SlideShare a Scribd company logo
Compounding in Hospitals.
Bulk compounding,
IV admixture
services and incompatibilities,
Total parenteral nutrition
• Bulk compounding
• It serves an important role for patients whose
medical needs cannot be fulfilled by an FDA-
approved drug.
Reasons for bulk compounding in hospital
• Drug shortage in hospital.
• Adjustment of dose require in premature infants.
• Changes need in dosage form to make medication
easier to ingest in children and elder patients.
• Patient has an allergy and needs a medication to be
made without certain dye.
• Individual doses of drugs that hospitals use on
regular basis such as IV preparations, eye drops,
injections, IV admixture services, TPN .
Planning For Bulk Compounding
Pharmacist should consider two points for control of the
manufacturing program
1.Budgetory control:-To regulate the economic aspects of the
program.
2.Quality control:-To govern the Quality,purity,and strength of the
manufactured products.
Budgetary Control
IF we must provide manufacturing program the hospital pharmacist
require to prepare the inventory and consumption rate for the
finished product, raw material requirement, manufacturing capacity
,available personnel and operating cost.
Planning For Bulk Compounding
Pharmacist should consider two points for control of the
manufacturing program
1.Budgetory control:-To regulate the economic aspects of the
program.
2.Quality control:-To govern the Quality,purity,and strength of the
manufactured products.
Budgetary Control
IF we must provide manufacturing program the hospital pharmacist
require to prepare the inventory and consumption rate for the
finished product, raw material requirement, manufacturing capacity
,available personnel and operating cost.
1.Manufacturing Requirement :-
Review the records of previous year and compare the figures
At first end pharmacist realizes that he has overestimated or
underestimated his requirements whichever case may be corrective
steps may be placed into effect for the second quarter.
Either increase the rate of volume of production or reduce the batch
quantity or frequency of manufacture or eliminate one batch of the
product.
2.Material Requirements:-
Once the hospital pharmacist has decided what products he plans to
manufacture and in what quantity,he must take the next steps for the
procurement of the nnecessary supplies.
These supplies includes raw materials, containers,labels,and
supplementary materials sauch as paper,filter pads,boxes and special
labels.
• The first step in this direction is to take each formula and determine
the quantity of chemical or other material which will be required to
produce the annual supply.
• This is done by taking the quantities of raw material from the
working formula and packaging specifications of each item and
multiplying these quantities by the number of times the formula
must be produced to fulfill the estimated annual need.
• The second step is to enter these quantities on a summary sheet
becoz the same drug chemical or container may be required by
many different formulas.
3.Manufacturing Capacity: Manufacturing capacity is depending on
the availability of equipment and its capacity to manufacture the
desired qty for manufacturing.
4.Manufacturing Equipment and its Sources :-
The size of manufacturing equipment in hospital pharmacy may vary
from institution to institution .Manufacturing program must be
consider.
• The quantities to be produced during any production
• The length of time that will be required to consume the pdt.
• The availability of personnel
• The availability of physical facilities.
• Modern technology has developed equipment to fulfill every
production need. The
• machinery can handle manufacturing capacity for a small or
medium sized hospital.
• addition, the larger hospitals have available to them automatic and
Semi-automatic
• duty production equipment which may be competent for managing
large volume.minimum of time.
4.Manufacturing Staff :-
• The manufacturing section of the pharmacy must be supervised by
a technically competent,legally qualified pharmacist.
• In addition, he must be supported with ancillary personnel who
• can be trained to carry on such non-technical pursuits as bottling,
filtering, labeling, etc.
• Too many personnel will raise the cost of a manufactured product
and too little help may mean the inability to maintain an adequate
production schedule and chances potential errors.
• Accordingly, production time must be determined for each formula
in order that proper planning and scheduling be affected.
5. Operating Cost
• Operating cost consists of direct cost only- direct labor and cost of
material but it should include both direct and indirect cost.
• The terminology &Over head cost is usually interchangeably with
Indirect cost includes the cost of supervisory personnel,
• space rent, insurance of equipment depreciation, maintenance,
housekeeping etc.
• The indirect cost should be compared with direct costs for the
purpose of calculating a ratio of overhead.
Quality control
is required to supervise the quality, purity and strength of the
manufactured product that will ensure the integrity of product.
This can best be accomplished by developing a series of cross checks
and laboratory analyses. Hospital pharmacist has responsibility to
follow cGMP for ensuring the high pharmaceutical standards of
product.
• IV admixture service and incompatibilities
• IV admixture :An IV admixture is a preparation of a
pharmaceutical mixture of two or more drugs
added into IV fluids alone or in combination for
medication purposes.
• PREPARATION OF IV ADMIXTURE
• Upon receipt of the physician original order sheet, a pressure sensitive label
must be prepared.
which provide the following information:
• Patient name
• Patient location
• Physician's name
• Name of the drugs with quantities added
• Date of compounding
• Expiration date
• Name of the pharmacist preparing the product
• Prepare the admixture under the laminar
flow hood using sterile needles and syringes
or double ended transfer needles
• Once the transfer is made, met a disc of the
container must be replaced with a new seal
crimped. For safety purposes,
• A different colored seal should be utilized
that it warns individuals regarding drugs
that have been added.
• Pharmacists must inspect the final product
before dispensing the final admixture.
• The inspection should contain a review of
the label, clarity of the solution, and the
calculation involved in the preparation.
• IV ADMIXTURE INCOMPATIBILITY
• Definition: It is the simultaneous dilution and/or administration of two or more
drugs that interfere with the therapeutic efficacy of the medications and patient
safety.
• The types of incompatibilities related with intravenous administration are
• Physical incompatibility
• Chemical incompatibility
• Physical incompatibility (PI): It occurs when a drug mixture produces changes in the
appearance of a solution. It is also known as "Pharmaceutical Incompatibility
or Visual Incompatibility".
• Chemical incompatibility : It occurs due to the chemical degradation of the
admixed drugs. It appears as change in colour, precipitation and turbidity.
• Therapeutic incompatibility may happen when two or more drugs are administered
concurrently resulting in undesirable pharmacological activity.
Types of Incompatibilities
A) Physical incompatibility
B) Chemical incompatibility
C) Therapeutic incompatibility
2/20/2024 14
A) PHYSICAL NCOMPATIBILITY
• When two or more than two substances are combined
together, a physical change take place and an
unacceptable product is formed.
Physical incompatibility is usually due to
1. Immiscibility
2. Insolubility
3. Precipitate formation or
4. Liquefaction of solid materials
• Physical incompatibility usually visible and can be easily
corrected by applying the pharmaceutical skill
2/20/2024 15
Physical incompatibilities may be
corrected by using following methods
1. Change the order of mixing of ingredients of the
prescription
2. Emulsification
3. Addition of suspending agent
4. Change in the form of ingredients
5. By addition, substitution or omission of
therapeutically inactive substance to help in
compounding of the prescription
2/20/2024 16
Examples of Physical compatibilities
and Their Methods of Correction
1. Immiscibility :
• Oils and water are immiscible with each other.
• They can be made miscible with water by
emulsification.
• Example:1
• Castor oil : 15 ml
• Water : 60 ml Emulsifier
2/20/2024 17
2.Insolubility
A) Liquid preparation containing indiffusible solids such as
chalk powder, acetyl salicylic acid, phenacetin, zinc
oxide etc.
• A suspending agent , which increase the thickness of
the preparation & give uniform distribution of the
insoluble substances.
2/20/2024 18
Example: 2
• Phenacetin 3 gm
• Caffeine 1 gm
• Orange syrup 12 ml
• Water up to 90 ml Make a mixture.
• In this prescription phenacetin is an indiffusible
substance. Tragacanth mucilage is used as a
suspending agent to make a stable suspension
2/20/2024 19
B) Drugs such as sulphur, antibiotic & certain
corticosteroids are insoluble in water and are
difficult to wet with water.
• Wetting agents like saponin & polysorbates are
used to distribute the powder in water.
2/20/2024 20
3. Precipitation
• Drug in solution may be precipitated, if it is
not soluble in solvent .
1. Resins:
Resins are insoluble in water, forming indiffusible
ppt. This can be prevented by slowly adding the
diluted tincture with vigorous stirring to the
diluted suspension or by adding some suitable
thickening agent.
2/20/2024 21
2. Gums:
Gum such as acacia, tragacanth and agar, sugars and
many other hydrocolloids are precipitated from their
aqueous solutions by alcohol or by electrolytes
through dehydration process.
3. Volatile oils
Volatile oils are soluble in alcohol. When water is
added into the alcoholic solution of volatile oil, the
non-aromatic portion of the oil get precipitated and
tuInrcobmipdatiibtilyity appears.
2/20/2024 22
4. Liquefaction
• When certain low melting point solids are mixed
together, a Iiquid or soft mass is produced
known as eutectic mixtures.
• This occurs due to the lowering of the melting
point of mixture to below room temperature.
• Eg: camphor, menthol, thymol, phenol, chloral
hydrate and aspirin.
2/20/2024 23
• To avoid this problem these substances can be
dispensed by anyone of the following methods:-
(i) Triturate together to form liquid and mixed with an
absorbent like light kaolin or light magnesium
carbonate to produce free flowing powder.
(ii) The individual medicament is powdered separately
and mixed with an absorbent and then combined
together lightly.
(iii) Individual medicament is packed separately & label
to mix before administration.
2/20/2024 24
B) CHEMICAL INCOMPATIBILITY
• When two or more than two substances are
combined together, chemical interactions occurs
and toxic or inactive product may be formed.
• While dispensing such prescriptions, precautions
should be taken either to prevent the formation of
harmful product or to correct them and the
prescriber must be informed in this regard.
2/20/2024 25
• Chemical incompatibilities often occur due to
1. Oxidation- reduction,
2. Acid base hydrolysis
3. or combination reactions
These reactions may be noticed by
• Precipitation
• Effervescence,
• Decomposition,
• Color change or
• Explosion.
2/20/2024 26
Types of Chemical incompatibilities
1. Tolerated: In tolerated incompatibilities, the chemical
interaction can be minimized by changing the order of
mixing or mixing the solutions in dilute forms but no
alteration is made in the formulation.
2. Adjusted: In adjusted incompatibilities the chemical
interaction can be prevented by addition or substitution
of one of the reacting ingredients of a prescription
with another of equal therapeutic value.
3. Intentional: When the prescriber knowingly prescribes
the incompatible drugs;
4. Un-intentional: When the prescriber prescribes the
drugs without knowing that there is incompatibility
between the prescribed drugs.
2/20/2024 27
Precipitate Yielding Interactions
• Strong solutions faster rate of reactions & thick
precipitate formation & ppt is indiffusible.
• Dilute solutions slow rate of reactions & light wt.
precipitate formation & ppt is diffusible.
• Hence the reacting substances should be diluted to the
maximum extent before mixing them.
2/20/2024 28
Precipitate Yielding Interactions
• Method A - The method is followed when diffusible
precipitates are formed in small quantity.
• Method B - The method is followed when indiffusible
precipitates are formed in large quantity.
• Suitable quantity of compound tragacanth powder is
used (2 g per 100 ml ) or mucilage (1/4th volume of
finished product)
• A secondary label "SHAKE WELL BEFORE USE" should
be fixed on the container whenever method A or
method B is followed.
2/20/2024 29
• CAUSES OF INCOMPATIBILITY
• Incompatibility generally occurs between:
• Two drugs (drug-drug incompatibility)
• Drugs and materials of IV containers
• When these are mixed together in the similar
infusion line or the similar IV container
• When these are administered one after the other in
the same infusion line
• Drugs and unsuitable diluents
• Drugs and adjuvants such as stabilizer and solvent
• . Major consequences of incompatibility are
• Damage from toxic products
Multi-organ failure, Severe liver dysfunction, Toxic shock,
Local embolus, Myocarditis Respiratory difficulties, Systemic
allergic reactions, Local allergic reactions, Thrombosis
Thrombophlebitis, Phlebitis, Local redness
• Particulate emboli from crystallization and separation
A large quantity of particles in injections is considered a
potentially life-threatening health hazard. Drug
incompatibility reactions may not only produce particles in
the infusion but also alter the drug into an inactive form and
injurious effects on the patient prescribed drug regimen.
• Tissue irritation due to major pH modifications
• Therapeutic failure
• Adverse effects of drug incompatibilities extend time span
and total cost of patient's hospitalization in hospital.
• Pharmacist role in intravenous admixture service
• Permanent supervision and involvement of Clinical
Pharmacist in IV admixture services.
• Prepares protocol and establish reporting error system
for IV admixture service.
• Provides expert advice on compatibility and stability for
the use of multiple drugs.
• To updates staff on new clinical practice guidelines.
• Can prevent dangerous incompatibility through the
available literature, databases, services and information
material.
• Color coding is given for preventing incompatibility.
• Prepare individual labeling for each drug preparation.
• It always checks the alternative methods of
administration and uses multi-lumen catheters.
• Total parenteral nutrition (TPN) is a method that
bypasses the GIT gastrointestinal tract, because
of its absorptive capacity is reduced. Fluids are
administered into a vein to deliver most of the
nutrients the body needs.. TPN provides a mixture
of fluid, electrolytes, carbohydrate, lipids
(fats), amino acids (protein), vitamins, minerals.
• Definition: Total parenteral nutrition (TPN) is
intravenous administration of nutrients in adequate
quantities to achieve tissue synthesis & anabolism.
What is Total Parenteral Nutrition (TPN)
Hyperalimentation?
TPN or Hyperalimentation is the IV infusion
of a nutritionally, complete formula,
including
– amino acids (protein/nitrogen)
– dextrose (carbohydrate/glucose)
– fat emulsions (fatty acids)
– vitamins
– electrolytes
– minerals
– trace elements
34
What is Total Parenteral Nutrition (TPN)
Hyperalimentation?
• TPN : is the administration of concentrated glucose & amino acid solutions
via a central or large diameter peripheral vein.
• TPN therapy is necessary when the GI tract cannot be used or is not used to
meet the Patient nutritional needs.
• TPN solutions may contain 20%-60% glucose and 3.5% to 10% protein (in
the form of amino acids) in addition to various amounts of electrolytes,
vitamins, minerals, & trace elements.
• These solutions can be modified, depending on the presence of organ
system impairment and/or the specific nutritional needs of the Patient.
• To provide necessary amounts of fat and the fat soluble vitamins (A, D, E,
and K), intralipids are often administered 2-3x a week along with TPN
(monitor triglyceride levels)
• TPN is often used in hospital, long term care, and subacute care, but is also
frequently used in the home-care setting.
35
• Types of TPN
• 1.Central Parenteral Nutrition
• 2.Peripheral Parenteral Nutrition
• INDICATIONS FOR USE
• Inability to absorb nutrients via the gastrointestinal
tract
• Patient who is not expected to eat sufficiently
• Moderate to serve pancreatitis when adequate enteral
intake is not expected for 5 to 7 days
• Chronic intestinal obstruction as in intestinal cancer
• Organ failures -liver, renal, respiratory
• Malnourished oncology patients
• When the patient is unable to sustain nutritional status
due to severe diarrhea or vomiting
• Patient who is not expected to eat sufficiently
• Malnourished patient before major Surgery
• COMPLICATIONS
• Metabolic abnormalities
• Electrolyte imbalance
• Liver toxicity
• Re-feeding syndrome in chronic alcoholic patients
• Sudden discontinuation cause hypoglycemia
• hyperglycemia
• over feeding
• Pneumothorax
• Bleeding
• Air embolism
• Vascular injury
• Thrombophlebitis
• Catheter site infections include bloodstream infection,
local skin infection at insertion site
• CONTENTS OF TPN
• TPN is mixture of separate components which contain
Carbohydrates, Lipids (fat), Amino acids, Electrolytes, Trace
elements, Vitamins and Fluids. TPN composition adjusted as per
requirement of individual patient.
• Carbohydrates:
• Carbohydrates is the main source of energy. such as galactose,
fructose & sorbitol should not be used as energy sources in TPN.
• Lipids (Fat):
• Linoleic acid is used as primary source of essential fatty acid in
TPN
• Electrolytes:
• Sodium (Na), Potassium (K), Magnesium (mg) Calcium (Ca),
Chloride
• Vitamins:
• Vitamins are required for the metabolism of carbohydrates,
proteins, fats. water soluble (B1, B2, B3, B5, B6, B7, B9, B12 & C) &
fat-soluble vitamins (A, D, E & K) used in TPN formulation.
Ch 5. Compounding in hospital.pptx hospital

More Related Content

Similar to Ch 5. Compounding in hospital.pptx hospital

hospitalpharmacyravinandanap-220309111500 (1).pdf
hospitalpharmacyravinandanap-220309111500 (1).pdfhospitalpharmacyravinandanap-220309111500 (1).pdf
hospitalpharmacyravinandanap-220309111500 (1).pdf
DicksonDaniel7
 
Hospital Pharmacy And Its Organization -Ravinandan A P
Hospital Pharmacy  And Its Organization -Ravinandan  A PHospital Pharmacy  And Its Organization -Ravinandan  A P
Hospital Pharmacy And Its Organization -Ravinandan A P
Ravinandan A P
 
Project work
Project workProject work
Project work
AnuragJha81
 
Project management of chemical, analytical, and formulation development by Vi...
Project management of chemical, analytical, and formulation development by Vi...Project management of chemical, analytical, and formulation development by Vi...
Project management of chemical, analytical, and formulation development by Vi...
Vishnu Datta Maremanda
 
Xylopia-Internship-PDF
Xylopia-Internship-PDFXylopia-Internship-PDF
Xylopia-Internship-PDF
Rishi Patel
 
GROUP # 2.pptx
GROUP # 2.pptxGROUP # 2.pptx
GROUP # 2.pptx
ShumailaQadir2
 
Good Regulatory Practices.pptx
Good Regulatory Practices.pptxGood Regulatory Practices.pptx
Good Regulatory Practices.pptx
Sudipta Roy
 
Parag semisolid
Parag semisolidParag semisolid
Parag semisolid
Parag Behura
 
2 hospital pharmacy organisation and manage ment
2 hospital pharmacy organisation and manage ment2 hospital pharmacy organisation and manage ment
2 hospital pharmacy organisation and manage ment
Chanukya Vanam . Dr
 
3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf
3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf
3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf
osos24
 
Evaluation of Herbal Drugs unit 4
Evaluation of Herbal Drugs unit 4Evaluation of Herbal Drugs unit 4
Evaluation of Herbal Drugs unit 4
Ashokrao Mane college of Pharmacy Peth-Vadgaon
 
HOSPITALFORMULARY.pptx
HOSPITALFORMULARY.pptxHOSPITALFORMULARY.pptx
HOSPITALFORMULARY.pptx
PunamGauchan1
 
Manufacturing Bulk and Sterile
Manufacturing Bulk and SterileManufacturing Bulk and Sterile
Manufacturing Bulk and Sterile
RiazulHasan3
 
Manufacturing bulk and sterile
Manufacturing bulk and sterileManufacturing bulk and sterile
Manufacturing bulk and sterile
RiazulHasan3
 
Community pharmacy
Community pharmacyCommunity pharmacy
Community pharmacy
Ravish Yadav
 
Intravenous admixtures
Intravenous admixtures Intravenous admixtures
Intravenous admixtures
AsmaaAbed2
 
Post marketing surveillance, outsourcing ba and be 1
Post marketing surveillance, outsourcing ba and be 1Post marketing surveillance, outsourcing ba and be 1
Post marketing surveillance, outsourcing ba and be 1
PratikShinde120
 
Quality assurance pharmaceutical analysis
Quality assurance  pharmaceutical analysisQuality assurance  pharmaceutical analysis
Quality assurance pharmaceutical analysis
Mahendra G S
 
PILOT PLANT SCALE-UP TECHNIQUES ppt.pptx
PILOT PLANT SCALE-UP TECHNIQUES ppt.pptxPILOT PLANT SCALE-UP TECHNIQUES ppt.pptx
PILOT PLANT SCALE-UP TECHNIQUES ppt.pptx
Abhishek Borkar15
 
Quality control grp.7 (49-56)
Quality control grp.7  (49-56)Quality control grp.7  (49-56)
Quality control grp.7 (49-56)
AkankshaLunge
 

Similar to Ch 5. Compounding in hospital.pptx hospital (20)

hospitalpharmacyravinandanap-220309111500 (1).pdf
hospitalpharmacyravinandanap-220309111500 (1).pdfhospitalpharmacyravinandanap-220309111500 (1).pdf
hospitalpharmacyravinandanap-220309111500 (1).pdf
 
Hospital Pharmacy And Its Organization -Ravinandan A P
Hospital Pharmacy  And Its Organization -Ravinandan  A PHospital Pharmacy  And Its Organization -Ravinandan  A P
Hospital Pharmacy And Its Organization -Ravinandan A P
 
Project work
Project workProject work
Project work
 
Project management of chemical, analytical, and formulation development by Vi...
Project management of chemical, analytical, and formulation development by Vi...Project management of chemical, analytical, and formulation development by Vi...
Project management of chemical, analytical, and formulation development by Vi...
 
Xylopia-Internship-PDF
Xylopia-Internship-PDFXylopia-Internship-PDF
Xylopia-Internship-PDF
 
GROUP # 2.pptx
GROUP # 2.pptxGROUP # 2.pptx
GROUP # 2.pptx
 
Good Regulatory Practices.pptx
Good Regulatory Practices.pptxGood Regulatory Practices.pptx
Good Regulatory Practices.pptx
 
Parag semisolid
Parag semisolidParag semisolid
Parag semisolid
 
2 hospital pharmacy organisation and manage ment
2 hospital pharmacy organisation and manage ment2 hospital pharmacy organisation and manage ment
2 hospital pharmacy organisation and manage ment
 
3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf
3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf
3. Section-IN PROCESS QUALITY CONTROL and QUALITY CONTROL.pdf
 
Evaluation of Herbal Drugs unit 4
Evaluation of Herbal Drugs unit 4Evaluation of Herbal Drugs unit 4
Evaluation of Herbal Drugs unit 4
 
HOSPITALFORMULARY.pptx
HOSPITALFORMULARY.pptxHOSPITALFORMULARY.pptx
HOSPITALFORMULARY.pptx
 
Manufacturing Bulk and Sterile
Manufacturing Bulk and SterileManufacturing Bulk and Sterile
Manufacturing Bulk and Sterile
 
Manufacturing bulk and sterile
Manufacturing bulk and sterileManufacturing bulk and sterile
Manufacturing bulk and sterile
 
Community pharmacy
Community pharmacyCommunity pharmacy
Community pharmacy
 
Intravenous admixtures
Intravenous admixtures Intravenous admixtures
Intravenous admixtures
 
Post marketing surveillance, outsourcing ba and be 1
Post marketing surveillance, outsourcing ba and be 1Post marketing surveillance, outsourcing ba and be 1
Post marketing surveillance, outsourcing ba and be 1
 
Quality assurance pharmaceutical analysis
Quality assurance  pharmaceutical analysisQuality assurance  pharmaceutical analysis
Quality assurance pharmaceutical analysis
 
PILOT PLANT SCALE-UP TECHNIQUES ppt.pptx
PILOT PLANT SCALE-UP TECHNIQUES ppt.pptxPILOT PLANT SCALE-UP TECHNIQUES ppt.pptx
PILOT PLANT SCALE-UP TECHNIQUES ppt.pptx
 
Quality control grp.7 (49-56)
Quality control grp.7  (49-56)Quality control grp.7  (49-56)
Quality control grp.7 (49-56)
 

Recently uploaded

Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
PsychoTech Services
 
vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
Dr.pavithra Anandan
 
DECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principlesDECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principles
anaghabharat01
 
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHYMERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
DRPREETHIJAMESP
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
rishi2789
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
MedicoseAcademics
 
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Kosmoderma Academy Of Aesthetic Medicine
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Health Advances
 
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptxCLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
Government Dental College & Hospital Srinagar
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
10 Benefits an EPCR Software should Bring to EMS Organizations
10 Benefits an EPCR Software should Bring to EMS Organizations   10 Benefits an EPCR Software should Bring to EMS Organizations
10 Benefits an EPCR Software should Bring to EMS Organizations
Traumasoft LLC
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tina Purnat
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
Pratik328635
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
Torstein Dalen-Lorentsen
 
Cervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptxCervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptx
LEFLOT Jean-Louis
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
FFragrant
 

Recently uploaded (20)

Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
 
vonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentationvonoprazan A novel drug for GERD presentation
vonoprazan A novel drug for GERD presentation
 
DECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principlesDECLARATION OF HELSINKI - History and principles
DECLARATION OF HELSINKI - History and principles
 
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHYMERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
MERCURY GROUP.BHMS.MATERIA MEDICA.HOMOEOPATHY
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdfCHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
 
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
 
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptxCLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
10 Benefits an EPCR Software should Bring to EMS Organizations
10 Benefits an EPCR Software should Bring to EMS Organizations   10 Benefits an EPCR Software should Bring to EMS Organizations
10 Benefits an EPCR Software should Bring to EMS Organizations
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
 
Outbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptxOutbreak management including quarantine, isolation, contact.pptx
Outbreak management including quarantine, isolation, contact.pptx
 
Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024Physical demands in sports - WCSPT Oslo 2024
Physical demands in sports - WCSPT Oslo 2024
 
Cervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptxCervical Disc Arthroplasty ORSI 2024.pptx
Cervical Disc Arthroplasty ORSI 2024.pptx
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptxPost-Menstrual Smell- When to Suspect Vaginitis.pptx
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
 

Ch 5. Compounding in hospital.pptx hospital

  • 1. Compounding in Hospitals. Bulk compounding, IV admixture services and incompatibilities, Total parenteral nutrition
  • 2. • Bulk compounding • It serves an important role for patients whose medical needs cannot be fulfilled by an FDA- approved drug. Reasons for bulk compounding in hospital • Drug shortage in hospital. • Adjustment of dose require in premature infants. • Changes need in dosage form to make medication easier to ingest in children and elder patients. • Patient has an allergy and needs a medication to be made without certain dye. • Individual doses of drugs that hospitals use on regular basis such as IV preparations, eye drops, injections, IV admixture services, TPN .
  • 3. Planning For Bulk Compounding Pharmacist should consider two points for control of the manufacturing program 1.Budgetory control:-To regulate the economic aspects of the program. 2.Quality control:-To govern the Quality,purity,and strength of the manufactured products. Budgetary Control IF we must provide manufacturing program the hospital pharmacist require to prepare the inventory and consumption rate for the finished product, raw material requirement, manufacturing capacity ,available personnel and operating cost.
  • 4. Planning For Bulk Compounding Pharmacist should consider two points for control of the manufacturing program 1.Budgetory control:-To regulate the economic aspects of the program. 2.Quality control:-To govern the Quality,purity,and strength of the manufactured products. Budgetary Control IF we must provide manufacturing program the hospital pharmacist require to prepare the inventory and consumption rate for the finished product, raw material requirement, manufacturing capacity ,available personnel and operating cost.
  • 5. 1.Manufacturing Requirement :- Review the records of previous year and compare the figures At first end pharmacist realizes that he has overestimated or underestimated his requirements whichever case may be corrective steps may be placed into effect for the second quarter. Either increase the rate of volume of production or reduce the batch quantity or frequency of manufacture or eliminate one batch of the product. 2.Material Requirements:- Once the hospital pharmacist has decided what products he plans to manufacture and in what quantity,he must take the next steps for the procurement of the nnecessary supplies. These supplies includes raw materials, containers,labels,and supplementary materials sauch as paper,filter pads,boxes and special labels.
  • 6. • The first step in this direction is to take each formula and determine the quantity of chemical or other material which will be required to produce the annual supply. • This is done by taking the quantities of raw material from the working formula and packaging specifications of each item and multiplying these quantities by the number of times the formula must be produced to fulfill the estimated annual need. • The second step is to enter these quantities on a summary sheet becoz the same drug chemical or container may be required by many different formulas. 3.Manufacturing Capacity: Manufacturing capacity is depending on the availability of equipment and its capacity to manufacture the desired qty for manufacturing.
  • 7. 4.Manufacturing Equipment and its Sources :- The size of manufacturing equipment in hospital pharmacy may vary from institution to institution .Manufacturing program must be consider. • The quantities to be produced during any production • The length of time that will be required to consume the pdt. • The availability of personnel • The availability of physical facilities. • Modern technology has developed equipment to fulfill every production need. The • machinery can handle manufacturing capacity for a small or medium sized hospital. • addition, the larger hospitals have available to them automatic and Semi-automatic • duty production equipment which may be competent for managing large volume.minimum of time.
  • 8. 4.Manufacturing Staff :- • The manufacturing section of the pharmacy must be supervised by a technically competent,legally qualified pharmacist. • In addition, he must be supported with ancillary personnel who • can be trained to carry on such non-technical pursuits as bottling, filtering, labeling, etc. • Too many personnel will raise the cost of a manufactured product and too little help may mean the inability to maintain an adequate production schedule and chances potential errors. • Accordingly, production time must be determined for each formula in order that proper planning and scheduling be affected.
  • 9. 5. Operating Cost • Operating cost consists of direct cost only- direct labor and cost of material but it should include both direct and indirect cost. • The terminology &Over head cost is usually interchangeably with Indirect cost includes the cost of supervisory personnel, • space rent, insurance of equipment depreciation, maintenance, housekeeping etc. • The indirect cost should be compared with direct costs for the purpose of calculating a ratio of overhead. Quality control is required to supervise the quality, purity and strength of the manufactured product that will ensure the integrity of product. This can best be accomplished by developing a series of cross checks and laboratory analyses. Hospital pharmacist has responsibility to follow cGMP for ensuring the high pharmaceutical standards of product.
  • 10. • IV admixture service and incompatibilities • IV admixture :An IV admixture is a preparation of a pharmaceutical mixture of two or more drugs added into IV fluids alone or in combination for medication purposes.
  • 11. • PREPARATION OF IV ADMIXTURE • Upon receipt of the physician original order sheet, a pressure sensitive label must be prepared. which provide the following information: • Patient name • Patient location • Physician's name • Name of the drugs with quantities added • Date of compounding • Expiration date • Name of the pharmacist preparing the product
  • 12. • Prepare the admixture under the laminar flow hood using sterile needles and syringes or double ended transfer needles • Once the transfer is made, met a disc of the container must be replaced with a new seal crimped. For safety purposes, • A different colored seal should be utilized that it warns individuals regarding drugs that have been added. • Pharmacists must inspect the final product before dispensing the final admixture. • The inspection should contain a review of the label, clarity of the solution, and the calculation involved in the preparation.
  • 13. • IV ADMIXTURE INCOMPATIBILITY • Definition: It is the simultaneous dilution and/or administration of two or more drugs that interfere with the therapeutic efficacy of the medications and patient safety. • The types of incompatibilities related with intravenous administration are • Physical incompatibility • Chemical incompatibility • Physical incompatibility (PI): It occurs when a drug mixture produces changes in the appearance of a solution. It is also known as "Pharmaceutical Incompatibility or Visual Incompatibility". • Chemical incompatibility : It occurs due to the chemical degradation of the admixed drugs. It appears as change in colour, precipitation and turbidity. • Therapeutic incompatibility may happen when two or more drugs are administered concurrently resulting in undesirable pharmacological activity.
  • 14. Types of Incompatibilities A) Physical incompatibility B) Chemical incompatibility C) Therapeutic incompatibility 2/20/2024 14
  • 15. A) PHYSICAL NCOMPATIBILITY • When two or more than two substances are combined together, a physical change take place and an unacceptable product is formed. Physical incompatibility is usually due to 1. Immiscibility 2. Insolubility 3. Precipitate formation or 4. Liquefaction of solid materials • Physical incompatibility usually visible and can be easily corrected by applying the pharmaceutical skill 2/20/2024 15
  • 16. Physical incompatibilities may be corrected by using following methods 1. Change the order of mixing of ingredients of the prescription 2. Emulsification 3. Addition of suspending agent 4. Change in the form of ingredients 5. By addition, substitution or omission of therapeutically inactive substance to help in compounding of the prescription 2/20/2024 16
  • 17. Examples of Physical compatibilities and Their Methods of Correction 1. Immiscibility : • Oils and water are immiscible with each other. • They can be made miscible with water by emulsification. • Example:1 • Castor oil : 15 ml • Water : 60 ml Emulsifier 2/20/2024 17
  • 18. 2.Insolubility A) Liquid preparation containing indiffusible solids such as chalk powder, acetyl salicylic acid, phenacetin, zinc oxide etc. • A suspending agent , which increase the thickness of the preparation & give uniform distribution of the insoluble substances. 2/20/2024 18
  • 19. Example: 2 • Phenacetin 3 gm • Caffeine 1 gm • Orange syrup 12 ml • Water up to 90 ml Make a mixture. • In this prescription phenacetin is an indiffusible substance. Tragacanth mucilage is used as a suspending agent to make a stable suspension 2/20/2024 19
  • 20. B) Drugs such as sulphur, antibiotic & certain corticosteroids are insoluble in water and are difficult to wet with water. • Wetting agents like saponin & polysorbates are used to distribute the powder in water. 2/20/2024 20
  • 21. 3. Precipitation • Drug in solution may be precipitated, if it is not soluble in solvent . 1. Resins: Resins are insoluble in water, forming indiffusible ppt. This can be prevented by slowly adding the diluted tincture with vigorous stirring to the diluted suspension or by adding some suitable thickening agent. 2/20/2024 21
  • 22. 2. Gums: Gum such as acacia, tragacanth and agar, sugars and many other hydrocolloids are precipitated from their aqueous solutions by alcohol or by electrolytes through dehydration process. 3. Volatile oils Volatile oils are soluble in alcohol. When water is added into the alcoholic solution of volatile oil, the non-aromatic portion of the oil get precipitated and tuInrcobmipdatiibtilyity appears. 2/20/2024 22
  • 23. 4. Liquefaction • When certain low melting point solids are mixed together, a Iiquid or soft mass is produced known as eutectic mixtures. • This occurs due to the lowering of the melting point of mixture to below room temperature. • Eg: camphor, menthol, thymol, phenol, chloral hydrate and aspirin. 2/20/2024 23
  • 24. • To avoid this problem these substances can be dispensed by anyone of the following methods:- (i) Triturate together to form liquid and mixed with an absorbent like light kaolin or light magnesium carbonate to produce free flowing powder. (ii) The individual medicament is powdered separately and mixed with an absorbent and then combined together lightly. (iii) Individual medicament is packed separately & label to mix before administration. 2/20/2024 24
  • 25. B) CHEMICAL INCOMPATIBILITY • When two or more than two substances are combined together, chemical interactions occurs and toxic or inactive product may be formed. • While dispensing such prescriptions, precautions should be taken either to prevent the formation of harmful product or to correct them and the prescriber must be informed in this regard. 2/20/2024 25
  • 26. • Chemical incompatibilities often occur due to 1. Oxidation- reduction, 2. Acid base hydrolysis 3. or combination reactions These reactions may be noticed by • Precipitation • Effervescence, • Decomposition, • Color change or • Explosion. 2/20/2024 26
  • 27. Types of Chemical incompatibilities 1. Tolerated: In tolerated incompatibilities, the chemical interaction can be minimized by changing the order of mixing or mixing the solutions in dilute forms but no alteration is made in the formulation. 2. Adjusted: In adjusted incompatibilities the chemical interaction can be prevented by addition or substitution of one of the reacting ingredients of a prescription with another of equal therapeutic value. 3. Intentional: When the prescriber knowingly prescribes the incompatible drugs; 4. Un-intentional: When the prescriber prescribes the drugs without knowing that there is incompatibility between the prescribed drugs. 2/20/2024 27
  • 28. Precipitate Yielding Interactions • Strong solutions faster rate of reactions & thick precipitate formation & ppt is indiffusible. • Dilute solutions slow rate of reactions & light wt. precipitate formation & ppt is diffusible. • Hence the reacting substances should be diluted to the maximum extent before mixing them. 2/20/2024 28
  • 29. Precipitate Yielding Interactions • Method A - The method is followed when diffusible precipitates are formed in small quantity. • Method B - The method is followed when indiffusible precipitates are formed in large quantity. • Suitable quantity of compound tragacanth powder is used (2 g per 100 ml ) or mucilage (1/4th volume of finished product) • A secondary label "SHAKE WELL BEFORE USE" should be fixed on the container whenever method A or method B is followed. 2/20/2024 29
  • 30. • CAUSES OF INCOMPATIBILITY • Incompatibility generally occurs between: • Two drugs (drug-drug incompatibility) • Drugs and materials of IV containers • When these are mixed together in the similar infusion line or the similar IV container • When these are administered one after the other in the same infusion line • Drugs and unsuitable diluents • Drugs and adjuvants such as stabilizer and solvent
  • 31. • . Major consequences of incompatibility are • Damage from toxic products Multi-organ failure, Severe liver dysfunction, Toxic shock, Local embolus, Myocarditis Respiratory difficulties, Systemic allergic reactions, Local allergic reactions, Thrombosis Thrombophlebitis, Phlebitis, Local redness • Particulate emboli from crystallization and separation A large quantity of particles in injections is considered a potentially life-threatening health hazard. Drug incompatibility reactions may not only produce particles in the infusion but also alter the drug into an inactive form and injurious effects on the patient prescribed drug regimen. • Tissue irritation due to major pH modifications • Therapeutic failure • Adverse effects of drug incompatibilities extend time span and total cost of patient's hospitalization in hospital.
  • 32. • Pharmacist role in intravenous admixture service • Permanent supervision and involvement of Clinical Pharmacist in IV admixture services. • Prepares protocol and establish reporting error system for IV admixture service. • Provides expert advice on compatibility and stability for the use of multiple drugs. • To updates staff on new clinical practice guidelines. • Can prevent dangerous incompatibility through the available literature, databases, services and information material. • Color coding is given for preventing incompatibility. • Prepare individual labeling for each drug preparation. • It always checks the alternative methods of administration and uses multi-lumen catheters.
  • 33. • Total parenteral nutrition (TPN) is a method that bypasses the GIT gastrointestinal tract, because of its absorptive capacity is reduced. Fluids are administered into a vein to deliver most of the nutrients the body needs.. TPN provides a mixture of fluid, electrolytes, carbohydrate, lipids (fats), amino acids (protein), vitamins, minerals. • Definition: Total parenteral nutrition (TPN) is intravenous administration of nutrients in adequate quantities to achieve tissue synthesis & anabolism.
  • 34. What is Total Parenteral Nutrition (TPN) Hyperalimentation? TPN or Hyperalimentation is the IV infusion of a nutritionally, complete formula, including – amino acids (protein/nitrogen) – dextrose (carbohydrate/glucose) – fat emulsions (fatty acids) – vitamins – electrolytes – minerals – trace elements 34
  • 35. What is Total Parenteral Nutrition (TPN) Hyperalimentation? • TPN : is the administration of concentrated glucose & amino acid solutions via a central or large diameter peripheral vein. • TPN therapy is necessary when the GI tract cannot be used or is not used to meet the Patient nutritional needs. • TPN solutions may contain 20%-60% glucose and 3.5% to 10% protein (in the form of amino acids) in addition to various amounts of electrolytes, vitamins, minerals, & trace elements. • These solutions can be modified, depending on the presence of organ system impairment and/or the specific nutritional needs of the Patient. • To provide necessary amounts of fat and the fat soluble vitamins (A, D, E, and K), intralipids are often administered 2-3x a week along with TPN (monitor triglyceride levels) • TPN is often used in hospital, long term care, and subacute care, but is also frequently used in the home-care setting. 35
  • 36. • Types of TPN • 1.Central Parenteral Nutrition • 2.Peripheral Parenteral Nutrition
  • 37. • INDICATIONS FOR USE • Inability to absorb nutrients via the gastrointestinal tract • Patient who is not expected to eat sufficiently • Moderate to serve pancreatitis when adequate enteral intake is not expected for 5 to 7 days • Chronic intestinal obstruction as in intestinal cancer • Organ failures -liver, renal, respiratory • Malnourished oncology patients • When the patient is unable to sustain nutritional status due to severe diarrhea or vomiting • Patient who is not expected to eat sufficiently • Malnourished patient before major Surgery
  • 38. • COMPLICATIONS • Metabolic abnormalities • Electrolyte imbalance • Liver toxicity • Re-feeding syndrome in chronic alcoholic patients • Sudden discontinuation cause hypoglycemia • hyperglycemia • over feeding • Pneumothorax • Bleeding • Air embolism • Vascular injury • Thrombophlebitis • Catheter site infections include bloodstream infection, local skin infection at insertion site
  • 39. • CONTENTS OF TPN • TPN is mixture of separate components which contain Carbohydrates, Lipids (fat), Amino acids, Electrolytes, Trace elements, Vitamins and Fluids. TPN composition adjusted as per requirement of individual patient. • Carbohydrates: • Carbohydrates is the main source of energy. such as galactose, fructose & sorbitol should not be used as energy sources in TPN. • Lipids (Fat): • Linoleic acid is used as primary source of essential fatty acid in TPN • Electrolytes: • Sodium (Na), Potassium (K), Magnesium (mg) Calcium (Ca), Chloride • Vitamins: • Vitamins are required for the metabolism of carbohydrates, proteins, fats. water soluble (B1, B2, B3, B5, B6, B7, B9, B12 & C) & fat-soluble vitamins (A, D, E & K) used in TPN formulation.