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2.2.3: Compound sterile and nonsterile products, considering identifying the presence of, and the cause of, product incompatibilities or degradation and methods for achieving stability

When preparing an IV formulation of amphotericin B deoxycholate (desoxycholate), the lyophilized amphotericin B powder must first be reconstituted with sterile water. What type of IV fluid must the reconstituted amphotericin B be placed in for IV administration?

(A) 0.9% sodium chloride

(B) 5% dextrose in water

(C) Lactated Ringer's solution

(D) 0.45% sodium chloride

The Correct Answer is: B

5% dextrose in water (B) will maintain the micellular distribution that is required for IV amphotericin B desoxycholate.

0.9% sodium chloride (A), lactated Ringer's solution (C), and 0.45% sodium chloride (D) will not maintain the micellular distribution.

Topic: Invasive Fungal Infections

Which one of the following would be most likely to cause instability when added to a TNA?

(A) Famotidine

(B) Regular insulin

(C) Iron dextran

(D) Folic acid

The correct answer is (C).

As a multivalent cation, iron dextran has the capacity to neutralize the zeta potential on fat globules, thus destabilizing a TNA. If parenteral iron is required in a patient receiving a TNA, it can either be administered outside the PN, or it can be administered via a dextrose/amino acid solution on days when the lipid is omitted from the formulation.

When administering drugs via enteral feeding tube:

(A) Extended-release medications are always preferable to immediate-release dosage forms.

(B) As long as tablets are crushed very finely they will retain their pharmacokinetic properties.

(C) All drugs that a patient receives should be given simultaneously to minimize feeding interruptions.

(D) Liquid medications may interact with nutritional formula and clog the feeding tube.

The correct answer is (D).

Some liquid medications have physical incompatibilities with enteral nutrition products, which may thicken the products or form a gel.

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