Question

Do you think the principles behind IV drug incompatibility can also be applied to other applications or modes of drug delivery? If so, what kind of applications could it be applied to? If not, why not?

Answer 1

Drug stability and compatibility are important factors in safe drug administration. A critically ill patient may be receiving multiple drug simultaneously and determining the compatibility of those agents is very essential. Drug incompatibilities can be defined as a reaction between drugs after mixing together which makes it no longer safe or effective for the patient. Drug incompatibilities can be characterized by its color change, hazy appearance, precipitation. The contributing factors to dug incompatibilities are light, temperature, dilution,concentration dependent,buffer capacity,pH and time. There are various types of incompatibilities that include physical, therapeutic,chemical and IV drug container incompatibilities. These IV drug incompatibilities may result in life threathening consequences both related to health and financial effects. The major principles to prevent IV drug incompatibilites are :

• Check for the compatibilty of the drugs.
• Use of standarized protocol for drug administration.
• Check for alternative modes of administration.
• Seperation of drug doses by time and place.
• Use of multilumen catheters and in-line filters.

These are the specific principles behind IV drug incompatibilites. There are other general principle which is applicable in all modes of drug administration including intravenous route like:

• Verify qualification of administration.
• Review Iv site before administration.
• Review methods of preparation and and administration.
• Calulation of correct dosage of drug.
• proper identification of patient.
• Understand the indication for use, its potential side effects.

The specific principle can be applied to intravenous drug, topical agents and medications used for instillation This is because all these mode of drug administration involves mixing of drug ingredients together than compared to the other modes of drug where one drug is taken after another. These principles can be applied while use of medications which are applied topically like creams and ointment or instilled into the body cavity like eye, ear drops.

The principle like standardized protocol for drug administration, proper identification of patient, calculation of correct dose of the drug, having knowledge about the drug compatibility, adverse effect and indication for use is applied even when the drug is admininstered through oral, subcutaneous, intradermal, intramuscular, sublingual as may exert an additive, synergestic or antagonist effect of the drug.