Narcotic Preparations
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Transcript of Narcotic Preparations
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Chapter 11Narcotic Preparations
2012 Paradigm Publishing
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Learning Objectives Gain an awareness of the history of narcotic medications. Understand the legal regulations and procedures that must be
followed when preparing various controlled substances for parenteral administration.
Identify the USP Chapter <797> procedures that must be performed when preparing narcotic compounded sterile preparations (CSPs).
Demonstrate correct technique in the preparation of narcotic CSPs.
2012 Paradigm Publishing
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Topics Learning Objectives Introduction Drug Schedules Properties of Narcotic CSPs Potential Complications of Parenteral Therapy Controlled Substance Storage Controlled Substance Record Keeping Patient-Controlled Analgesia USP Chapter <797> Guidelines for Controlled
Substance CSPs Understand the Resources and Supplies Preview the Lab Procedure Chapter Summary
2012 Paradigm Publishing
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Introduction
The CSA classifies controlled substances according to their potential for abuse and addictionmost narcotic CSPs
prepared by IV technicians are comprised of a C–II narcotic mixed with a base solution
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Drug Schedules
The CSA organizes controlled substances into five drug schedules or classes based on their potential for abuse and addictionin addition to these federal
regulations enforced by the DEA, each individual State Board of Pharmacy provides guidelines and oversight regarding the prescribing and dispensing of controlled substances
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Drug Schedules…/2
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Drug Schedules…/3
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Drug Schedules…/4
Community or retail pharmacies often stock C–III through C–V medications on the shelf along with noncontrolled substance medicationsin this type of environment, C–II controlled substances
must be tracked using a perpetual inventory system Most institutional or hospital pharmacies store all
classes of controlled substances under a double-lock system
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Properties of Narcotic CSPs
The physical and chemical properties of narcotic medications vary widelymost narcotics have chemical properties that are generally
isotonic, isoosmotic, and pH neutraloccasionally, narcotics have an acidic pH value or are
hypertonic or hyperosmoticin those instances, the narcotic must be injected into an IV
or IVPB base solution; the resulting CSP has physical and chemical properties that are generally isotonic, isoosmotic, and pH neutral
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Potential Complications of Parenteral Therapy
All patients receiving parenteral therapy should be monitored for the following complications:nosocomial infectionallergic reaction (including anaphylaxis)phlebitistissuingembolismextravasationcellulitisStevens-Johnson syndromenephrotoxicity
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Potential Complications of Parenteral Therapy…/2
Patients with end-stage cancer or other terminal diseases sometimes build up a narcotic tolerance to the narcotic medications used to control their painthe IV technician may be required to prepare an LVP
preparation by injecting a C–II narcotic, such as hydromorphone or morphine into an IV base solution
In the hospital, hospice, or home healthcare setting, nursing personnel typically administer the compounded preparation to the patient
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Potential Complications of Parenteral Therapy…/3
Patients receiving high-dose narcotics face a heightened risk from central nervous system (CNS) depressionmust be closely monitored
to prevent a potentially fatal reduction in their respiratory or cardiac functions
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Controlled Substance Storage
Controlled substances carry various levels of risk with regard to their potential for drug abuse and controlled substance diversion, or narcotic diversionproper controlled substance storage is essential in
mitigating these risks
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Controlled Substance Storage…/2
In the institutional setting, all controlled substances within the pharmacy are kept in the narcotic room under a double-lock system
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Your Turn
2012 Paradigm Publishing
1) Most narcotic CSPs prepared by IV technicians are comprised of this narcotic mixed with a base solution.a. C–Ib. C–IIc. C–IIId. C–IV
2) Most institutional or hospital pharmacies store all classes of controlled substances under this system.a. no-lockb. single-lockc. double-lockd. triple-lock
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Controlled Substance Record Keeping
Proper controlled substance record keeping is also critical for reducing the possibility of drug abuse and controlled substance diversionthere is one aspect of controlled
substance record keeping that all sterile compounding personnel should know: the use of a perpetual inventory record
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Controlled Substance Record Keeping…/2
Perpetual Inventory Log Book The perpetual inventory log book is an official, legal
record with pages titled “Perpetual Inventory Record” or “Controlled Substance Record”is kept in the narcotic room or vault and is a record of all
activity relating to the medications in the narcotic room
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Controlled Substance Record Keeping…/3
Perpetual Inventory Log Book…continued
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Controlled Substance Record Keeping…/4
Perpetual Inventory Log Book…continued Every controlled substance that leaves the narcotic
room—for example, to fill floor stock, prepare an epidural cassette, or compound a PCA syringe—must be signed out and subtracted from the perpetual inventory recordthis process is referred to as a narcotic sign-out, or a
controlled substance sign-out
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Controlled Substance Record Keeping…/5
Perpetual Inventory Log Book…continued
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Controlled Substance Record Keeping…/6
Error Correction in the Perpetual Inventory Log Book In most facilities, pharmacy personnel will record an
entry or addition to the log in black ink, and record withdrawals or negative balances in red inkpersonnel should never erase, scribble over, or use
correcting tape or fluid to cover transcription errorsinstead, technicians should note an error by drawing a
single line through the entire entry and placing their circled initials next to the text with the strike-through line
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Controlled Substance Record Keeping…/7
Security and Disposal of Controlled Substances To provide the utmost security, sterile compounding
personnel should always ensure that the narcotics, the keys to the narcotic room, and all narcotic records are kept in their control if a discrepancy is discovered while creating a record in the
perpetual inventory log book, IV technicians must immediately report it to their instructor or pharmacist
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Controlled Substance Record Keeping…/8
Security and Disposal of Controlled Substances…continued IV technicians must also properly dispose of unused
controlled substance solutions after completing sterile compounding procedures
In order to prevent narcotic diversion, all narcotic waste procedures must be recorded in the perpetual inventory record and must be observed by a narcotic waste witness
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Patient-Controlled Analgesia
IV technicians need to be familiar with several different controlled substance CSPs and their preparation, including LVPs used for chronic, severe pain control as well as epidurals and patient-controlled analgesia (PCA)
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Patient-Controlled Analgesia…/2
A PCA provides narcotic pain control, or narcotic analgesia, for hospitalized patientsallows a patient to self-administer a dose of the
medication intravenously by pressing a handheld controller
is preprogrammed to lock out the patient if a dose is requested before the scheduled time
experience has shown that patient control of analgesia leads to less narcotic use and, therefore, less potential for issues related to drug tolerance or side effects
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USP Chapter <797> Guidelinesfor Controlled Substance CSPs
In addition to the detailed record-keeping mandates for controlled substances, there are a number of other procedures that must be carefully followed while compounding controlled substance preparationsthese procedures are presented in USP Chapter <797> and
are reinforced in each facility’s P&P manualsterile compounding personnel must pay strict attention to
aseptic protocols both in the anteroom and clean room
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Understand the Resources and Supplies
Essential Supplies Most sterile compounding procedures require the
same essential supply items to be available for use in both the anteroom and the clean room
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Understand the Resources and Supplies…/2
Procedure-Specific Supplies Controlled-Substance
Perpetual Inventory Log Book
PCA Supply Itemsa Luer-to-Luer connector is
a small plastic device used to join the tips of two syringes
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Understand the Resources and Supplies…/3
Procedure-Specific Supplies…continued PCA Supply Items…continued
need to attach a sterile, plastic cap, called a syringe cap, to the tip of the PCA syringe
an IVA syringe seal is an adhesive seal that is often affixed to a syringe cap to provide evidence of tampering
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Understand the Resources and Supplies…/4
Procedure-Specific Supplies…continued IVPB Base Solutions
the same type of bag used for other vial-based IVPBs: a bag with a tail injection port
insert the needle directly into the injection port of an IVPB without regard to the position of the needle bevel and without creating any bend to the needle
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Understand the Resources and Supplies…/5
Critical Sites of Essential Supplies and PCA Supplies Before beginning preparatory procedures in the
anteroom or clean room, the IV technician must recall the critical sites of the suppliesidentifying the critical site of each supply item helps you to
determine the proper procedure for handling the supply item once you enter the clean room and begin working in the hood
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Preview the Lab Procedure Anteroom Preparatory Procedures
verifying the CSP label against the medication order
performing correct pharmacy calculations to determine type, size, and number of supply items needed
gathering and cleaning of suppliesperforming aseptic garbing and hand
washingdonning a sterile gown
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Preview the Lab Procedure…/2
Clean Room Preparatory Procedureswhen preparing controlled substance preparations for
patient administration, sterile compounding personnel must diligently follow established pharmacy clean room protocols as well
once the preparatory steps have been completed, narcotic PCA syringe compounding procedures may begin
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Preview the Lab Procedure…/3
Narcotic PCA Syringe Compounding Procedureafter the verification check,
aseptically remove the needle from the narcotic syringe and carefully attach one end of a Luer-to-Luer connector to the tip of the filled narcotic syringe
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Your Turn
2012 Paradigm Publishing
3) This log book is an official, legal record.a. perpetual accountb. perpetual stashc. perpetual inventoryd. perpetual stock
4) This is often affixed to a syringe cap to provide evidence of tampering. a. IVA syringe capsuleb. IVA syringe tubec. IVA syringe seald. IVA syringe cap
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