21 abril, 2009

Qual o volume máximo para a aplicação de injeção intramuscular?

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O volume máximo de líquido é de 5 mL.

Caso haja um volume maior, deve ser aplicada em dois locais diferentes. Utilizar agulhas 30 x 7 ou 30 x 8 para evitar o risco de perda de medicamento por refluxo e formação de nódulos doloridos.

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A região dorsoglútea (nádega), contém músculos amplos e espessos, ótimos para aplicação de injeções em adultos e crianças maiores de 2 anos. Em crianças menores a região da coxa é considerada mais segura.

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A injeção na região deltoideana (Braço), de pequena massa muscular e com inúmeros nervos e vasos sanguineos, é mais dolorida e sujeita a complicações, devendo ser evitada sempre que possível. Evitar volume de líquido acima de 3 mL.


Texto preparado por: Silvia Moreira Taketsuma (formanda da Faculdade de Farmácia da Universidade Federal Fluminense)

Referência:
Becton Dickinson. Manual de técnicas de aplicação. São Paulo:SP.

19 abril, 2009

FDA alerta sobre la interacción de ceftriaxona con productos que contengan calcio

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Alerta de la FDA sobre la interacción de ceftriaxona con productos que contengan calcio

15/04/2009

LA FDA ha elaborado una alerta de seguridad sobre la interacción entre ceftriaxona y productos que contengan calcio, tras dos comunicaciones de casos fatales en neonatos.

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A requerimiento de la FDA, Roche, el laboratorio fabricante de ceftriaxona, llevó a acbo dos estudios in Vitro, uno usando plasma de adutos y otro con plasma neonatal, para valorar el potencial de precipitación de ceftriaxona-calcio cuando ceftriaxona y los productos que contienen calcio son mezclados en viales y en líneas de infusión. Basándose en los resultados de estos estudios, la FDA hace las siguientes recomendaciones:

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• Está contraindicado el uso concomitante de ceftriaxona y productos que contengan calcio en neonatos (<28 días de edad). Ceftriaxona no debe usarse en neonatos (<28 días de edad) si están tratados con (o esperan ser tratados) con productos intravenosos que contengan calcio.

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• En pacientes >28 días de edad, ceftriaxona y los productos que contienen calcio pueden ser administrados secuencialmente, limpiando las líneas de infusión con fluido compatible entre las infusiones.

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• Ceftriaxona no debe administrarse simultáneamente con soluciones intravenosas que contengan calcio en Y en cualquier grupo de edad

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• La FDA recomienda que ceftriaxona y productos que contienen calcio pueden ser administrados concomitantemente en pacientes>28 días de edad teniendo la precaución de seguir los pasos mencionados en los puntos anteriores ya que el riesgo de precipitación es bajo en esta población.

Referência: www.sefh.es

04 abril, 2009

Stability of Reconstituted Fluconazole Oral Suspension in Plastic Bottles and Oral Syringes

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Stability of Reconstituted Fluconazole Oral Suspension in Plastic Bottles and Oral Syringes

Paul J Dentinger, MS, Chemist, Department of Pharmacy, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY

Chad F Swenson, BS Pharm, Supervisor of Compounding Services, Department of Pharmacy, University of Rochester Medical Center, Strong Memorial Hospital

BACKGROUND: Fluconazole for oral suspension is a dry powder with a beyond-use date of 14 days after being reconstituted. Dispensing fluconazole liquid in the inpatient setting would be much more efficient if prefilled oral syringes containing standard doses were readily available. In addition, if the beyond-use date could be extended, the resulting decreased waste would be economically beneficial.

OBJECTIVE: To determine the stability of reconstituted fluconazole oral suspension using high-performance liquid chromatography (HPLC).

METHODS: Diflucan lyophilized powder was reconstituted to fluconazole 40 mg/mL using Sterile Water for Irrigation, USP. Samples were stored at room temperature in both the original Diflucan plastic bottles and in amber polyethylene oral syringes with silicon elastomer plunger tips that were sealed with high-density polyethylene caps. Samples were analyzed immediately and at 14, 28, 42, 56, and 70 days. Fluconazole concentrations were measured using a modified stability-indicating HPLC method. At each test interval, the density of the suspension was determined gravimetrically and then used to calculate the exact volume of sample used for each analysis. Excessive degradation was defined as greater than 10% loss of the initial concentration.

RESULTS: The stock internal standard was stable for at least 77 days when stored in the dark at room temperature. The stock and working fluconazole standard solutions were prepared fresh at each test interval. Reconstituted oral suspension retained more than 90% of the initial fluconazole concentration for at least 70 days at 22–25 °C. No changes in color, odor, or visible microbiological growth were observed in any sample. The pH of the suspension was initially 4.2 and remained essentially unchanged throughout the study.

CONCLUSIONS: Reconstituted fluconazole oral suspension is stable in both the product's original plastic bottles and in amber polyethylene oral syringes for at least 70 days when stored at 22–25 °C.

REFERENCE: Published Online, February 10, 2009. www.theannals.com