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2.2.2: Compound sterile and nonsterile products, considering physicochemical properties of active and inactive ingredients

Select the salt formation of piperacillin/tazobactam.

(A) Potassium

(B) Hydrochloride

(C) Sodium

(D) Piperacillin is not available in a salt formulation

The correct answer is (C).

Piperacillin is a sodium salt and may increase sodium levels. 4.5 g of piperacillin/tazobactam contains 11/17 mEq of sodium and 3.375 g contains 8.38 mEq of sodium.

Answers (A), (B) and (D) are incorrect.

Which one of the following amino acid profiles best describes a specialty formulation for use in patients with hepatic encephalopathy compared to standard amino acid formulations?

(A) Lower in branched chain amino acids, lower in aromatic amino acids

(B) Higher in branched chain amino acids, lower in aromatic amino acids

(C) Higher in essential amino acids, lower in nonessential amino acids

(D) Fortified with dipeptides containing glutamine

The correct answer is (B).

Aromatic amino acids tend to accumulate in hepatic failure, whereas branched chain amino acids in the blood are decreased. According to the false neurotransmitter theory, aromatic amino acids compete for transport across the blood-brain barrier with branched chain amino acids and are converted to false neurotransmitters such as octopamine, leading to hepatic encephalopathy. Feeding of a parenteral amino acid formula fortified with branched chain amino acids and with lesser amounts of aromatic amino acid formulas can help normalize amino acid levels in the blood. Such formulas have been shown to help patients "wake up" from hepatic encephalopathy, but data demonstrating improved outcomes in terms of mortality with use of these products are limited. They should be reserved for use in hepatic encephalopathy patients who have failed standard medical therapy.

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