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NUTR 442 > ASPEN ch 15 - PN formulation > Flashcards

ASPEN ch 15 - PN formulation Flashcards

1
Q

less frequently used CHO energy substrate is ___ that provides __kcal/g

A

glycerol; 4.3

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2
Q

modified a.a. formulation designed for use in _____ contains increased amts ___ and decreased amts ____

A

hepatic encephalopathy; BCAAs; AAA

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3
Q

why BCAA thought be beneficial for severe stress?

A

^ skel muscle catabolism

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4
Q

__ content higher in more concentrated products but ____ may be used to balance ratio and avoid acid base probs

A

acetate; chloride salts

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5
Q

why less use of 10% lipid now?

A

higher phospholipid:triglyceride ratio compared to 20%, so ^ presence free phospholipids which interfere with lipoprotein lipase activity (v lipid clearance)

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6
Q

what does SMOF stand for?

A

soybean, medium chain RG, olive oil, fish oil

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7
Q

SMOFlipid good for these pt:

A

don’t tolerate soy well, if have carnitine deficiency (MCT is carnitine independent)

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8
Q

causes of PNALD?

A

omega 6s pro-inflam, IV admin phytosterols, ox stress

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9
Q

ILE infusion rate should NOT exceed ___g/kg/h

A

0.11

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10
Q

why not higher ILE infusion rate?

A

hypertriglyceridemia, infectious complication, fat overload syndrome

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11
Q

fat overload syndrome characterized by:

A

headaches, seizures, fever, jaundice, hepatosplenomegaly, ab pain , resp distress, pancytopenia, shock

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12
Q

in critically ill, limit ILE to ___ g/kg/d

A

1

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13
Q

advantages of olive oil based ILE?

A

decreased peroxidation, lack of lymphocyte function inhibition, preserve hepatic function

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14
Q

use of ____ based ILE associated with faster termination of mech vent and less time to ICU discharge

A

olive oil and fish oil

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15
Q

preferred forms of calcium and magnesium in PN:

A

calcium gluconate and magnesium sulfate

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16
Q

why these forms of Ca and Mg?

A

less likely produce physicochemical incompatibilities compared to others

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17
Q

PN formulations for single vits not available for :

A

biotin, pantothenic acid, riboflavin, vit a, vit d, vit e

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18
Q

common trace elements in PN:

A

zinc, copper, chromium, manganese, selenium

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19
Q

a.a. thought to have role in intestinal integrity, immune fxn, pro synth during stress

A

glutamine (not actually recommended to be supplemented)

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20
Q

quarternary amine necessary for proper transport/metabolism of LCFA into mito for beta-ox

A

carnitine

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21
Q

ILE in 2-in-1 is administered in a ___ infusion

A

piggyback

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22
Q

advantage of TNA:

A

convenience, cost, more sanitary, efficient, tolerance may be better, better in fluid restricted, fat clearance better

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23
Q

why limit hang time ILE to max 12 hours?

A

cuz has potential support bacterial/fungal growth

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24
Q

disadvantages of TNA

A

larger particle size, less stable (prone to separation), compatibility and solubility of ca and na/k less, lower pH a.a., difficult visualize precipitate, some meds incompatible, > risk catheter occlusion, shorter catheter lifespan

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25
Q

what does ILE stand for?

A

injectable lipid emulsion

26
Q

success in v thrombophlebitis thru addition of ____ and/or small amt ____ to PPN

A

heparin; hydrocortisone

27
Q

technique to minimize thrombophlebitis includes use of ___ patch at venous insertion site

A

nitroglycerin

28
Q

3 different risk levels of contamination?

A

low (simple closed system aseptic), medium (reconstitution to transfer or large vol PN prep), high (preparation from bulk, nonsterile ingredients or prep from sterile ingredients exposed to < ISO Class 5 standards)

29
Q

what are ISO class 5 standards?

A

no circulating particles 0.5 micrometre or larger to exceed 100 particles/cubic food

30
Q

what is in-use time?

A

time before which a conventionally manufactured product used to make CSP must be used once opened/punctured

31
Q

Category 1 CSPs?

A

assigned max beyond-use-date = / < 12 hrs controlled rm temp or =/< 24 hr refrigerated

32
Q

category 2 CSP?

A

BUD > 12 hr temp or > 24 hr fridge

33
Q

what is BUD:

A

date/time after which CSP should NOT be stored/transported/admin and determined from date/time prep was compounded

34
Q

what are ACDs

A

automated compounding devices

35
Q

main advantage of ACD?

A

accuracy ^ of dosage form (also more safe)

36
Q

disadvantage ACD?

A

cost and space

37
Q

major methods used for verifying accuracy of compounding process by ACDs are ______ and _____ analysis

A

volumetric; gravimetric

38
Q

___ used to determine whether PN formulations compounded properly

A

refractometry (doesn’t work w/ TNA)

39
Q

why internal membrane to separte macronutr into diff chambers?

A

prevent Maillard rxn that alters integrity of dextrose and a.a.

40
Q

advantages of using standard commercially available PN?

A

reduce cost, v comp time, less risk for errors, less infections, shelf stable and heat sterilized

41
Q

stability in PN refers to ___ and compatibility refers to ____

A

degradation of nutr components that changes original characteristics (eg. maillard rxn) and ability maintain chem integrity and activity; formation of precipitates

42
Q

polar regions on fat droplet create ___ charge (called ___ potential) on surface of fat drop that promotes repulsion between neighboring lipid particles of same charge

A

negative; zeta

43
Q

factors that alter electric charge on fat drop surface include:

A

v in pH, addition of electrolyte salts

44
Q

what is a cracked ILE?

A

oil phase separates from water

45
Q

most critical factor influencing pH of PN formulation is _____ used

A

crystalline amino acid

46
Q

why add cysteine hydrochloride?

A

although it is destabilizing, can request cuz have taurine and L-cysteine HCl can be added to ^ ca phosphate solubility

47
Q

why a.a. with dextrose?

A

buffers acidity of dextrose

48
Q

low osmolarity PN formulations (eg. PPN) pose high threat for _____ precipitation

A

calcium phosphate

49
Q

___ indicates that fusion of fat droplets has occurred and the individual droplet size has increased

A

coalescence

50
Q

how to reduce likelihood that ca and P will precipitate?

A

lower pH, ^ a.a. concentration. ^ dextrose concentration

51
Q

TNA is discouraged from use in these populations:

A

neonatal and pediatric

52
Q

^ risk of ca p precipitation cuz:

A

^ Ca / P concentration, CaCl use, ^ temp

53
Q

risk of ____ must be considered when Ca provision < 10-15 mEq/d

A

metabolic bone disease

54
Q

trace element contamination include:

A

arsenic, Al, Cr, Zn, Mn, Cu

55
Q

max Al load permitted?

A

25mcg/L

56
Q

why store in plastic instead of glass?

A

less Al content at expiration

57
Q

pt at risk of Al toxicity:

A

1) significant renal dysfunction 2) high intake PN 3) Fe deficiency

58
Q

why filters used now?

A

ca p precipitation risk minimization, v pathogenic microorgs

59
Q

can’t use filters with:

A

ILE

60
Q

if 2 in 1 used, 2 filters required:

A

0.22 (inline) and 1.2

61
Q

inline filter can ^ incidence of ____

A

occlusion alarms

62
Q

dextrose ____ or ____% should be used for compounding PN in fluid restriction

A

50; 70

NUTR 442 (34 decks)

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