Q: 58 year old male with IPF (interstitial Pulmonary fibrosis) became unstable and required intubation. "Swan" is floated with high pulmonary pressure. Nebulized Flolan (Epoprostenol) is initiated at room temperature. How frequent Nebulizer, infusion tubing and connections should be changed?

A) Once a day

B) Once a week

C) Every 8 hours

D) Every 72 hours

E) There is no need to change

Answer: C

Flolan for nebulized delivery must be reconstituted with glycine and is usually not compatible with any other solution. Glycine is sticky and viscous and also needs to be shielded from light. It is recommended to keep reconstituted solution cold with icepacks during administration (around 2-8 degrees C) as Flolan is stable for 8 hrs at room temp., and 24 hours if refrigerated. Nebulizer, infusion tubing and connections should be changed every 24 hrs (refrigerated) or every 8 hrs (unrefrigerated) as drug expires.