# Immunotherapy RN

1. Recently I found a part-time job in a Immunology doctors office. I found myself having trouble understanding mixing and preparation of drugs for injection. Also an explanation of the two doctors was different and no logic. I found theoretic material , and with it I realized and understand dilution of concentrations from high to low.Please give me tips to understand, because I had no problems in mathematics.
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2. ### About yhl1975, MSN, CNS

Joined: Aug '07; Posts: 172; Likes: 36

3. You'll get stock of a certain extract, like 1:10 trees, for example. With that vial, take 1 ml of it and put it in another empty vial. Add 9ml of saline, and now you have a 10mL vial of 1:100 trees. (1 part allergen to 9 parts saline dilutes it by 10-fold) Take 1 cc of your new vial of 1:00 and do the same thing to get 1:1000, 1:10000 and 1:100,000. Now you have multiple 9cc bottles of varying strengths. Most programs will start a patient on the lowest dosage, slowly increasing the volume in that dosage for a certain amount of shots before graduating to the next dilution

For example
Shot 1: 0.1mL of 1:100,000
Shot 2: 0.2mL of 1:100,000
Shot 3: 0.4mL of 1:100,000
Shot 4: 0.6mL of 1:100,000
Shot 5: 0.8mL of 1:100,000
Shot 6: 1 mL of 1:100,000
Shot 7: 0.1mL of 1:10,000
Shot 8: 0.2mL of 1:10,000
etc

Certain allergens you can put together like grasses and weeds, so for shot 1 you have 0.1mL of each in the same syringe to save the patient a stick. Only issue with this is that if the patient has a reaction, you don't know which the patient was reacting to. The next shot you can separate them, or combine them differently to figure out which one the patient reacted to, and you can monitor it if you need to slow down the weekly adjustment. Hope this helps - let me know if you have any other questions
4. Thank you for the explanation. as I wrote it was understood by me from the internet. It makes sense.What I do not understand is:
If I have grass 40.000 u/ 1 ml
I need to make 10.000u
So I took 1 ml
Added 4 ml saline
My doctor told me: I make a mistake.

Could you enplane what is my mistake?
Last edit by yhl1975 on Dec 26, '10
5. My explanation is 0.25 ml-10.000u
and I will put 1ml saline.
So 0.25ml+1ml saline is the same as 1ml+4ml saline.
What is not good?
6. Quote from yhl1975
Thank you for the explanation. as I wrote it was understood by me from the internet. It makes sense.What I do not understand is:
If I have grass 40.000 u/ 1 ml
I need to make 10.000u
So I took 1 ml
Added 4 ml saline
My doctor told me: I make a mistake.

Could you enplane what is my mistake?
Quote from yhl1975
My explanation is 0.25 ml-10.000u
and I will put 1ml saline.
So 0.25ml+1ml saline is the same as 1ml+4ml saline.
What is not good?
For your dilution you need to put 1mL of the 40.000 u/ml into 3 mL saline, so your total volume is 4mL. You'll therefore have 1 part of your stock into 4 total parts of volume. 1/4 multipled by 40.000 = 10.000

If you put your 1mL 40.000 into 4 parts saline, you'll have a total volume of 5ml which would mean 1/5, which when multiplied by 40.000 which would give you 8.000

Just like 1 part stock into 9mL saline equals 10mL total volume, which dilutes your allergen by 1/10.

If you take .25 of the 40.000 u, then you are correct that the 0.25mL will contain 10.000 units (10.000 per 0.25mL). However if you add 1mL saline then while you will still have the 10.000u, the concentration will however change, so it will then be 10.000 units per 1.25mL(which is 8.000 per mL). If you add 50mL of saline then the concentration will be 10.000 per 50.25mL(which is 0.199units per mL). Likewise, if you take 1mL of the 40.000 units and add 4mL of saline you will have 40.000 units per 5 mL which is also 8.000 units per mL. You want to keep the concentration at 10.000u "per 1mL"

I am surprised this doc does not have these formulas written down. They honestly need to be, for every office that does this stuff, and the math needs to be checked by the doc. The dilutions also need to be done in a quiet area with no interruptions. If you dilute a vial wrong it could send a person into anaphylactic shock, so its very important to have the equations written down and followed every time, even when you are very experienced at this. It is a way to double check yourself and ensure safety, which is a big part of immunology.

Hope this makes sense, best of luck!
7. Thank you! yeah:Today I found the formulas written in the office, and other patient doctor explained the same that you did.
I was sure that I do not have any problems with math, I never did, and all this delusions made me ill.
I found patient information about Immunotherapy in my office.How could I find the same information in Spanish?Kind regards.
8. Other question is about clinical research in Immunotherapy.
Do you have any drug clinical researches,because in Europe there are PO and Sub lingual tabs for immunotherany.
I am interested in phase 3-4 researches . How could a doctor from his privet clinic to get IRB/ERC permission?
Again I have to say that I am working in the privet clinic, not hospital and our doctors work with many medical insurance companies.

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