous infusions must be checked for compatibility prior to prescription and administration of injectable medication.

Source: grpcc.com.au
Clinical Resource: Guideline
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Last Checked: 29/11/16 Link Error: Report It

 

Syringe Driver Drug Compatibilities - Guide to Palliative Care Practice 2016
Eastern Metropolitan Region Palliative Care Consortium

Source: emrpcc.org.au
Clinical Resource: Guideline
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Last Checked: 29/11/16 Link Error: Report It

 

Drug Compatibility in Subcutaneous Infusions Chart in Standard Forms

Printable colour pictorial chart with indicators of drug compatibility

Source: grpcc.com.au
Clinical Resource: Chart
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Last Checked: 29/11/16 Link Error: Report It

 

Can potassium be given by subcutaneous infusion?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

There is very limited information available describing the subcutaneous administration of potassium and a wide range of concentrations of potassium chloride have been used.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

How should intravenous (IV) potassium chloride be administered in adults?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Potassium administration via the intravenous route should only be used when the oral or enteral route is not available or will not achieve the required increase of serum potassium within a clinically acceptable time.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Can magnesium sulphate be given subcutaneously?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

There is very limited published information available describing the subcutaneous administration of magnesium sulfate and a wide range of concentrations have been used.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

CosmoFer®
Healthcare Professionals

CosmoFer.com offers information about iron deficiency anaemia and parenteral iron therapy.

Source: cosmofer.com
Clinical Resource: Various
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Last Checked: 22/02/17 Link Error: Report It

 

How do I use CosmoFer® (iron dextran) total dose infusion for correction of iron deficiency anaemia?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

The dose and dosage schedule for CosmoFer® must be determined individually based on a calculation of the patients total iron deficit; the total cumulative dose is determined by the patients haemoglobin (Hb) concentration (in g/dL) and their body weight (in kg).

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Aintree University Hospitals NHS
Guidelines for prescription and administration of intravenous Iron Sucrose

Source: aintreerenalunit.nhs.uk/aintreerenal
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

Parenteral iron preparations and iron deficiency anaemia

Source: auspharmlist.net.au
Clinical Resource: Pharmacy E-Bulletin
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Last Checked: 22/02/17 Link Error: Report It

 

Immunoglobulin: when to use
Public Health England

This handbook contains information, indications and guidance for the use of immunoglobulin preparations for each individual disease.

Documents

  • General product information and how to administer immunoglobulin
  • Chickenpox (varicella-zoster) immunoglobulin
  • Diphtheria anti-toxin
  • Hepatitis A immunoglobulin
  • Hepatitis B immunoglobulin
  • Babies of hepatitis B infected mothers
  • Measles immunoglobulin
  • Measles immunoglobulin as post-exposure prophylaxis
  • Mumps and immunoglobulin
  • Polio immunoglobulin
  • Human rabies immunoglobulin
  • Tetanus immunoglobulin
Source: gov.uk
Clinical Resource: Handbook
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Last Checked: 22/02/17 Link Error: Report It

 

Update of the Guideline on the use of high-dose intravenous immunoglobulin in dermatology

Developed by the Guideline Subcommittee “Immunoglobulin” of the European Dermatology Forum

Source: euroderm.org
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

Royal College of Nursing
Assessing, managing and monitoring biologic therapies for inflammatory arthritis

This guidance has been developed to support practitioners in the safe and effective assessment, screening and management of patients when biologic therapies are being considered. It provides practitioners with practical information to help them care for patients with different forms of inflammatory arthritis, in all care settings.

The aim of this document is to provide practitioners with an outline of current biologic therapies, both licensed and unlicensed, and refers the reader to additional key documents and resources that will support practitioners in the UK to develop a standardised approach to caring for patients receiving biologic therapies.

Source: rcn.org.uk
Clinical Resource: Guidance
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Last Checked: 22/02/17 Link Error: Report It

 

Association of British Neurologists Guidelines for the Use of Intraveneous Immunoglobulins in Neurological Conditions

Source: theabn.org
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

Anti-convulsants used in treating status epilepticus

Source: epilepsy.com
Clinical Resource: Table
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Last Checked: 22/02/17 Link Error: Report It

 

Administration of intravenous IV phenytoin injection

To clarify the two correct methods of administering IV phenytoin, the Medicines Governance Project Team have prepared the enclosed administration summary sheet.

Update to Safety Memo 4

Source: medicinesgovernance.hscni.net
Clinical Resource: Memo and Update
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Last Checked: 22/02/17 Link Error: Report It

 

Can small volume intramuscular injections be given to patients taking oral anticoagulants?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

This Medicines Q&A focuses on the potential risks of adverse effects associated with the administration of small volume IM injections to patients taking oral anticoagulants.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Anne Arundel Medical Center
Guidelines for Use of Intravenous Amiodarone (Cordarone®)

Source: aahs.org
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

Digoxin - Loading Dose Guide (Adults)

The intravenous route should be reserved for use in patients requiring urgent digitalisation for supraventricular arrhythmias

Source: icid.salisbury.nhs.uk
Clinical Resource: Guidance
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Last Checked: 22/02/17 Link Error: Report It

 

Continuous Antibiotic Infusions

These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center

Source: surgicalcriticalcare.net
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

Can a 2 gram dose of flucloxacillin be given as a slow intravenous injection?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

The highest strength of flucloxacillin available on the UK market is 1 gram.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Intravenous-to-Oral Switch Therapy

Switching from intravenous (IV) to oral (PO) therapy as soon as patients are clinically stable can reduce the length of hospitalization and lower associated costs. While intravenous medications may be more bioavailable and have greater effects, some oral drugs produce serum levels comparable to those of the parenteral form. Medications involved in switch therapy include antibiotics, analgesics, antipsychotics, and antivirals.

Source: medscape.com
Clinical Resource: Article
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Last Checked: 28/11/16 Link Error: Report It

 

Criteria for Conversion of Medications From Intravenous to Oral/Enteral (IV/PO)
NewYork-Presbyterian Hospital

A number of commonly used medications are known to have virtually equivalent bioavailability when given by either the PO or IV routes.

Source: cumc.columbia.edu
Clinical Resource: Policy
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Last Checked: 28/11/16 Link Error: Report It

 

East Cheshire NHS Trust
Paracetamol IV to oral switch protocol

This document provides nursing, pharmacy and medical staff with a clear framework of how to switch from IV to oral paracetamol.

Source: eastcheshire.nhs.uk
Clinical Resource: Protocol
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Last Checked: 28/11/16 Link Error: Report It

 

Paracetamol - oral or intravenous (iv)?

Efficacy and adverse effects of paracetamol are reported to be similar for both the oral and the iv route. There are, advantages and disadvantages of each route. The iv preparation has disadvantages from safety, use of consumables and administration time perspectives. The oral route has the disadvantage of variable absorption. This bulletin compares these two routes and considers their place in therapy.

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 22/02/17 Link Error: Report It

 

What is the evidence to support the use of IV paracetamol for the short-term treatment of moderate to severe pain?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Intravenous (IV) paracetamol is licensed for the short-term treatment of moderate pain, especially following surgery and for the short-term treatment of fever.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

National Institute for Health and Care Excellence (NICE) Guidance > Intravenous fluid therapy in adults in hospital

Source: nice.org.uk
Clinical Resource: Guidance
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Last Checked: 22/02/17 Link Error: Report It

 

Fluid Management in Adults and Children: Core Curriculum 2014

An understanding of fluid compartments, including the structure and function of the cell and capillary membranes and the changes that occur in health and in disease, is key to providing appropriate fluid management.

Source: ajkd.org
Clinical Resource: Journal Article
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Last Checked: 22/02/17 Link Error: Report It

 

British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients

On behalf of BAPEN Medical - a core group of BAPEN, the Association for Clinical Biochemistry, the Association of Surgeons of Great Britain and Ireland, the Society of Academic and Research Surgery, the Renal Association and the Intensive Care Society.

Source: bapen.org.uk
Clinical Resource: Guideline
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Last Checked: 22/02/17 Link Error: Report It

 

Intravenous Fluids: It’s More Than Just “Fill ’Er Up!”

The purpose of this article is to review basic water and sodium metabolism and relate it to the choice of IV fluid as a function of the volumetric status of the “typical” hospitalized patient and their serum sodium concentration.

Source: virginia.edu
Clinical Resource: Journal Article
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Last Checked: 25/04/16 Link Error: Report It

 

What are Current Recommendations for Treatment of Drug Extravasation?

Source: uic.edu
Clinical Resource: Frequently Asked Question
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Last Checked: 22/02/17 Link Error: Report It

 

Injectable medicines: prescribing, preparing, and administering

After completing this module you should be able to:

  • Adopt a safe system of prescribing, preparing, and administering injectable medications
  • Accurately calculate injectable drug dosages, rates of administration, and volumes of dilutant
  • Use the safety triangle when administering injectable medications
  • Add a medicine to an intravenous infusion
  • Set up a syringe driver.
Source: learning.bmj.com
Clinical Resource: CPD / CME / Learning
Register to Access Content: Yes - registration is FREE

Last Checked: 22/02/17 Link Error: Report It

 

Subcutaneous injection sites

To gain an understanding of the issues associated with Subcutaneous injection sites.

Source: nottingham.ac.uk
Clinical Resource: CE / CPD / Learning
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Last Checked: 22/02/17 Link Error: Report It

 

Subcutaneous injection techniques

To gain an understanding of the issues associated with Subcutaneous injection techniques.

Source: nottingham.ac.uk
Clinical Resource: CE / CPD / Learning
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Last Checked: 22/02/17 Link Error: Report It

 

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