Sterile Compounding>Incompatibility Identification Practice Test

A 57-year-old man with a seizure disorder is admitted for aspiration pneumonia. The team asks the IV room to prepare several medications now: phenytoin sodium 100 mg IV to be compounded at 6 mg/mL and run over 20 minutes; vancomycin 1 g IV diluted to 4 mg/mL in normal saline (NS) and infused over 2 hours; cefazolin 1 g IV in 100 mL dextrose 5% (D5W) over 30 minutes; and metronidazole 500 mg IV in 100 mL D5W over 60 minutes. The pharmacist must verify diluent compatibility before compounding and batching these first doses. Review each planned drug-and-diluent pairing and identify if any should not be prepared as requested due to a known IV incompatibility that could lead to precipitation or drug degradation in the bag or line.

A 58-year-old man with status epilepticus arrives to the ED. Orders include: phenytoin sodium loading dose 1,000 mg IV, fosphenytoin 1,000 mg PE IV as alternative if needed, levetiracetam 1,500 mg IV, and maintenance IV fluids of NS or D5W per compatibility. The pharmacist must select appropriate diluents and determine safe combinations for preparation. The team prefers premixing each antiepileptic in a 100 mL bag and infusing via central access as soon as possible.