Drug-Nutrient Interactions Flashcards
Define DNI.
Drug Nutrient Interaction ASPEN defines DNI as βan event that occurs when nutrient availability is altered by a medication, or when a drug effect is altered or an adverse reaction is caused by the intake of nutrients.β
The presence of XXXX seems to be a critical property for determining risk of developing a physical interaction.
Complex protein (ie: intact or whole protein)
XXXX, XXXX, and XXXX of the EN formulation have not been shown to affect the risk of physical interactions with drugs in studies reported in the literature.
Fiber content N content Dilution of the EN formulation
What two factors are of particular importance with drugs in liquid form?
- Acidic pH 2. Base components, especially sugar-water syrups, alcohol-containing elixirs, or oil-based products.
(TRUE/FALSE) 1/3 of drugs in liquid dosage have demonstrated undesirable effects with at least 1 EN formulation.
TRUE.
(TRUE/FALSE) Physical interactions are best avoided by not allowing drugs to mix with either PN or EN formulations. Ideally, drugs should be administered via a route other than the feeding administration device.
TRUE.
When a drug must be administered through the same device as the PN or EN formulation, what is the procedure?
The feeding should be stopped, and the access device should be flushed with fluid that is compatible with the PN or EN formulation as well as the drug. The access device should be flushed before and after drug administration and between drugs if multiple drugs are administered.
What is the ideal fluid of choice for flushing VADs?
0.9% sodium chloride, or sometimes 5% dextrose solution is required
What is the ideal fluid of choice for flushing EN tubes?
Water
(TRUE/FALSE) Acidic products, such as carbonated beverages and cranberry juice may be used for flushing.
FALSE. They can be particularly problematic.
(TRUE/FALSE) The minimum recommended volume used to flush enteral feeding tubes in adults is 30 mL.
FALSE. 15 mL; although usually larger volumes are often used.
What type of medications (as a general rule), should not be crushed or dissolved?
Special dosage forms such as long-acting, sustained-release, slow-release, or delayed-release containing several doses in 1 tablet/capsule Watch for: CD, CR, ER, LA, SA, SR, TR, XL, or XR (generally these need to be taken intact)
(TRUE/FALSE) Administration into the jejunum negates the need for an enteric coating since the jejunum is where the coating is designed to dissolve.
TRUE. Dissolving the coating in bicarbonate solution, then crushing the table is acceptable for jejunal administration, although the process can be slow (30 to 45 minutes) and caution is still required to avoid tube occlusion.
(TRUE/FALSE) Film coatings are used to make tablets easier to swallow or to mask unpleasant taste. They also impart special characteristics such as those associated with enteric coatings.
FALSE They DO NOT impact special characteristics. Crushed film-coated tables should not result in altered drug activity or increased risk of adverse effects. They can be problematic because they often remain as undissolved pieces that become sticky in water and can occlude the feeding tube.
(TRUE/FALSE) Intact pellets may be administered through the feeding tube, provided the pellets are small enough to completely pass through the tube.
TRUE. Usually a larger tube (min. 16-Fr) is necessary for successful administration of these dosage forms.
What liquid would you use to administer a drug with intact pellets?
Acidic juice as the vehicle for microencapsulated pieces as it should reduce the risk of the beads or pellets sticking to the tube. NOTE: Water should be used to clear the tube of the EN formulation before and after administration of the acidic-juice mixture to avoid physical DNIs between the EN formulation and an acidic product.
What is the recommendation administration for pancreatic enzmyes?
With no viable options, it may be necessary to dissolve an enteric coating on the beads or pellets in a sodium bicarb. solution, then crush and administer the drug with a small volume of sodium bicarbonate solution.
(TRUE/FALSE) Diluting hyperosmolar products with water before administration reduces the osmolality and may reduce the risk of GI intolerance.
TRUE.
(TRUE/FALSE) Proper tube flushing cannot prevent pharmaceutical interactions. However, flushing with adequate quantities of water remains an important technique to prevent concomitant physical interactions
TRUE. Pharmaceutical interactions may also be minimized by using alternate routes of administration or by using a therapeutic alternative that is available in a form conductive to administration via the feeding tube.
Define pharmacokinetics.
Refers to studies of the time course for drug absorption, distribution, metabolism, and excretion. The term can also be applied to nutrients because the same processes occur with nutrients.
Define bioavailability.
Describes the amount of drug that reaches systemic circulation after administration.
List some examples of what can decrease bioavailability.
- Drug or nutrient loss during administration
- Adverse pH effects
- Complex formation between nutrient(s) and drug
- Presystemic metabolism in the gut mucosa (CYP450)
- Hepatic first-pass metabolism
(TRUE/FALSE)
The potential for chemical reactions and stability issues exists whenever a solid dosage form of drug is made into a liquid form.
TRUE.
Water tends to accelerate chemical reactions that result in loss of drug activity.
Rapid gastric emptying accompanied by rapid GI transit can result in XXX absorption becauseβ¦..
Poor absorption because there is insufficient contact time between the drug/nutrient and the absorptive surface of the small bowel.