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Preparation and handling of hazardous drugs for special administration


NOTE: Please consult Drug Information or a pharmacist for specific instructions before proceeding to reconstitute any hazardous drugs, including cytotoxics!

  • Administration of Oral Esomeprazole Tablet (both Nexium and Esoz)
    Patients without swallowing difficulty Swallow whole with water Do not chew or crush tablet Patients WITH swallowing difficulty Do not chew or crush tablet Disperse tablet in half a glass of water Stir until the tablet disintegrates into pellets Drink the liquid with pellets immediately or within 30 minutes Rinse the glass with half a glass of water and drink Patients on Nasogastric Feeding Tube (NGT) Do not crush tablet Put the tablet into a syringe and fill syringe with approximately 25mL (up to 50mL) water and approximately 5mL air Shake the syringe immediately for approximately 2 minutes to disperse the tablet Hold the syringe with the tip up and check that the tip is not clogged Attach the syringe to the tube whilst holding it with the tip up Shake the syringe, then position it with the tip down Inject 5 - 10 mL into the NGT immediately Invert the syringe after injection (with the tip pointing up) and shake Turn the syringe with the tip down and inject another 5 - 10mL into the tube immediately Repeat Steps 7 and 8 until the syringe is empty Fill the syringe with 25mL (up to 50mL) of water and 5mL of air Repeat Steps 7 and 8 to wash down any sediment left in the syringe References: 1) Esomeprazole Product Inserts (respective brands) Last reviewed 3 Jul 2023
  • Preparation of Oral Vitamin K (Phytomenadione)
    Break the Vitamin K (10mg/mL) ampoule at the neck Using the insulin syringe (29 Gauge, long needle, 3/10 cc), syringe out entire contents from Vitamin K ampoule and deposit it into a clean dry plastic cup Add 9mL of water with a Terumo syringe (no needle). This will give you Vitamin K 10mg in 10mL Using the Terumo syringe, syringe out the required number of mg (1mg = 1mL) as prescribed Deposit this into a second plastic cup and add water to make at least 15mL (to increase total volume for easier consumption) Shake cup slightly to mix well. Give to the patient to drink immediately If alot of oily liquid is left at the bottom after patient drinks, rinse with water and drink again Discard the broken Vitamin K ampoule and insulin syringes responsibly into the sharps bin Last reviewed 3 Jul 2023
  • Preparation of Oral Vancomycin solution
    - For Pharmacy Lab to prepare during office hours Reconstitute 1 vial of Vancomycin (500mg) with 10mL water for injection (WFI). This gives a solution of concentration 50mg per 1mL. Draw out the prescribed dose using a Terumo syringe into a plastic cup (E.g. for a dose of 125mL, draw 2.5mL of solution; for a dose of 500mg, draw 10mL) Further dilute the dose in the cup to 20mL with WFI and serve the preparation to the patient. (D5 may also be used in place of WFI for palatability) Store diluted solution in the refrigerator (2 - 8 degrees Celsius) and use within 24 hours *The stipulated 24 hours time frame is for manually-prepared oral solution done by non-lab staff

Last updated 04 Jul 2023

Rationale For Closed System Administration of Cytotoxics
  • This closed system is preferred for cytotoxics for which no liquid formulation is available, so as to avoid environmental contamination and exposure of carer to the hazardous medicine. Not recommended to be crushed due to risk of powder inhalation

  • Exposure to such substances is dangerous; therefore, contact with the skin and inhalation of dust should be avoided and protective equipment devices (gloves and mask) must be used

  • Women with pregnancy potential should avoid handling crushed or broken tablets. To wear gloves and mask when handling

  • Suitable protective clothing should be worn. Contaminated equipment should be disposed of as cytotoxic waste

  • Adapted from: White, R., & Bradnam, V. (2015). Handbook of drug administration via enteral feeding tubes. London: Pharmaceutical Press.

1) White, R., & Bradnam, V. (2015). Handbook of drug administration via enteral feeding tubes. London: Pharmaceutical Press.
2) Drug Product Inserts for respective drugs

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