Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5334_Библиотеки_им_академика_М_И_Перельмана
.pdf
44.
45.
46.
47.
48.
Aminophylline is not to be administered in pediatric patients at a rate
greater than 25 mg/min, to avoid excessive peak serum concentrations
and possible circulatory failure. What should be the maximum
infusion rate, in milliliters per minute, for a solution containing 10
mg/mL of aminophylline in 100 mL of D5W?
An intravenous infusion contains 5 mg of zoledronic acid
(RECLAST) in 100 mL. If the infusion is to be administered in 15
minutes, how many (a) milligrams of zoledronic acid and (b)
milliliters of infusion must be administered per minute? And (c),
using a drip set that delivers 20 drops/milliliter, how many drops per
minute must be infused?
Abatacept (ORENCIA), used to treat rheumatoid arthritis, is available
in vials, each containing 250 mg of powdered drug, intended to be
reconstituted to 10 mL with sterile water for injection. The dose of
abatacept depends on a patient’s body weight: <60 kg, 500 mg; 60 to
100 kg, 750 mg; and >100 kg, 1 g. The contents of the appropriate
number of vials are aseptically added to a 100-mL infusion bag or
bottle of sodium chloride injection after the corresponding volume of
sodium chloride injection has been removed. The concentration of
abatacept in an infusion for a 200-lb patient would be:
a. 5.8 mg/mL
b. 6.25 mg/mL
c. 6.8 mg/mL
d. 7.5 mg/mL
Temsirolimus (TORISEL), for use in advanced renal cell carcinoma,
is prepared for infusion by adding 1.8 mL of special diluent to the
drug vial resulting in 3 mL of injection containing 10 mg/mL of
temsirolimus. The required quantity is then added to a 250-mL
container of sodium chloride injection for infusion. The
recommended dose of temsirolimus is 25 mg infused over 30 to 60
minutes. The quantity of drug delivered, in mg/mL, and the rate of
infusion, in mL/min, for a 30-minute infusion are:
a. 0.099 mg/mL and 8.42 mL/min
b. 0.099 mg/mL and 8.33 mL/min
c. 1 mg/mL and 8.42 mL/min
d. 1 mg/mL and 8.33 mL/min
Nicardipine hydrochloride (CARDENE IV) is administered in the
short-term treatment of hypertension by slow intravenous infusion at
a concentration of 0.1 mg/mL. A 10-mL vial containing 25 mg of
nicardipine hydrochloride should be added to what volume of D5W to
achieve the desired concentration of infusion?
a. 80 mL
49.
50.
51.
52.
53.
b. 100 mL
c. 240 mL
d. 250 mL
Calculations of Monoclonal Antibody (mAb) Infusions
The mAb eculizumab is available in 30-mL vials containing 300 mg
of drug. Prior to administration by intravenous infusion, the solution
is diluted with sodium chloride injection to a concentration of 5
mg/mL. The dose of eculizumab is 600 mg infused over a 35-minute
period. Calculate the rate of infusion in drops/minute using an
administration set that delivers 15 drops/mL.
Using Table 13.4 and Figure 8.2 as references, (a) calculate the initial
dose of cetuximab for a 140-lb patient measuring 65 inches in height.
If cetuximab is available in vials containing 200 mg/100 mL, (b)
calculate the volume to be used in an infusion. If the infusion is
delivered over 120 minutes and the package insert states that rate of
delivery of cetuximab should not exceed 10 mg/min, (c) calculate
whether or not that standard is being met.
The mAb natalizumab is available in vials containing 300 mg/15 mL.
Prior to infusion, the contents are added to 100 mL of normal saline
injection. Refer to Table 13.4 as needed, and calculate (a) the
concentration of natalizumab in the infusion, in mg/mL, and (b) the
rate of infusion, in mL/min.
Cetuximab (ERBITUX) injection is used by intravenous infusion in
the treatment of certain cancers. It has a recommended initial dose of
400 mg/m2 to be administered over 120 minutes with a maximum
infusion rate of 10 mg/min. The injection is supplied in single-use
vials containing cetuximab, 100 mg/50 mL. (a) Using the BSA
equation, calculate the dose for a patient weighing 154 lb and
measuring 5 feet 8 inches in height. (b) How many milliliters of
cetuximab injection will provide the dose required? (c) If the
calculated dose is administered over 120 minutes, what would be the
rate of flow in mg/min?
The dose of ofatumumab (ARZERRA) for a patient is 300 mg. In
preparing an intravenous infusion, a pharmacist draws a calculated
volume of ofatumumab injection from a 50-mL vial containing 1 g of
ofatumumab. This quantity is then added to a 1-L bag of sodium
chloride injection for the intravenous infusion. The infusion is
programmed to flow at a rate of 3.6 mg of ofatumumab/hour.
Calculate (a) the volume, in milliliters, of ofatumumab injection to
use, (b) the rate of flow of the infusion in mL/min, and (c) the total
flow time, in hours, for completion of the infusion.
Critical Care Calculations
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
11
A medication order calls for dopamine, 400 mg in 500 mL of D5W,
to run initially at 4 mcg/kg/min and then titrated to 12 mcg/kg/min to
stabilize blood pressure in a 140-lb patient. Calculate the (a) initial
infusion rate in mL/h and (b) titrated rate in mL/h.
11
A medication order calls for esmolol hydrochloride, 5 g/500 mL of
D5W, for the rapid control of ventricular rate in a 143-lb patient. The
infusion is programmed to run at 50 mcg/kg/min. Calculate the
infusion rate in mL/h.
11
Sodium nitroprusside is ordered at 0.3 mcg/kg/min for a 220-lb
patient. A vial containing 50 mg of sodium nitroprusside in 2 mL is
diluted to 250 mL with NSI and ordered to run at 14 mL/h. Is this run
rate correct? If not, what should be the correct infusion rate?
11
Procainamide 0.5 g in 250 mL of D5W is ordered to run at 2
mg/min. Calculate the flow rate in mL/h.
A pharmacist prepared a dopamine HCl solution to contain 400
mg/250 mL D5W. Calculate:
a. the concentration of dopamine HCl in the infusion, in mg/mL, and
b. the infusion flow rate, in mL/h, for a 150-lb patient, based on a dose
of 5 mcg/kg/min.
11
The following was ordered for a critical care patient: 2 L
D5W/0.45%NS to run over 24 hours with a 2000-mL IV fluid daily
limit. An IVPB antibiotic is ordered to run every 6 hours separately in
50 mL of D5W over 30 minutes. The drop factor is 60 drops/mL.
Calculate the flow rates, in drops/minute, of the (a) IVPB and (b)
D5W/0.45% NS.
Miscellaneous Calculations
NIMBEX injection contains 2 mg cisatracurium besylate/mL in 5-mL
single-dose vials. The contents of the vial are diluted in dextrose
injection to a drug concentration of 0.1 mg/mL prior to infusion. How
many milliliters of dextrose injection are required to prepare the
infusion?
If the NIMBEX infusion, as described in problem 60, is administered
to a 70-kg patient at the rate of 1.5 mcg/kg/min, calculate the delivery
rate in mL/h.
How many minutes will the NIMBEX infusion, as described in
problems 60 and 61, run until empty?
If the infusion delivery set for the NIMBEX infusion, as described in
problems 60 and 61, delivers 60 microdrops/milliliter, how many
microdrops/minute would be delivered?
If the infusion rate for epoprostenol sodium (FLOLAN) at a
concentration of 3 mcg/mL is prescribed as 10 ng/kg/min, calculate
65.
66.
67.
68.
the infusion delivery rate, in mL/h, for a patient weighing 132 lb.
If the infusion, as described in problem 64, runs for 15 minutes, how
many mcg of epoprostenol sodium will have been infused?
Eptifibatide (INTEGRILIN) injection, for intravenous infusion, is a
platelet aggregation inhibitor. The usual dose is 180 mcg/kg as an
intravenous bolus followed by infusion at 2 mcg/kg/min. Calculate,
for a 220-lb patient, the (a) bolus dose, in mL, from a single-use vial
containing eptifibatide, 2 mg/mL; and (b) infusion rate, in mL/h,
using an infusion containing eptifibatide, 0.75 mg/mL.
The dose of an antimicrobial drug for pediatric patients ≤ 3 months of
age and weighing ≥ 1500 g is given as:
<1 week of age: 25 mg/kg every 12 hours
1 to 4 weeks of age: 25 mg/kg every 8 hours
4 weeks to 3 months of age: 25 mg/kg every 6 hours
Doses of 500 mg or less should be administered by intravenous infusion
over 15 to 30 minutes.
Doses greater than 500 mg should be infused over 40 to 60 minutes. If the
infusion is prepared to contain 250 mg of drug/100 mL of solution,
calculate (a) the dose, in milligrams/__ hours, for a patient who is 2
months old and weighs 3.76 kg and (b) the rate of the infusion, in mL over
____ minutes.
The following questions relate to the product label shown in Figure
13.7.
FIGURE 13.7 Drug product label. (Source:
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?
setid=e518dfc6-7e93-4fee-a66c-51e1ab71c056. Courtesy Pfizer,
Inc.)
a. Pharmacy directions: The contents of the vial are added to 5%
dextrose injection to prepare an intravenous infusion to have a drug
concentration in the range of 0.12 mg/mL to 2.8 mg/mL. How
many milliliters of infusion may be prepared for each concentration
extreme?
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
b. If a drug concentration of 2.8 mg/mL is prepared and the dose for a
patient is 125 mg/m2 infused over 90 minutes, what should be the
rate of flow in mL/min for the patient having a BSA of 0.8 m2?
CALCQUIZ
13.A. aA hospital pharmacy receives a medication order for 500 mg
aminophylline in 250-mL normal saline solution for a 132-lb patient.
The aminophylline is to be administered at a dose of 300 μg/kg/h using
an IV set that delivers 60 drops/mL. The pharmacy has 20-mL vials of
injection containing aminophylline, 25 mg/mL. Calculate the following:
a. The milliliters of aminophylline injection that should be added to
the normal saline solution
b. The total volume of the intravenous infusion
c. The milligrams of aminophylline administered per hour
d. The duration, in hours, for the complete infusion
e. The number of milliliters of infusion delivered per hour (flow rate,
mL/h)
f. The number of drops administered per minute (flow rate,
drops/minute)
13.B. aA hospitalized patient is receiving an intravenous infusion
containing 40 mEq of potassium chloride in a liter of fluid. The IV set
being used is calibrated to deliver 15 drops/mL with a flow rate of 12
drops/minute. How many (a) milligrams, (b) milliequivalents, and (c)
millimoles of potassium chloride are delivered each hour?
13.C. A physician submits a medication order for a 110-lb patient
calling for an intravenous drip containing 400 mg of dopamine in a 250mL bag of normal saline solution. The drip is to be run at 5 μg/kg/min
with an IV set that delivers 15 drops/mL. Calculate the following:
a. The milliliters of a dopamine injection, 40 mg/mL, to use in the
infusion
b. The concentration of dopamine in the infusion in mg/mL
c. The drip rate in drops/minute
d. The infusion rate in mL/h
13.D. A medication order for a patient in the critical care unit of a
hospital calls for a continuous intravenous infusion of isoproterenol, 5
μg/min. The standard protocol is to add the contents of a 5-mL ampul of
a 1:5000 isoproterenol injection to 250 mL of dextrose 5% in water. The
critical care nurse uses an IV set programmed to deliver 12 drops/mL.
Calculate the following:
1.
2.
a. The quantity of isoproterenol, in μg/mL, in the 5-mL ampul of
isoproterenol injection
b. The concentration of isoproterenol, in μg/mL, in the infusion
c. The flow rate of the intravenous infusion in drops/minute
d. The duration of the completed infusion in minutes
13.E. A hospital pharmacy received an order for 250 mL of a
premixed injection containing 50 mg of nitroglycerin in D5W. The
initial infusion rate was prescribed at 5 μg/min to be increased by 5
μg/min every 5 minutes as needed up to a maximum of 20 μg/min. An
infusion set delivering 60 microdrops/mL was used. Calculate the
following:
a. The concentration of nitroglycerin in the infusion in μg/mL
b. The initial rate of infusion in mL/h
c. The maximum rate of infusion (20 μg/min) in microdrops/min and
in mL/h
a
Problem courtesy of Flynn Warren, Bishop, GA.
ANSWERS TO “CASE IN POINT” AND
PRACTICE PROBLEMS
Case in Point 13.1
a. 15 mg/min × 10 min = 150 mg amiodarone HCl needed for the rapid
infusion. Vial contains 50 mg/mL, so 3 mL are needed = one 3-mL
vial.
b. 150 mg amiodarone in 103 mL; 150 mg ÷ 103 mL = 1.46 mg/mL
c. 3 (vials) × 3 mL = 9 mL × 50 mg/mL = 450 mg amiodarone HCl
450 mg ÷ 259 mL = 1.74 mg/mL amiodarone HCl
d. 60 minutes × 1 mg/min = 60 mg amiodarone HCl
60 mg ÷ 1.74 mg/mL = 34.5 mL/h
e. 34.5 mL × 15 drops/mL = 517.5 drops in 1 hour
517.5 drops ÷ 60 = 8.625 or about 9 drops/minute
f. 1 mg/min × 60 min/h × 6 h = 360 mg
g. 0.5 mg/min × 60 min/h × 18 h = 540 mg
Practice Problems
1.8 g sodium chloride
40 g dextrose
2.08 g dextrose
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
0.19 g sodium chloride
50 drops/minute
2:00 PM
8 hours, 20 minutes
300 minutes
500 minutes
6 mL daptomycin injection
5 mL lidocaine injection
2 mg/mL fluconazole
1344 mL IVIG
3.03 mcg/kg/min dopamine HCl
0.6 mL
13.33 mL
1.8 mL amikacin sulfate injection
500 minutes
a. 7.1 mL
b. 1.79 mL/min
c. 35.7 or 36 drops/minute
a. 1.82 mL
b. 0.89 mg/mL vancomycin
a. 3.94 or 4 drops/minute
b. 5.26 or 5 drops/minute
c. 15.77 or 16 drops/minute
a. 41.67 or 42 drops/minute
b. 166.67 mL/h
1.1 mL
52.8 mg
8.33 mg
40 drops/minute
7 mL amphotericin B
a. 2.5 mL heparin
b. 2.08 mL/min
32.5 or 33 drops/minute
41.67 or 42 drops/minute
192 mg
9:35 PM
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
a. 25 vials
b. 3 vials
c. 3 bags
40 drops/minute
a. 31.25 or 31 drops/minute
b. 0.31 unit
a. a.14.4 mg/h
b. 72 drops/minute
Approximately 50 drops/minute
3.5 minutes
8.08 mL/h
a. 5 mL
b. 0.53 mL/min
a. 24 mL/h
b. 6 drops/minute
75 mL/h
40 minutes
14.25 mL/h
15.82 or 16 drops/minute
65 mL/h
0.58 mL/min
2.5 mL/min
a. 0.33 mg zoledronic acid
b. 6.67 mL
c. 133 drops/minute
d.7.5 mg/mL
a.0.099 mg/mL and 8.42 mL/min
c.240 mL
51.43 or 51 drops/minute
a. 680 mg cetuximab
b. 340 mL
c. 5.67 mg/min; yes
a. 2.61 mg/mL natalizumab
b. 1.92 mL/min
a. a.733.04 mg cetuximab dose
b. 366.52 mL cetuximab injection
c. 6.11 mg/min
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
1.
2.
3.
4.
5.
6.
a. 15 mL ofatumumab injection
b. 0.203 mL/min
c. 83.33 hours
a. 19.09 mL/h
b. 57.27 mL/h
19.5 mL/h
No; 9 mL/h
60 mL/h
a. 1.6 mg/mL
b. 12.78 mL/h
a. 100 drops/minute IVPB
b. 83 drops/minute D5W/0.45%NS
95 mL dextrose injection
63 mL/h delivery rate of infusion
95.24 minutes
63 microdrops/minute
12 mL/h
9 mcg epoprostenol sodium
a. 9 mL, bolus dose
b. 16 mL/h
a. 94 mg drug every 6 hours
b. 37.6 mL infused over 15 to 30 minutes.
a. 35.71 mL (at 2.8 mg/mL) to 833.33 mL (at 0.12 mg/mL)
b. 0.397 mL/min
References
US Pharmacopeial Convention, Inc. General Chapters. <797> Pharmaceutical Compounding
—Sterile Preparations. In: United States Pharmacopeia 42 National Formulary 37 [book
online]. Rockville, MD: US Pharmacopeial Convention, Inc.; 2019.
Boh L. Pharmacy Practice Manual: A Guide to the Clinical Experience. Baltimore, MD:
Lippincott Williams & Wilkins; 2001:418.
Papadopoulos J, Rebuck JA, Lober C, et al. The critical care pharmacist: an essential intensive
care practitioner. Pharmacotherapy 2002;22(11). Available at:
http://www.medscape.com/viewarticle/444371. Accessed July 2, 2020.
Critical care drugs. Available at: http://quizlet.com/12905842/critical-care-drugs-flash-cards/.
Accessed July 2, 2020.
Workplace Nurses LLC. Commonly used critical care infusions. Available at:
http://workplacenurses.com/id69.html. Accessed July 2, 2020.
ISMP Safe Practice Guidelines for Adult IV Push Medications. Institute for Safe Medication
Practices; 2015. Available at: https://www.ismp.org/sites/default/files/attachments/201711/ISMP97-Guidelines-071415-3.%20FINAL.pdf. Accessed July 2, 2020.
7.
8.
9.
10.
11.
Larsen GY, Howard PB, Cash J, et al. Standard drug concentrations and smart-pump
technology reduce continuous-medication-infusion errors in pediatric patients. Pediatrics
2005;116:e21–e25. Available at: http://pediatrics.aappublications.org/content/116/1/e21.full.
Accessed July 3, 2020.
Mitchell A, Sommo P, Mocerine T, et al. A standardized approach to pediatric parenteral
medication delivery. Hospital Pharmacy 2004;39:433–459.
Gomella TL, Cunningham MD, Eyal FG, et al. Neonatology: Management Procedures, On-
Call Problems, Diseases, and Drugs. New York, NY: Lange Medical Books; 2004:69–73.
Craig GP. Clinical Calculations Made Easy. 2nd Ed. Philadelphia, PA: Lippincott Williams &
Wilkins; 2001:225–228.
Lacher B. Pharmaceutical Calculations for the Pharmacy Technician. Baltimore, MD:
Lippincott Williams & Wilkins; 2008:287.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Соседние файлы в папке Библиотека им академика М.И. Перельмана