Appleton Chapter 3: Pharmacy Flashcards by Aidyl XXX

Q

DIRECTIONS (Questions 1 through 203): Each of
the numbered items or incomplete statements in
this section is followed by answers or by comple-
tions of the statement. Select the ONE lettered an-
swer or completion that is BEST in each case.
1. Official standards for individual drugs and
chemicals formulated into dosage forms are
published in
(A) USP/NF
(B) USP DI Volume I
(C) USP DI Volume II
(D) USP DI Volume III
(E) PDR

A

(A) Official standards in the form of drug
monographs are presented in the United
States Pharmacopeia/National Formulary (USP/NF).
These monographs may describe therapeuti-
cally active drugs or other ingredients,
known as excipients, that are essential for
formulating a stable drug product. (24:9)

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Q

The agency in the United States responsible
for selecting appropriate nonproprietary
names for drugs is the
(A) AMA
(B) APhA
(C) FDA
(D) USAN
(E) USP

A

(0) The United States Adopted Names
(USAN) Council establishes nonproprietary
drug names. The Council is jointly sponsored
by the AMA, United States Pharmacopoeial
Convention, and the APhA. Because the
USAN is not an official government agency,
the chosen names are not formally recog-
nized until they are published in the Federal
Register. (24:32)

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Q

Descriptions of the Federal Controlled Sub-
stances Act, Approved Drug Products with
Therapeutic Equivalence Evaluations, and
USP/NF dispensing requirements may be
found in the
(A) USP DI Volume I
(B) USP DI Volume II
(C) USP DI Volume III
(D) Facts and Comparisons
(E) PDR

A

(C) Federal drug laws and regulations are
described in the USP Dispensing Information
(01), Volume III, which also contains listings
of therapeutic equivalent drugs and drugs
that are biologically inequivalent. The latter
information is from the FDA’s “Orange
Book.” (18c:VI-52)

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Q

Prescription drug descriptions expressed in
layperson’s terms and useful as handouts for
patients may be photocopied from the
(A) USP DI Volume I
(B) USP DI Volume II
(C) USP DI Volume III
(D) Facts and Comparisons
(E) Remington’s Pharmaceutical Sciences

A

(B) Volume II of the USP DI contains drug
monographs written for the layperson. Phar-
macists have permission to photocopy indi-
vidual drug descriptions for distribution to
the patient when dispensing the drug. Vol-
ume I of the USP DI contains drug informa-
tion for health professionals. It includes more
detailed and more scientific information than
Volume II. (1Sb; 18c)

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Q

According to the USP, the instruction “pro-
tect from light” in a monograph indicates
storage in a
(A) dark place
(B) amber glass bottle
(C) light-resistant container
(D) hermetic container
(E) tight glass container

A

(C) A container that reduces light transmis-
sion in the range between 290 and 450
nanometers to the level specified in the USP
90
may be considered light resistant and suit-
able protection from light. The container may
be constructed of glass or plastic. Although
amber units are most common, other colored
or opaque containers may meet the official
requirements. (4:12.6; 18c:VI-5; 24:154)

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Q

According to USP standards, a refrigerator
can be used to store pharmaceuticals that
specify storage in a
I. freezer
II. cool place
III. cold place
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(B) A cold place indicates a temperature not
exceeding 8° C (46° F). A refrigerator is a cold
place in which the temperature is maintained
between 2 and 8° C (36-46° F). A cool place
refers to areas maintained between 8 and 15°
C. A freezer is defined as a storage area held
between _10° and -20°. (18c:VI-6; 24:146)

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Q

The expiration date on a pharmaceutical con-
tainer states “Expires July 2005.” This state-
ment means that by that expiration date, the
product may have lost

(A) up to 5% of its activity
(B) up to 10% of its activity the use of extremely small doses of drugs is
(C) up to 20% of its activity known as
(D) up to 50% of its activity
(E) sufficient activity to be outside USP
monograph requirements

A

(E) The expiration date for a pharmaceutical
is based on the length of time during which
the product continues to meet the specified
monograph requirements. Requirements are
stated in terms of amount of active ingredient
that is present as determined by suitable as-
say. Most drug products are considered us-
able until approximately 10% of the drug or
drug activity has been lost. However, some
monographs specify other ranges. For exam-
ple, digoxin tablets must assay between 92%
and 108% of label claim. (1:639)

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Q

If a bottle of tablets has an expiration date of “July 2002,” the pharmacist may continue to
dispense the product
(A) up to 1 year after the expiration date several ways.
(B) only through July 1, 2002 of solubility is given in the USP,
(C) only through July 15, 2002
(D) only through July 31,2002 (A) g of solute soluble in 1 mL of solvent
(E) if the pharmacist informs the patient to
discard unused tablets in 6 months

A

(0) When expiration dates are expressed
only in terms of month and year, the in-
tended expiration date is the end of the last
day of the stated month. (1:639; 4:4.1)

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Q

A pharmacist has reconstituted a powder (D) mL of solvent required to dissolve 100 g dosage form to form a solution. Which of the of solute
following statement(s) concerning a Beyond- (E) mL of solvent required to prepare 100 Use Date is (are) appropriate when determin- mL of saturated solution ing an expiration date for this product?
I. The beyond-use date is identical to the
manufacturer’s expiration date.
II. The beyond-use date is never more than 10 days for reconstitute product’s
III. The beyond-use date for nonsolid dosage forms shall not be greater than one
year from the date of dispensing

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(B) Pharmacists are using beyond-use dating
quite often as guidelines when dispensing
prescriptions to limit prolonged use of the
drug by the patient. This date is usually a
shorter time span than the manufacturer’s
expiration date found on the original pack age. The beyond-use date shall be no later
than either the expiration date on the manu-
facturer’s container or one year from the date
of dispensing, whichever is earlier. For recon-
stituted products, the beyond-use date will
be of a significantly shorter duration and is
based on the manufacturer’s recommenda-
tion in the package insert or on the package.
(4:4.1)

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Q

Which one of the following practices would
NOT be classified as “alternative medicine” in the US?

(A) allopathy
(B) chiropractic
(C) naturopathy
(D) nutraceutical
(E) reflexology

A

(A) Allopathy is the treating of disease by
using remedies that produce effects on the
body that differ from those produced by the
disease. This new set of conditions is incom-
patible with or antagonistic to the original
symptoms of the disease. The term is now
used when referring to standard or orthodox
medical practice. Naturopathy indicates heal-
ing by the exclusive use of natural remedies
(heat, light, vegetables, fruits, etc.) but no
surgery or drugs. Nutraceutical practice is
one in which foods are used to promote heal-
ing and health. (1:840; 27:69)

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Q

An alternative medical practice that stresses the use of extremely small doses of drugs is
(A) folk medicine
(B) holistic medicine
(C) homeopathic medicine
(D) orthomolecular medicine
(E) faith healing

A

(C) Homeopathy involves the use of sub-
stances that produce symptoms similar to the
symptoms of the disease (the law of similars).
The drugs used, mainly herbals, are adminis-
tered as very high dilutions, that is, in ex-
tremely low doses. Holistic medicine refers to
therapies that treat the whole person-both
mind and body. (27:909; 1:840)

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Q

Solubility of a substance may be expressed in

(A) g of solute soluble in 1 mL of solvent
(B) g of solute soluble in 100 mL of solvent
(C) mL of solvent required to dissolve 1 g of solute
(D) mL of solvent required to dissolve 100g of solute
(E) mL of solvent required to prepare 100ml of saturated solution

A

(C) For example, boric acid solubility in wa-
ter is expressed as 1:18. This indicates that 1
gram of boric acid added to exactly 18 mL of
purified water will result in a saturated solu-
tion. When compounding, it is advisable to
use excess solvent because saturated solu-
tions are difficult to prepare and may precipi-
tate if there are changes in temperature.
(1:194)

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Q

Which of the following alkaloids exhibit good water solubility?
I. morphine HCl
II. cocaine
III. atropine

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(A) Naturally occurring alkaloids, which are
weak organic bases, have relatively poor wa-
ter solubility but are soluble in alcohol. Most
pharmaceutical products use the alkaloid
salts such as morphine Hel, cocaine Hel, and
atropine sulfate to increase the drugs’ water
solubility. (1:398)

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Q

Which of the following forms of the basic drug haloperidol will have good water solubility?

I. hydrochloride
II. lactate
III. decanoate
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(C) Haloperidol is a butyrophenone deriva-
tive and the base form has very poor water
solubility (1 g in more than 10,000 mL). The
hydrochloride salt is water soluble, as is the
lactate salt, which is utilized in preparing the
aqueous injection of haloperidol. Haloperidol
decanoate is the ester form that is dissolved
in an oil vehicle. This injection product is in-
jected intramuscularly and has a half-life of
approximately 3 weeks. (1:1184)

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Q

Which one of the following chemicals is NOT
suitable as a drug excipient?
(A) methyl paraben
(B) starch
(C) glycerin
(D) benzocaine
(E) lactose

A

(D) Pharmaceutical excipients are selected
for specific characteristics that will improve
the drug formulation. These include solvents
(glycerin), ointment bases (petrolatum), tablet
diluents (lactose), antioxidants (sodium bi-
sulfite), and antimicrobial preservatives (the
parabens). Because they must be relatively in-
ert therapeutically, the local anesthetic benzo-
caine would not be suitable. (24:111)

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Q

Which of the following chemicals may be in-
cluded in a drug solution as a chelating
agent?
(A) ascorbic acid
(B) hydroquinone
(C) edetate
(D) sodium bisulfite
(E) fluorescein sodium

A

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Q

Which of the following ions may be effec-
tively chelated by EDTA?
I. sodium
II. lithium
III. lead
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

A

(B) Edetate calcium disodium (Versenate) is
usually administered by intramuscular par-
enteral injection to reduce blood levels and
depot stores of lead in acute and chronic lead
poisoning and lead encephalopathy. The
chelate formed with lead is stable, water-
soluble, and readily excreted by the kidneys.
The other choices, lithium and sodium, are
monovalent ions and will not complex with
EDTA. (1:935)

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Q

Although most drugs in pharmaceutical
dosage forms are expected to decompose fol-
lowing first-order kinetics, an exception are
drugs formulated in
(A) capsules
(B) oral solutions
(C) oral suspensions
(D) tablets
(E) suppositories

A

(C) Drugs in suspensions are likely to follow
zero-order kinetics because the limiting fac-
tor is the amount of drug actually in solution.
The classic example is aspirin suspension.
(12:286)

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Q

An early sign of a decomposing epinephrine
solution is the presence of a
(A) brown precipitate
(B) pink color
(C) white precipitate
(D) crystal
(E) red color

Study These Flashcards

A

(B) Epinephrine, a catecholamine, is very
sensitive to oxidation, which results in bio-
logically inactive products. The first indica-
tion of oxidation is the development of a pink
color that darkens to form a brown precipi-
tate. (1:989; 24:83)

Q

On exposure to air, aminophylline solutions
may develop
(A) crystals of theophylline
(B) a gas
(C) a precipitate of aminophylline
(D) a precipitate of ethylenediamine
(E) a straw color

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A

(A) Aminophylline consists of theophylline,
which has been reacted with ethylenedi-
amine to improve its water solubility. On ex-
posure to air, carbon dioxide is absorbed and
free theophylline forms. Addition of small
amounts of ethylenediamine redissolves
these crystals. A note in the monograph for
Aminophylline Injection USP states: Do not
use the injection if crystals have separated.
(1:972)

Q

The process of grinding a substance to a very
fine powder is termed
(A) levigation
(B) sublimation
(C) trituration
(D) pulverization by intervention
(E) maceration

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A

(C) The term trituration usually refers to re-
ducing the particle size of powders often in a
mortar and pestle. However, trituration has
also been used to describe the simple mixing
of two or more powders in the mortar. Levi-
gation is the process of reducing the particle
size of solids by adding a small amount of a
liquid or an ointment base to make a paste,
which is then rubbed with a spatula on an
ointment tile. Sublimation is the conversion
of a solid to a vapor without passing through
a liquid phase. Pulverization by intervention
is a process for reducing particle size by us-
ing a second agent that can then be readily
removed. For example, camphor is reduced
by the intervention of alcohol. Maceration is
an extraction process in which the ground
drug is soaked in a solvent until the cellular
structure is penetrated and the soluble con-
stituents have been dissolved. (24:166; 1:1612;
1:1521)

Q

The term “impalpable” refers to a substance
that is
(A) bad tasting
(B) not perceptible to the touch
(C) greasy
(D) nongreasy
(E) tasteless

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A

(B) Powders that are either directly applied
to the skin or are incorporated into topical
products should be extremely fine or impal-
pable. Trituration is often needed to reduce
particles to an extremely fine size so that the
patient will not discern individual particles
when the product is rubbed on the skin. Usu-
ally a particle size of 50 microns or smaller is
desired.

Q

Which one of the following general charac-
teristics is NOT true for alkaloids?
(A) contain nitrogen in the molecule
(B) have good alcohol solubility
(C) have pKa’s less than 7
(D) often exhibit stereoisomerism
(E) have poor water solubility

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A

(C) Most alkaloids have a pKa above 7;
therefore, they are weak bases that will form
salts with an acid (eg, pilocarpine hydrochlo-
ride, morphine sulfate). Stereoisomerism is
common in alkaloid structures; large differ-
ences in therapeutic activity can be expected
among isomers. (1:398)

Q

The term “chiral” is related to a drug’s
(A) chelating ability
(B) eutectic properties
(C) stereoisomerism
(D) partition coefficient
(E) water solubility

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A

(C) Chiral relates to the optical activity of a
molecule. Stereoisomers of a specific drug
may exhibit distinctly different degrees of
therapeutic activity. For some drugs the ac-
tivity or major side effects may be due to
only one of the isomers present. (1:155)

25. Different crystalline forms (polymorphs) of the same drug exhibit different I. metabolism rates II. melting points III. solubilities (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

25. (D) Polymorphs differ in their melting points, x-ray diffractions, infrared spectra, and dissolution rates. For example, riboflavin has three polymorphs, each with significantly different solubilities. Theobroma oil (cocoa butter) can exist in four forms, each differing in melting points. Gentle heating of cocoa butter will favor the formation of the stable beta polymorph. This crystalline form is de- sired because it melts at 34.5 0 C, which is close to but lower than body temperature. Metabolic rates of a drug's polymorphs will not vary because once the drug has dis- solved, the polymorphs no longer exist. (1:168)

26. Benzalkonium chloride is a germicidal sur- factant that is rendered inactive in the pres- ence of (A) organic acids (B) gram-negative organisms (C) cationic surfactants (D) soaps (E) inorganic salts

(D) Benzalkonium chloride is a cationic sur- face active agent. In the presence of anionic agents such as soaps, benzalkonium chloride and similar cationic agents are inactivated be- cause the combination of large cations with large anions of soaps form inactive products. (1:1264)

27. The shrinkage that occurs when alcohol and purified water are mixed is primarily due to (A) attractive van der Waals forces (B) covalent bonding (C) hydrogen bonding (D) ionic bonding (E) temperature changes

27. (C) Hydrogen bonding is an attractive force between hydrogen atoms and electronegative atoms such as oxygen, fluorine, and nitrogen. Although weak, hydrogen bonds can bring about the miscibility of certain solvents or the solubility of certain chemicals. Hydrogen bonding is also responsible for the shrinkage phenomenon that occurs when mixing cer- tain liquids. For example, when equal vol- umes of Alcohol USP and purified water are mixed, there is approximately 3% shrinkage from the theoretical volume. If one wishes to prepare 100 mL of Diluted Alcohol USP, a so- lution that contains 49% VIV ethanol plus purified water, equal volumes of each are used. However, one must also remember to use an excess of at least 3% of each ingredient to assure obtaining the required volume. (12:23,213)

28. An example of a nonionic surfactant would be (A) ammonium laurate (B) cetylpyridinium chloride (C) dioctyl sodium sulfosuccinate (D) sorbitan monopalmitate (E) triethanolamine stearate

28. (D) Sorbitan monopalmitate is a sorbitan fatty acid ester, commercially available as Span 40. It is classified as nonionic because the molecules would not have the tendency to migrate to either pole in an electric field. Ammonium laurate, dioctyl sodium sulfo- succinate, and triethanolamine stearate are anionic surfactants. This designation implies that the large active portion of the surfactant molecule would bear a negative charge and, therefore, would migrate to the anode in an electric field. For example, the stearate por- tion of triethanolamine stearate is considered the active ion. Cetylpyridinium chloride is a cationic surfactant. The active surfactant por- tion, cetylpyridinium, has a positive charge and migrates to the cathode. (1:286)

29. According to the Poiseuille equation, the fac- tor that has the relatively greatest influence on the rate of flow of liquid through a capil- lary tube is the (A) length of the tube (B) viscosity of the liquid (C) pressure differential on the tube (D) radius of the tube (E) temperature of the liquid

29. (D) The equation may be expressed as r4xtx~P V = 8xlxn The volume of liquid (V) passing during a unit of time (t) is directly proportional to the radius of the tube (r) and the pressure differ- ential (~P) at each end of the tube and in- versely proportional to the length of the tube (1) and the viscosity of the liquid (n). Because the radius is raised to the fourth power, doubling the radius would cause a 16-fold change in the flow provided all other factors remained constant. The capillary can be envi- sioned as a simple glass tube or a human blood vessel. (1:295; 12:462)

30. Patients following low-sodium diets may re- sort to the use of sodium-free salt substitutes such as NoSalt. The major ingredient in these products is (A) ammonium chloride (B) calcium chloride (C) potassium chloride (D) potassium iodide (E) none of these

30. (C) Potassium chloride is an obvious substi- tute for sodium chloride because it has a sim- ilar salty taste, is crystalline, and is an elec- trolyte already present in the body. However, the use of these salt substitutes is contraindi- cated in patients with severe kidney disease or oliguria. Symptoms such as weakness, nausea, and muscle cramps indicate exces- sive sodium depletion. Increased sodium in- take is warranted.

31. Potassium supplements are administered in all of the following manners EXCEPT (A) IV infusion (B) IVbolus (C) elixirs, po (D) effervescent tablets (E) slow-release tablets, po

31. (B) IV injection of high concentrations of potassium may cause cardiac arrest. Intra- venous administration must be by slow infu- sion to allow dilution of the potassium to oc- cur. When plasma potassium levels are above 2.5 mEq/L, rates up to 10 mEq/h (total of 100 to 200 mEqlday) may be set. In more serious conditions, with plasma levels below 2 mEq/L, rates of 40 mEq/h (total of 400 mEql day) have been employed. Available in- jection forms contain 10-80 mEq per vial. IV admixtures are prepared by diluting these so- lutions to 250-1000 mL. Oral dosage forms include Kay Ciel elixir, Kaon tablets, K-Lor, and K-Lyte packets. Slow-K tablets have a wax matrix from which the KCl slowly dis- solves in the GI tract. (1:930)

32. Which of the following statements concern- ing fluorouracil is NOT true? (A) Its chemical structure is a modified pyrimidine similar to uracil and idoxuri- dine. (B) It is effective only when administered by injection. (C) Anorexia and nausea and vomiting are very common side effects. (D) The drug interferes with the synthesis of ribonucleic acid. (E) Leukopenia is a major clinical toxic ef- fect.

32. (B) Topical dosage forms are used. For exam- ple, both creams and solutions are available under the trade names of Efudex and Fluoro- plex. In fact, however, fluorouracil is usually administered by IV injection. It is not given orally because of irregular absorption from the GI tract. (3:2881; 6:1249)

33. The product inserts for many drug products contain cautionary statements. Which one of the following sequences lists the three types of cautions in the order of least serious to most serious? (A) contraindication, precaution, warning (B) precaution, warning, contraindication (C) warning, contraindication, precaution (D) warning, precaution, contraindication (E) contraindication, warning, precaution

33. (B) A "precaution" is intended to advise the physician of possible problems that may oc- cur with the use of a drug. For example, the use of tetracycline may result in overgrowth of nonsusceptible microorganisms. A "warn- ing" signifies a more serious problem with greater potential for harm to a patient. For example, renal impairment may require re- duction in the drug dose. A "contraindica- tion" is the most restrictive limitation be- cause it refers to an absolute prohibition against the use of a drug under certain condi- tions. For example, the use of penicillin de- rivatives is prohibited in patients known to be sensitive to penicillin. (24:55)

34. A comparison of individual amino acids present in commercial amino acids injection solutions may be found in I. Facts and Comparisons II. Trissel's Handbook on Injectable Drugs III. Remington's Pharmaceutical Sciences (A) I only (B) III only (C) I and II only (D) II and III only (D) I, II, and III

34. (C) Both Facts and Comparisons and the Hand- book on Injectable Drugs present tables comparing the commercial amino acid injections. (21:26-27; 10)

35. The containers used to package drugs may consist of several components andlor be composed of several materials. The release of an ingredient from packaging components into the actual product is best described by the term (A) adsorption (B) absorption (C) leaching (D) permeation (E) porosity

35. (C) The term "leaching" is used specifically to designate the release of a container ingre- dient into the product itself. For example, zinc and accelerators may be leached from rubber closures into a parenteral vial. Ad- sorption would refer to the binding of a sub- stance onto the surface of the container wall. Diffusion is the passage of a substance through a second substance. For example, volatile oil or dye may diffuse from a solu- tion through the walls of a plastic container. Permeation would denote the solution of a substance in the cell wall followed by pas- sage through the wall. Porosity indicates small holes or passages through which a sub- stance could pass. (24:139-40)

36. Hypodermic needle sizes are expressed by gauge numbers. The gauge number refers to the (A) bevel size (B) external diameter of the cannula (C) internal diameter of the cannula (D) length of the needle (E) size of the lumen opening

36. (B) Hypodermic needle sizes are expressed by a gauge system based on the external di- ameter of the cannula: the larger the number, the smaller the diameter of the needle. For example, the 21-gauge needle is smaller in di- ameter than the 19-9auge needle. Generally, the length of the cannula is also specified. This measurement, expressed in inches, rep- resents the distance from the needle tip to the junction with the hub. (13:325)

37. "Winged" needles are most closely associated with which type of injections? (A) intradermal (B) intramuscular (C) intrathecal (D) intravenous (E) subcutaneous

37. (D) The winged (scalp-vein, scalp, or butter- fly) needle consists of a stainless steel needle with two flexible plastic winglike projections. The wings serve two purposes: They ease manipulation of the needle during insertion into the vein and then allow the needle to be anchored with tape to the skin. (13:326)

38. Insulin preparations are usually adminis- tered by (A) intradermal injection (B) intramuscular injection (C) intravenous bolus (D) intravenous infusion (E) subcutaneous injection

38. (E) Insulin is usually administered by sub- cutaneous injection into the arm or thigh. Absorption of the insulin is good, and this route is both convenient and safe for self- administration of the drug. Some studies indicate that the absorption rate from the arm is 50% faster than from the thigh. (13:110)

39. Which one of the following needles is most suited for the administration of insulin solu- tions? (A) 16G 5/8" (B) 21G 1/2" (C) 21G 5/8" (D) 25G 5/8" (E) 25G I"

(D) Insulin solutions have low viscosities, and only small volumes are injected. There- fore, small-bore needles (25G up to 30G) may be used. Short (3/8" to 518") needles are ade- quate for the usual subcutaneous route of in- sulin administration. (13:327)

40. The term "venoclysis" is most closely associ- ated with (A) intravenous injections (B) intrathecal injections (C) intravenous infusions (D) intrapleural withdrawals (E) peritoneal dialysis

41. The designation "minibottles" refers to (A) partially filled parenteral bottles with 50- to 150-mL volumes (B) any parenteral bottle with a capacity of less than 1 L (C) 10 to 30 mL glass vials (D) prescription bottles with capacities of 4 oz or less (E) vials with a capacity of less than 10 mL

41. (A) Partially filled glass containers (minibot- tIes) usually consist of 250-mL bottles con- taining 50, 100, or 150 mL of either DsW or NS. To these bottles one can easily add drug solutions, taking advantage of the vacuum present in the minibottle. Plastic bags are also employed for preparing parenteral admix- tures. The plastic units do not have a vacuum but are flexible enough to accommodate ad- ditionalliquids. (1:1551, 1553)

42. The term "piggyback" is most commonly as- sociated with (A) intermittent therapy (B) intrathecal injections (C) intravenous bolus (D) slow intravenous infusions (E) total parenteral nutrition

42. (A) Intermittent therapy refers to adminis- tration of parenteral drugs at spaced inter- vals. One of the most convenient methods for administration is for the pharmacist to pre- pare a minibottle containing active drug solu- tion such as an antibiotic added to a diluent. This unit is attached to the tubing of a large- volume parenteral (LVP) bottle already hang- ing on the patient. This "piggyback" concept saves the patient from multiple injections and assures high blood levels of the additive drug because the minibottle solution is infused in a short period of time. (1:1551-53; 13:145)

43. Which of the following acronyms refer to parenteral nutrition? I. TPN II. TNA III. PMN (A) I only (B) III only (C) I and II only (D) II and III only (E) I, II, and III

43. (C) TPN (total parenteral nutrition) and TNA (total nutritional admixture) refer to so- lutions administered parenterally to provide calories, amino acids, and other nutrients by parenteral infusion. PMN is an abbreviation sometimes used for phenylmercuric nitrate, an antimicrobial preservative. (4:33.1)

44. What is the approximate maximum volume of fluid that should be administered daily by intravenous infusion to a stabilized patient? (A) 1L (B) 4L (C) 8L (D) 12 L (E) 16 L

44. (B) Although the maximum volume will vary depending on the condition of the pa- tient, the normal daily water requirement is approximately 25 to 40 mL/kg of body weight or 2000 mL per square meter of body weight. Daily volumes greater than 3 to 4 L in normal (nondehydrated) patients may cause a fluid overload. A dehydrated patient will require larger quantities. Water replace- ment therapy (hydration therapy) in an adult

45. Although isotonicity is desirable for almost all parenterals, it is particularly critical for (A) intra-articular injections (B) intradermal injections (C) intramuscular injections (D) intravenous injections (E) subcutaneous injections

45. (E) A subcutaneous injection will come into contact with a large number of nerve endings and may remain at the injection site for a long period of time. Pain will be experienced if the solution is not isotonic. The potential effects of hypotonic or hypertonic intra- venous solutions are offset by their dilution in the large volume of blood into which they are injected, provided the volume injected is not excessive and the rate of injection is slow. (1:61; 24:401)