25 RODRIGUEZ, Jannie Belle P.

09 May 2020
1IPH
CHAPTER 15: PARENTERALS

1. Summarize the five general types of injectable materials and identify which can be used
directly/require reconstitution before administration: a) injection, b) for injection, c)
injectable emulsion, d) injectable suspension, and e) for injectable suspension.

1) Injections; liquid preparations that are drug substances or solutions thereof (e.g.,
Insulin Injection, USP)
2) For injection: Dry solids that, upon addition of suitable vehicles, yield solutions
conforming in all aspects to the requirements for injections (e.g., Cefuroxime for
Injection, USP)
3) Injectable emulsion: Liquid preparation of drug substance dissolved or dispersed
in a suitable emulsion medium (e.g., Propofol, USP)
4) Injectable suspension: Liquid preparation of solid suspended in a suitable liquid
medium (e.g., Methylprednisolone Acetate Suspension, USP)
5) For injectable suspension: Dry solid that, upon addition of suitable vehicle, yields
preparation conforming in all respects to the requirements for the injectable
suspensions (e.g., Imipenem and Cilastatin for Injectable Suspension, USP)

2. Make a list of drugs that can cause electrolyte imbalance.

Certain medications may cause an electrolyte imbalance such as:
a) Chemotherapy drugs (cisplatin)
b) Diuretics (furosemide[Lasix] or bumetanide [Bumex])
c) Antibiotics (amphotericin B)
d) Corticosteroids (hydrocortisone)

3. In a table, summarize the advantages and disadvantages of IV administration.

Advantages Disadvantages
 Precise control of dose and  Requires administration by trained
administration rate medical staff
 Rapid exposure  Increased cost
 Potential for reducing injection site  Preparation and injection is time
reactions for irritating agents consuming
 Minimal volume constraints  Requirement for extended duration
of observation post-injection
 Risk of systemic infection
 Needle insertion can be difficult
4. List examples of compounded sterile products from each risk category, that is, low,
medium, and high.

Low-risk category:
a) Reconstitution of a single-dose vial
b) Single preparation of a small volume parenteral
c) single large volume IV replacement fluids with no more than 3 components

Medium-risk category:
a) Batched syringes
b) total parenteral nutrition
c) ophthalmic preparations made from sterile products
d) pooled admixtures
e) batch-compounded preparations without bacteriostatic additives
f) preparations made using automated compounders or other automated devices

High-risk category:
a) CSPs prepared from bulk
b) Nonsterile components or in final containers which are not sterile
c) preparations that must be terminally sterilized before administration

5. Given simulated, daily blood glucose levels, follow a diabetes diet for one week and
calculate your insulin requirements at each meal.

Monday
Breakfast: One poached egg and half a small avocado spread on one slice of Ezekiel
bread, one orange. Total carbs: Approximately 39. Insulin requirement: 3.9 units

Lunch: Mexican bowl: two-thirds of a cup low-sodium canned beans, 1 cup chopped
spinach, a quarter cup chopped tomatoes, a quarter cup bell peppers, 1 ounce (oz) cheese,
1 tablespoon (tbsp) salsa as sauce. Total carbs: Approximately 30. Insulin requirement: 3
units

Dinner: 1 cup penne pasta, 1.5 cups veggie tomato sauce (cook garlic, mushrooms,
greens, zucchini, and eggplant into it), 2 oz lean chicken. Total carbs: Approximately 35.
Insulin requirement: 3.5 units

Tuesday
Breakfast: 1 cup (100g) cooked oatmeal, three-quarters of a cup blueberries, 1 oz
almonds, 1 teaspoon (tsp) chia seeds. Total carbs: Approximately 34. Insulin
requirement: 3.4 units
Lunch: Salad: 2 cups fresh spinach, 2 oz grilled chicken breast, half a cup chickpeas, half
a small avocado, a half cup sliced strawberries, one quarter cup shredded carrots, 2 tbsp
dressing. Total carbs: Approximately 52. Insulin requirement: 5.2 units

Dinner: Mediterranean couscous: two-thirds cup whole wheat cooked couscous, half a
cup sautéed eggplant, four sundried tomatoes, five jumbo olives chopped, half a diced
cucumber, 1 tbsp balsamic vinegar, fresh basil. Total carbs: Approximately 38. Insulin
requirement: 3.8 units

Wednesday
Breakfast: Two-egg veggie omelet (spinach, mushrooms, bell pepper, avocado) with a
half cup black beans, three-quarters cup blueberries. Total carbs: Approximately 34.
Insulin requirement: 3.4 units

Lunch: Sandwich: two regular slices high-fiber whole grain bread, 1 tbsp plain, no-fat
Greek yogurt and 1 tbsp mustard, 2 oz canned tuna in water mixed with a quarter cup of
shredded carrots, 1 tbsp dill relish, 1 cup sliced tomato, half a medium apple. Total carbs:
Approximately 40. Insulin requirement: 4 units

Dinner: Half a cup (50g) succotash, 1 tsp butter, 2 oz pork tenderloin, 1 cup cooked
asparagus, half a cup fresh pineapple. Total carbs: Approximately 34. Insulin
requirement: 3.4 units

Thursday
Breakfast: Sweet potato toast: two slices (100 g) toasted sweet potato, topped with 1 oz
goat cheese, spinach, and 1 tsp sprinkled flaxseed. Total carbs: Approximately 44. Insulin
requirement: 4.4 units

Lunch: 2 oz roast chicken, 1 cup raw cauliflower, 1 tbsp low-fat French dressing, 1 cup
fresh strawberries. Total carbs: Approximately 23. Insulin requirement: 2.3 units

Dinner: A two-thirds cup of quinoa, 8 oz silken tofu, 1 cup cooked bok choy, 1 cup
steamed broccoli, 2 tsp olive oil, one kiwi. Total carbs: Approximately 44. Insulin
requirement: 4.4 units

Friday
Breakfast: A one-third cup of Grape-Nuts (or similar high-fiber cereal), half a cup
blueberries, 1 cup unsweetened almond milk. Total carbs: Approximately 41. Insulin
requirement: 4.1 units

Lunch: Salad: 2 cups spinach, a quarter cup tomatoes, 1 oz cheddar cheese, one boiled
chopped egg, 2 tbsp yogurt dressing, a quarter cup grapes, 1 tsp pumpkin seeds, 2 oz
roasted chickpeas. Total carbs: Approximately 47. Insulin requirement: 4.7 units
 Dinner: 2 oz salmon filet, one medium baked potato, 1 tsp butter, 1.5 cups steamed
asparagus. Total carbs: Approximately 39. Insulin requirement: 3.9 units

Saturday
Breakfast: 1 cup low-fat plain Greek yogurt sweetened with half a banana mashed, 1 cup
strawberries, 1 tbsp chia seeds. Total carbs: Approximately 32. Insulin requirement: 3.2
units

Lunch: Tacos: two corn tortillas, a one-third cup cooked black beans, 1 oz low-fat cheese,
2 tbsp avocado, 1 cup coleslaw, salsa as dressing. Total carbs: Approximately 70. Insulin
requirement: 7 units

Dinner: Half medium baked potato with skin, 2 oz broiled beef, 1 tsp butter, 1.5 cups
steamed broccoli with 1 tsp nutritional yeast sprinkled on top, three-quarters cup whole
strawberries. Total carbs: Approximately 41. Insulin requirement: 4.1 units.

Sunday
Breakfast: Chocolate peanut oatmeal: 1 cup cooked oatmeal, 1 scoop chocolate vegan or
whey protein powder, 1 tbsp peanut butter, 1 tbsp chia seeds. Total carbs: Approximately
21. Insulin requirement: 2.1 units

Lunch: One small whole wheat pita pocket, half a cup cucumber, half a cup tomatoes,
half a cup lentils, half a cup leafy greens, 2 tbsp salad dressing. Total carbs:
Approximately 30. Insulin requirement: 3 units

Dinner: 2 oz boiled shrimp, 1 cup green peas, 1 tsp butter, half a cup cooked beets, 1 cup
sauteed Swiss chard, 1 tsp balsamic vinegar. Total carbs: Approximately 39. Insulin
requirement: 3.9 units

6. Review the daily requirements of electrolytes, vitamins, and essential/non-essential

amino acids, and then compare these values to your daily dietary intake and the contents
found within a representative daily multivitamin product.
 Comparing the daily requirements of electrolytes, vitamins, and non-
essential/non-essential amino acids to my daily dietary intake, I can say that I am
inconsistent with my nutrient intake. Some days I may be taking the sufficient
quantities but some days I don’t. However, I am able to supply myself with these
essential vitamins and electrolytes through multivitamins as well as electrolyte
drinks.

7. Perform a primary literature search that addresses the use of standardized versus
individualized TPN orders, and compare/contrast the pros/cons of each.
 Parenteral nutrition can be administered either as a regular formulation of
standard PN (SPN) or as an individualized formulation of PN (IPN). SPN may
have advantages in terms of rapid availability, fewer prescription errors, lower
risk of infection and cost savings but IPN, specifically tailored to the needs of an
infant, may achieve better nutrient intake and weight gain results.
25 RODRIGUEZ, Jannie Belle P. 09 May 2020
1IPH
CHAPTER 16: BIOLOGICS

1. List vaccination resources: Health care providers can refer patients and caregivers to
regarding scheduled vaccines for adult and children.
 Centers for Disease Control and Prevention (CDC)
 American Pharmacists Association (APA)
 World Health Organization (WHO)
 The International Federation of Red Cross and Red Crescent Societies

2. Define and explain the term “cold chain” as it relates to the storage, handling, and
shipping of biologics.
 The overriding theme for the pharmacist in storage, handling, and shipping of
biologic products is to maintain the cold chain. This implies continuity from the
manufacturer’s refrigerator to one’s pharmacy, clinic, or office administration. If
the cold chain is maintained, the pharmacist can be assured that the quality of the
product will not be diminished.

3. Describe the different methods of inducing immunity via bacterial vaccines.

 The organism is grown in a suitable broth medium in a controlled environment of
temperature, pH, and oxygen tension. Another way to create a vaccine is to
employ purified antigen subunits produced with use of recombinant DNA.

4. List the required components of maintaining permanent vaccination records.

a) The vaccine manufacturer.
b) The lot number of the vaccine.
c) The date the vaccine is administered.
d) The name, office address, and title of the healthcare provider administering the
vaccine.
e) The Vaccine Information Statement (VIS) edition date located in the lower right
corner on the back of the VIS. When administering combination vaccines, all
applicable VISs should be given and the individual VIS edition dates recorded.
f) The date the VIS is given to the patient, parent, or guardian.

5. Compare and contrast the different types of oncological vaccinations.

 T cells, lymphokine-activated killer cells, and natural killer cells have antitumor
activity.
 Autologous tumor vaccines are developed from antigenic material procured from
the tumor of the patient.
 Allogeneic tumor vaccines use the concept of shared or tumor-specific antigens.
 Anti-idiotypic vaccines are three-dimensional immunogenic regions on the
antibody that binds antigen.
 Gene therapy allows a DNA template to be placed within a cell, transcribed into
messenger RNA, and expressed as a costimulatory protein.
25 RODRIGUEZ, Jannie Belle P. 09 May 2020
1IPH
CHAPTER 17: SPECIAL SOLUTIONS AND SUSPENSIONS

1. List eye care resources that health care providers can refer patients and caregivers to
regarding proper use of contact lens products.
 American Optometric Association
 World Health Organization
 All About Vision

2. Go to the American Optometric Association website, that is, www.aoa.org, and perform
the classroom exercises, which are created for parents and educators (lower left corner).
 Classroom Exercises: Day and Night
 Classroom Exercises: Pinhole Focusing

3. Describe the procedure for the chemical disinfection of an RPG or soft contact lens.

How to disinfect soft contact lenses:

a) Rub and rinse contact lenses and place them in a fresh solution every time they
are cleaned.
b) In the case, never mix fresh solution with old or used solution — a technique
called "topping off "— because it decreases disinfection effectiveness.
c) Rub and rinse contact lens storage case with fresh solution, not water, daily.
d) Remove from the case any excess solution and dry it with a new, clean tissue.
e) In a clean, dry environment, store the clean case upside down on a fresh, clean
tissue with the caps off after each use to prevent germs from building up in the
case.

4. List precautions associated with contact lens use, and write how you would counsel a
patient to avoid adverse effects associated with misuse.

Lens Wearing Precautions:

a) Remove your lenses immediately if redness or irritation occurs in your eyes.
b) Never wear your lenses beyond the recommended amount of time by your eye
doctor.
c) Avoid all vapors and fumes which are harmful or irritating while wearing your
contacts.
d) You are advised to remove your soft lenses prior to swimming or while taking a
bath as this may increase the risk of eye infection.
e) Always throw away worn lenses as prescribed by your eye doctor.
5. Isotonicity Calculation Exercise:
a) How many milligrams of sodium chloride should be used to compound the following
prescription? Given: Ephedrine sulfate SCE = 0.20

Rₓ: Ephedrine sulfate 0.3

Sodium chloride qs
Purified water qsad 30
Sig: Use as directed

Ans. 60 mg

b) How many grams of anhydrous dextrose (SCE = 0.18) should be used to prepare one
liter of a 0.5% isotonic ephedrine sulfate nasal spray? 0.6 g

6. How to use a pump nasal spray:

1) Shake. Hold the bottle with your index and middle fingers on each side of the
bottle and your thumb on the bottom of the bottle.
2) Prime the bottle. This is typically done by spraying the product one or more
times into the air or into a tissue. See the product label for specific instructions.
3) Blow. Blow your nose gently. This will help clear the nostrils.
4) Close the nostril that is not receiving the medication. Do this by gently pressing
on that side of your nose.
5) Aim. Insert the tip of the bottle into the other nostril.
6) Breathe and spray. Breathe in deeply through that nostril as you press down on
the pump with your index and middle fingers. Remove the bottle and sniff once or
twice. Repeat if directed. Wait at least 10 seconds between sprays.
7) If directed, repeat steps 3–6 for the other nostril.