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2.2.4: Compound sterile and nonsterile products, considering physiochemical properties of drugs that affect solubility and 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

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 antifungal preparation carries a relative contraindication against use in patients with severe renal insufficiency (due to risk of renal complications from a carrier molecule)?

(A) IV fluconazole

(B) IV voriconazole

(C) Oral itraconazole

(D) IV caspofungin

(E) Oral fluconazole

The correct answer is (B).

IV voriconazole uses a cyclodextrin carrier molecule. Related cyclodextrins have been associated with nephrotoxicity in some animal studies.

Which one of the following increases the solubility of calcium and phosphate in a PN solution?

(A) Increased temperature

(B) Use of sodium phosphate compared to potassium phosphate

(C) Use of calcium chloride instead of calcium gluconate

(D) Increased amino acid concentration in the PN

The correct answer is (D).

Increasing the amino acid concentration of the PN tends to decrease the pH of the solution, thus increasing the solubility of calcium and phosphate. The low amino acid concentration of neonatal PN solutions, together with high requirements for calcium and phosphate in neonates, ...

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