Term
| How much water should be used to flush medications? |
|
Definition
| 15 mL water before and after |
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Term
| Should you replace an occluded NG tube in an alert and oriented patient with a larger bore size NG tube to prevent further occlusions? |
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Definition
| No because the discomfort associated with it makes it a poor choice for short-term feeds |
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Term
| What causes physical drug-nutrient interaction? What are the results? |
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Definition
Physical interactions are caused by drug and formulation pH, chemical reactions, protein complexity, time, temperature, duration of exposure.
Physical interactions result in precipitation in PN or EN, disruption of emulsions for IVFE or EN, altered viscosity, change in consistency, clumping, or curdling of EN formulation. |
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Term
| What is a pharmaceutical drug-nutrient interaction? What is the result? |
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Definition
Pharmaceutical interaction caused by alteration of a specialized dosage form or administration by a different route than what was intended.
Results in loss of drug activity or toxicity |
|
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Term
| What is a pharmacokinetic drug-nutrient interaction? What is the result? |
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Definition
Pharmacokinetic interactiion occurs before the drug reaches the site of action and can be caused by altered absorption, presystemic metabolism, hepatic metabolism.
Results in loss of drug activity, toxicity |
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Term
| What is a pharmacodynamic drug-nutrient interaction? What are the results? |
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Definition
A pharmacodynamic interaction occurs at the site of action. Binding sites or receptors are usually involved.
It results in loss of drug activity or toxicity. |
|
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Term
| What is a pharmacological drug-nutrient interaction? What are the results? |
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Definition
A pharmacological drug-nutrient interaction is an extension of the drug's normal pharmacological actions.
It can result in the inability to provide PN or EN due to adverse effects. |
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Term
| What is a common outcome of a physical DNI in relation to EN? |
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Definition
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Term
| Which type of DNI typically occurs before the drug or nutrients reach the patient? |
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Definition
|
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Term
| Which vitamin quickly degrades when added to PN? Why? |
|
Definition
| Thiamin due to hydrolysis, photodegradation, and other forms of chemical degradation |
|
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Term
| How does pH of a drug affect compatibility with PN? |
|
Definition
| Drugs that are a very high or very low pH are typically incompatible with PN |
|
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Term
| How can calcium precipitate in a VAD be treated? |
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Definition
| A 0.1 N hydrochloric acid can be instilled in the occluded lumen to dissolve the precipitate, or the VAD can be replaced. |
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Term
| How does EN protein type influence the risk of physical drug interaction with EN? |
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Definition
| The presence of a complex protein (not hydrolyzed or free AA) increases risk of physical DNI |
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Term
| What components of EN have been shown to NOT affect risk of drug-nutrient interaction? |
|
Definition
Fiber content, nitrogen content, dilution of formulation
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Term
| How does protein type affect risk of physical drug interaction in EN? |
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Definition
| Protein source (caseinates, soy, whey) may have some effect on interactions. Casein seems to be more reactive than whey because it is less acid-stable. |
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Term
| How do the base components of a drug affect its risk of physical interaction with EN? |
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Definition
| Base components (whether the drug is water-based, alcohol-based, or alcohol-based) affects the compatibility of the drug with EN more than the drug itself in most cases |
|
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Term
| Which drug has been shown to be incompatible with fiber-containing EN formulas and compatible with fiber-free ones (it is an exception)? |
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Definition
|
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Term
| What is the best way to prevent physical drug nutrient interactions? |
|
Definition
| The best way to prevent physical DNIs is by not allowing the drugs to mix with either EN or PN formulations |
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Term
| How should EN or PN be handled when administering a drug through the same device as the EN or PN infusion?? |
|
Definition
| The EN or PN should be stopped, and the access device should be flushed with fluids that are compatible with the EN/PN formulation as well as the drug. |
|
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Term
| How should EN/PN access devices be flushed when administering medications? |
|
Definition
| The access device should be flushed before and after drug administration and between administrations if more than one drug is administered. |
|
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Term
| What is the typical flush fluid of choice for VADs? |
|
Definition
| Normal saline is typically the fluid of choice, but D5 is sometimes used |
|
|
Term
| What is the minimum recommended volume of fluid for flushing feeding tubes in adults? |
|
Definition
|
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Term
| What are alternative methods for preventing physical drug interaction with EN or PN formulation? |
|
Definition
| Altering infusion time (for instance cyclic infusion for daily drugs), the nutrition formulation (for instance switching to a hydrolyzed protein formula), or the drug |
|
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Term
| What is the most common form of altering a dosage form of a drug? |
|
Definition
| Crushing or dissolving a solid form to create a liquid for administration via feeding tube |
|
|
Term
| How should tablets and capsules be administered via tube? |
|
Definition
Solid dosage form: crushed into very fine powder and mixed with warm water
Capsule: opened and content mixed with water to form slurry |
|
|
Term
| What types of drugs should not be crushed for administration? |
|
Definition
- Sustained-release, slow-release, delayed release
- Enteric-coated meds
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|
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Term
| What drug sweetening agents can cause GI problems? |
|
Definition
| Mannitol, sucrose, and particularly sorbitol |
|
|
Term
| What are methods for preventing pharmaceutical interactions? |
|
Definition
- Using immediate-release forms rather than long-acting forms
- Avoiding special dosage forms such as enteric-coated or sublingual when administering via feeding tube
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Term
| Can proper tube flushing prevent pharmaceutical interactions? Can it prevent physical interactions? |
|
Definition
| Flushing does not prevent pharmaceutical interactions, but can prevent concomitant physical ones |
|
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Term
| Which type of drugs are most likely to be adsorbed by a container? |
|
Definition
| Fat-soluble ones (e.g. vitamin A) |
|
|
Term
| What consistency should slurries/suspensions be made into before administering via feeding tube? Why? |
|
Definition
| As thin as possible to avoid adhering to the tube |
|
|
Term
| How does low pH affect gastric vs small bowel motility? |
|
Definition
| It decreases gastric motility and increases small bowel motility |
|
|
Term
| How do products with extreme high or low osmolality affect gastric and small bowel motility? |
|
Definition
| They decrease gastric motility and increase small bowel motility |
|
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Term
| How do large volumes affect gastric and small bowel motility? |
|
Definition
| They decrease gastric motility and increase small bowel motility |
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Term
| How does drug absorption differ in the duodenum vs jejunum? |
|
Definition
| Most drugs are absorbed throughout the bowel, but some have a major decrease in bioavailability when administered into the jejunum (Cipro for instance) |
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|
Term
| Is it necessary to hold continuous feeds in order to given meds that are supposed to be taken on an empty stomach? |
|
Definition
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Term
| What is recommended to avoid EN interaction with phenytoin? |
|
Definition
- Holding EN administration for at least 1 hour and possibly 2 hours before and after administration
- Monitoring of serum phenytoin concentrations
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|
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Term
| What is the recommendation with administering carbamezipine? |
|
Definition
- Adequate dilution of the solution or slurry prior to administration and adequate flushing after the dose are the first choice to prevent EN-carbamezipine interactions
- When these measures fail, hold feedings before and after administration
|
|
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Term
| How does phenytoin interact with tube feeds? Can this cause an occlusion? |
|
Definition
| Phenytoin can bind to the EN formula or the tube, but this is not expected to increase risk of occlusion |
|
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Term
| How do EN formulations affect fluoroquinolone antibiotics? |
|
Definition
| EN formulations appear to reduce bioavailability of fluoroquinolone antibiotics |
|
|
Term
| What are examples of fluoroquinolone antibiotics? |
|
Definition
| Ciprofloxacin, levofloxacin, ofloxacin |
|
|
Term
| What is the recommendation for administering EN with fluoroquinolone antibiotics? |
|
Definition
| Hold administration of EN for at least 1 hour before and 2 hours after dosing |
|
|
Term
| What are the recommendations for administering warfarin with EN? |
|
Definition
- Minimize contact of drug with feeding tube
- If the first approach fails, hold EN for 1 hour before and after warfarin dose
- Closely monitor PT/INR while increasing dose
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