Reconstituting Powdered Medications Medications that lose potency quickly in solution are supplied in powdered form; are reconstituted using an appropriate diluent. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Instructions for reconstitution are found on the drug label, in the package insert, or in the PDR. Follow instructions that are specific to the medication to be administered.

Reconstituting Powdered Medications (cont.) Determine the solvent to be used to dilute medication. Sterile water Saline Bacteriostatic solution Some meds are packaged with the appropriate solvent. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Bacteriostatic saline contains a preservative to prevent growth of microorganisms. The label or package insert lists how much solvent to combine with the medication. Read the directions carefully. Sometimes different amounts of solvent are used, based on whether the medication is for IM or IV use.

Reconstituting Powdered Medications (cont.) Some medications are mixed with lidocaine. This decreases pain on injection. Label or package insert indicates when lidocaine can be used. Must have a physician’s order to use it. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Lidocaine is a local anesthetic and helps to decrease pain during injection. Always check to be sure lidocaine can be used. Be careful to use only lidocaine and NOT the combination of lidocaine and epinephrine. Epinephrine will cause vasoconstriction at the injection site and delay absorption of the medication. Never use without a physician’s order.

Reconstituting Powdered Medications (cont.) Rule 14-5 To reconstitute a powdered medication: find the directions; use a sterile syringe and aseptic technique to draw up the diluent; Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Directions for reconstitution will be on the label or in the package insert. Be sure to use the correct amount of the appropriate diluent.

Reconstituting Powdered Medications (cont.) Rule 14-5 (cont.) inject the diluent into the medication vial; agitate the mixture by rolling, inverting, or shaking the vial. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Check the directions on the label or package insert for which of these methods to use.

Reconstituting Powdered Medications (cont.) Rule 14-5 (cont.) make sure the powdered medication is completely dissolved. The solution must be free of visible particles. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Inspect the solution carefully.

Reconstituting Powdered Medications (cont.) Use the specified amount of diluent. Too much – Dosage strength will be incorrect. Too little Powder may not dissolve completely. Dosage strength will be incorrect. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Powder takes up volume even when dissolved, and the volume of the reconstituted medication includes the volume of the diluent and that of the powder. Medications that lose potency quickly should be reconstituted just before administration. Medications may be reconstituted in a facility’s pharmacy and delivered ready for use.

Reconstituting Powdered Medications (cont.) Rule 14-6 When storing a medication after reconstitution: record the date, the time of expiration, and your name or initials; for multiple-dose medications, also record the solution strength. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Some facilities may require date of reconstitution. Check the drug label or package insert for the length of time a reconstituted medication may be stored. Storage time may depend on whether the medication is refrigerated.

Reconstituting Powdered Medications (cont.) Amount of diluent = 5 mL Route = IV only Diluent = 0.9% NaCl without preservatives Instructions = shake to dissolve Solution strength = 38 mg/mL Storage = no refrigeration Example Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Refer to label for exercises 10-15. Solution strength = write on label Storage – single dose vial; discard unused portion

Reconstituting Powdered Medications (cont.) Ordered: Gemcitabine HCl 125 mg IVSS On hand: see label H = 38 mg Q = 1 mL D = 125 mL Example (cont.) Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Dose on hand is based on the reconstituted medication. Cannot use 200 mg because you do not know the actual volume of solution after reconstitution. It will be more than 5 mL because the powder adds volume.

Reconstituting Powdered Medications (cont.) Step A No conversion is necessary. Step B Calculate amount to administer using preferred method. 125 mg / 38 mg x 1 mL = A 3.29 x 1 mL = A 3.3 mL = A Example (cont.) Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Because the amount is greater than 1, round to the nearest tenth.

Reconstituting Powdered Medications (cont.) Step C Dose ordered (125 mg) is greater than 3 time that of dose on hand (38 mg), so 3.3 mL is reasonable. Example (cont.) Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications.

Error Alert! Select the correct instructions for the strength and route ordered. Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications.

Practice How much diluent should you add to this vial? What are the storage instructions? Answer: 1 mL Answer: store between 2° and 8° C Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. Diluent – 1 mL sterile water Must be used within 6 hours of reconstitution.

Practice Ordered: Synagis 75 mg IM Q8H On hand: What is the amount to administer? Learning Outcome 14.3 Calculate doses of reconstituted parenteral medications. H = 100 mg; Q = 1 mL; D = 75 mg Step A No conversion is necessary. Step B 75 mg/100 mg X 1 mL = A [cancel units (mg)] 0.75 x 1 mL = 0.75 mL = A Step C 75 mg is three-fourths of 100 mg, so ¾ mL is reasonable. Answer: 0.75 mL