Question

Hi, listed below are questions with explanations on what is needed. really need help with solving problems .

Preparation #1: Azithromycin 500 mg IV Infusion Preparation: Transfer 500-mg of azithromycin solution to an appropriate volume of D5W. Case: You receive an order for Azithromycin 500-mg IV infusion (2-mg/ml final concentration) for the treatment of Community Acquired Pneumonia (CAP). The recommended infusion time at this concentration is 3 hours. Formula: per package insert Azithromycin 500-mg Dry Powder for Injection Vial 500-mg Sterile Water for Injection (SWFI) 4.8ml D5W IV Solution as Total Volume • Per azithromycin 500-mg dry powder for injection label, add 4.8-ml of SWFI to achieve 100-mg/ml concentration. • DSW Injection Solution is available in package Sizes: 50-ml, 100 ml: 250 ml: 500 ml; 1-L Supplies: Azithromycin 500-mg Dry Powder for Injection Vial SWFI 10-ml vial D5W IV Solution (volume determined by desired concentration) Sterile needle(s) Sterile Syringe(s) 70% EtOH Swabs Procedure: (All manipulations are to be performed in an ISO Class 5 work area) 1. Calculate the required quantity of each ingredient 2. Aseptically introduce containers and supplies into the PEC. 3. Aseptically attach a sterile needle to a syringe and withdraw the appropriate (calculated) volume from the DSW IV bag 4. Withdraw needle, recap and detach needle, and discard in sharps container. Place syringe in tote for verification 5. Aseptically attach a sterile needle to a sterile syringe and withdraw the appropriate volume of SWFI from the SWFI vial. 6. Inject the SWFI into the dry powder for injection vial. Carefully allow air to fill the syringe (volume approximate to the volume of SWFI injected into the vial). Do not invert the vial until needle is withdrawn. 7. Recap and detach the sterile needle and discard in the sharps container. 8. Immediately attach a new sterile needle to the syringe and set needle and syringe aside. Maintain contact of first air to critical sites. "May utilize a new syringe for this step. 9. Dissolve the dry powder for injection by agitating the vial. Use caution to maintain contact between first air and critical site of vial. Do not touch the rubber stopper of the vial. 10. Aseptically withdraw the calculated volume of azithromycin injection solution and transfer to the IV bag. 11. Withdraw and recap the needle, then detach and discard the needle in the sharps container 12. Pull back the plunger on the syringe to the volume measured and place empty syringe in tote 13. Place finished CSP and empty drug containers in the tote and place in pass-through for verification.

Answer 1

Preparation - 1

1. To achieve 2mg/ml the total volume of compounded iv infusion will be 250ml

500mg + 250ml = 2mg/ml

2.

a. The infusion rate over 3 hours for this preparation is 2.7mg/min

Total mg to be administered in 3 hours(180 min) is 500 mg.

500mg + 180min = 2.7mg/min

b.

i. The total solution is 250ml

245 ml of D5W and 5 ml of the drug(4.8mlswfi+0.2ml space is for powder for injection)

So, you need to withdraw 5ml first from the D5W solution then mix the same amount of drug i.e 5ml.

ii.

You need to infuse 250ml for over 3 hours. so, you have to infuse 1.4 ml per minute

(1.4ml/min)

250ml = 180min = 1.38ml/min

Here CSP risk is very low(Low-risk) because in this case there is use of sterile needle and syringes in sterile techniques to transfer azithromycin into the D5W solution.

Preparation 2

Patient weight is187lbs (84.82kg)

Ordered dose 2mcg/kg

1. The patient requires 170mcg of fentanyl for IV Push

(170mcg)

84.82kg x 2mcg/kg = 169.64mcg

2. Available solution 250mcg of fentanyl solution in 5ml

So, 0.02ml of solution contains 1 mcg of fentanyl.

5ml - 250mcg = 0.02ml

We need to administer 170 mcg of fentanyl

170mcg x 0.02ml/1mcg = 3.4ml

So, 3.4ml of the solution should be administered.