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Manage Mixing Medicines Safely 💊💉 (Guidance of mixing in the UK 📝 (Be…
Manage Mixing Medicines Safely
💊💉
Common incompatibility reactions in practice 🔬
Physicochemical reactions
Ionic reactions
Form a highly insoluble salts
Avoid to mix products containing polyvalent ion
Change in concentration
Affect the compatibility of some drug combination
Give attention to minimal volumes those are required
Change in pH
Precipitate of unionised, insoluble drug.
Buffer of diluent solution will resist any small changes to pH.
Addition Alcohol or lipid solvents
Improve the solubility of poorly water soluble drugs.
Propylene glicol
Glycerine
Polyethylene glicol
e.g.
Fat emulsions
Easily be destabilised, cracked or separated
Electrolytes should only ever be added to TPN in a specialist pharmacy aseptic unit
TPN
Drug Formulations
Intralipid
Chemical instability
Adsorption
Reduces the amount of drug available to be administered
in-line filters are required for certain medicines
TPN
Monoclonal antibodies
Phenytoin
e.g.
Denaturation
Monoclonal antibodies, should never be mixed with other drug compounds
Always be administered through separate lines.
Oxidation, reduction and hydrolysis
The chemcial degradation of drug
The addition of an aqueous solution
Changes in temperature or pH
Exposure to oxygen
Examples of Incompatible Drug Reactions
Calcium and Phospate
Concenteration related. Insoluble additive is formed
Oxycodone and cyclizine
Concenteration related. Precipitation above 3 mg/ml of cyclizine
Amphotericin & electrolyte solutions
Ionic incompatibilities. Amphotericin can precipitate out
Atracurium high pH solutions
High pH solutions
Risks of mixing medicines ⚠
Incompatible with one another drug's ingredients
Wrong mixing medicine or dose
Clinical consequences of inappropiate mixing : cause severe harm to a patient
Reducing Risk ⏬
Monitor for reaction
Injection site reaction
Signs of organ failure
Thrombophlebitis
Seek advice
Reference Source
The Online Medusa database for Injectables
American Society of Health-System Pharmacists's Handbook on injectable drugs
Avoid Mixing
Prescribing a suitable alternative drug
Alternative route of drug administration (e.g. rectal/sublingual)
Guidance of mixing in the UK 📝
Be avoided where possible
Take place in pharmacy
Only be undertaken in the best interests of the patient
Done by professional/competent
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