Drug stability and compatibility in oncology care
Massachusetts College of Pharmacy and Allied Health Sciences, Boston 02115, USA.The Journal of infusional chemotherapy 02/1996; 6(4):195-202.
Infusional chemotherapy has been increasingly used based upon the fact that most drugs have a relatively short half-life following bolus exposure, and increasing the available drug concentration over time may maximize the antitumor effect. As a practical matter, the application of infusional chemotherapy especially in an ambulatory setting, absolutely requires that the individual antineoplastic agents be stable in solution at room temperature (or at body temperature for implanted pump systems) and that the drugs in the infusion (including antiemetics) be compatible. The capacity to mix antineoplastic agents and antiemetics (also colony-stimulating factors) in a single solution facilitates infusional combination chemotherapy. Technologic advances are on the horizon which will provide the capability of administration of multiple drugs through a single access site to allow one to utilize a single delivery source obviating the need for admixtures of drugs. However, in the interim, admixtures represent the optimal method for the delivery of multi-agent chemotherapy in the setting in which continuous infusional drug delivery for 24 hours or more is employed. The goal of continuous infusion cancer chemotherapy is to ensure delivery of an unaltered cytotoxic drug, avoiding situations that could affect the stability of the infusion admixture. With cancer chemotherapy infusion therapy being administered through oncology clinics without the benefits of a pharmacist, the nurse plays a pivotal role in the preparation of the infusion, supervision of the patient, and when applicable in providing counseling on the proper storage, handling of the cytotoxic drugs, and disposal of contaminated infusion materials. Thus, by optimizing the integrity of the chemotherapeutic infusion, the patient achieves maximum benefits of cancer chemotherapy and the level of success anticipated with oncology care. The nurse may also be involved with clinical studies involving the preparation of other combinations of infusional chemotherapy including antiemetics and colony-stimulating factors, requiring integrity of the infusion to incompatibility and instability. In order to avoid failure of the infusion through improper preparation or reconstitution of the infusion or improper storage conditions and the resulting unnecessary waste and disposal expenses, the nurse needs to be fully aware of the factors affecting the stability and compatibility of the infusion and to interact with other health professionals and the literature for the critical information related to maintaining the integrity of the cancer chemotherapy infusion. "Good intentions without good communication equals potential disaster."
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ABSTRACT: Pharmacists are responsible for the correct and sterile preparation of cytotoxic and hazardous drugs. Registered nurses or technicians are employed for drug preparation. Various organizations have developed specific guidelines for the safe handling and disposal of antineoplastic agents to ensure optimal quality care and patient safety, and to limit exposure to workers. We will present a review of the recommended guidelines for drug preparation, storage, transport, administration, drug and waste disposal, in the event of a spill, and during home health care. The cornerstone of all these guidelines is the education and training of health professionals, patients and their families, and the use of supplies and equipment to reduce exposure.
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ABSTRACT: Preparation of intravenous solutions in advance could be an efficient approach to improve quality assurance, security, time management, and cost saving of drug provision. The purpose of this paper is to investigate the stability of sodium folinate solutions at 3.2 mg mL-1 in 5% dextrose polyolefin bags at 4degreesC. The stability of five polyolefin bags of solution containing approximately 3.2 mg mL-1 of sodium folinate in 5% dextrose prepared under aseptic conditions and stored at 48degreesC have been studied over 30 days. Sodium folinate concentrations have been measured by high performance liquid chromatography and the results have been analysed by regression analysis. Solutions have been visually inspected and pH measured. No colour change or precipitation occurred in the preparations. Based on a shelf-life of 90% residual potency, sodium folinate solutions have been observed to be stable for a period of at least 30 days at 4degreesC, where lower confidence limits of the results value remain above 90% of the initial concentration. During this stability period, the pH values of infusions have been observed to decrease slightly without affecting chromatographic parameters. Within these limits, sodium folinate in 5% dextrose infusion may be prepared and stored in advance by a centralized intravenous admixture service.
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ABSTRACT: Objective: to analyze the various aspects related to the use of continuous subcutaneous infusion (CSI) in the treatment of terminally-ill cancer patients at home. Material and method: we studied 424 deaths at home (173 due to oncological disease), between 1/1/2003 and 30/6/2007, under the supervision of a home care team. Results: among all 173 oncological patients who died at home, 115 (66.4%) received their treatment through CSI; 47 of them were female (41%). Overall mean of age was 72 years. Fifty-three percent of patients were addressed to us from primary care (n=61), and 24% from the UFISS-palliative care (n = 27). Mean stay under the PADES program was 46.4 days. The most prevalent diagnoses were related to the gastrointestinal tract (n = 43; 37.4%) and lung (n = 19; 16.5%). In 40 patients a readjustment in the dose or number of drugs was necessary. The mean CSI use duration was 10.8 days. In patients undergoing no changes in dose or number of drugs the most commonly used combination of drugs was morphine + haloperidol + midazolam (n = 13; 17.3%). Mean doses for these drugs were 32.8, 4.5, and 12 mg, respectively. Conclusions: the use of continuous subcutaneous infusion (CSI) contributed to symptom control in patients who died in their homes. Up to 9 different drugs can be used, alone or in combination, during the end stage of cancer.
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