2012 OPEN FORUM Abstracts
MEDICATION COMPATIBILITY: IMPLICATIONS FOR COMBINATION THERAPY.
Christopher Russian, Joshua F. Gonzales; Respiratory Care, Texas State University-San Marcos, San Marcos, TX
Rationale: Aerosolization and inhalation is an accepted and ubiquitous option for the delivery of numerous pharmaceuticals. Patients with complex pulmonary problems may receive up to four medications for inhalation in several intervals throughout the day. Patients and healthcare practitioners will combine many of these medications in a single nebulizer cup to shorten treatment times. Although the combining of inhaled medications is quite common the compatibility of all nebulized medications has not been fully investigated. Objective: The purpose of this project was to expand upon current medication compatibility knowledge. Methodology: A review of the available literature was conducted to determine the compatibility of common inhaled pulmonary medications. The following databases/sites were utilized for this review: CINAHL, Pubmed, Google Scholar, Cochran Collaboration. The researchers created a matrix to record the types of compatibility accepted and published in the available literature. Results: The literature search numerous assessment techniques to assess medication compatibility, e.g. visual inspection, pH change, high-pressure liquid chromatography, temperature change, aerosol particle size change, precipitation formation, drug recovery, chemical compatibility, differential scanning calorimetry, differential thermal analysis, mass spectroscopy, solid state stability, surface oxidation, radio-labeled techniques, flourescence spectroscopy, FDA approval. No medication combination has been verified by assessment options. Table 1 demonstrates the medication combinations and the compatibility level. Blank spaces in the table indicate areas without any assessment of compatibility. Table 1 medications represent those with documented compatibility and test information. Medications without any documentation of compatibility were not included in this table. Also, medications believed to be compatible but failing to identify the test used to assess compatibility were not included. Conclusion: The literature review revealed an enormous void in medication compatibility information related to aerosolized pulmonary medications. It is not known from this review if combining these medications leads to any adverse events. We suspect many of these medications can be safely combined without incident. However, it seems reasonable to require at least one form of medication compatibility assessment prior to mixing. Sponsored Research - None Table 1. Medication Compatibility