CHAPTER 19 IV DRUG COMPATIBILITY

● Handbooks for drug incompatibilities: Trissel’s and ● Sometimes things are incompatible if mixed in the
King’s same bag, but compatible if mixed in the line→ you
● DEHP: main reason why certain things cannot be must check both
placed in PVC. This is a plasticizer to make it more ● Drugs with filter requirements:
flexible. ○ Pushy Guys and LALA land→ most require a
○ Primary concerns: 0.22 micron filter, but some need a 1.2
■ Leaching of DEHP into container micron filter*
■ Sorption of drug into container ■ Phenytoin
● Drugs that require non-PVC containers: ■ Golimumab
○ Lorazepam ■ Lipids*
○ Amiodarone ■ Amphoteracin B (lipid
○ Tacrolimus formulations→ needs a 5 micron
○ Insulin filter)*
○ Nitroglycerin ■ Lorazepam
○ Other drugs are mostly chemo, sufetanil ■ Amiodarone
and thiopental ○ If compounding IV medications packaged in
● Place these drugs in: glass ampules, filter needles or filter straws
○ Polyolefin are used to prevent particulates from
○ Polypropylene entering.
○ Glass ● Stability:
● SALINE: do not place these drugs in dextrose ○ The longer a drug remains in solution, the
○ ACID APE dips his bananas in salt. He’s a higher likelihood of a chemical rxn
salt fiend. No dextrose for him. ■ Ex. Zosyn extended infusions are
■ Ampicillin used to increase the time above
■ Caspofungin MIC in order to counter drug
■ Infliximab resistance with Pseudomonas,
■ Daptomycin Enterobacter, and Acinetobacter
■ Ampicillin/sulbactam ● Longer infusion also causes
■ Phenytoin more significant
■ Ertapenem compatibility issues
○ Others: ○ Higher temperatures also promote chemical
■ Abatacept reactions, so most meds are refrigerated
■ Monoclonal antibodies (-umab) ■ Exception: furosemide crystallizes in
■ Iron sucrose the fridge
■ Sodium ferric gluconate complex ● Do not refrigerate:
● DEXTROSE: do not place these drugs in saline ○ Dear Sweet Pharmacist, Marry Me-Forever
○ This hunky pharmacist needs sugar to Eternally!
maintain his ABS; only dextrose for him. ■ Dexmedetomidine
■ Amphoteracin B (all) ■ Sulfamethoxazole/Trimethoprim
■ Bactrim ■ Phenytoin-crystallizes
■ Synercid (quinupristin/dalfopristin) ■ Metronidazole
○ Others: ■ Moxifloxacin
■ Carfilzomib ■ Furosemide-crystallizes
■ Mycophenolate ■ Enoxaparin
■ Pentamidine ○ Others:
■ IV APAP
 ■ Acyclovir-crystallizes
■ Keppra
■ Pentamidine-crystallizes
■ Valproate
● Protect from light
○ Deliver Every Needed Medication...with a
light protective cover
■ Doxycycline
■ Epoprostenol
■ Nitroprusside
■ Micafungin
○ Others:
■ Anthracyclines
■ Dacarbazine (if extravasates,
protect exposed tissues from light)
■ Pentamidine
■ Phytonadione
● Drugs destroyed by agitation:
○ Alteplase
○ Immune globulins
○ Insulins
○ Rasburicase
○ Some vaccines--zoster
○ Quinupristin/dalfopristin and etanercept--
should not be shaken. Only swirl when
reconstituting or else it will foam.