Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nutrition Final > Drug-nutrient interactions > Flashcards

Drug-nutrient interactions Flashcards

1
Q

What mechanisms does drug/nutrient interactions affect?

A

Absorption
Distribution
Metabolism
Excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the rate limiting step for most solid-dose formulations?

A

Disintegration and dissolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the rate limiting step for liquid medications in solution?

A

Blood perfusion of the intestines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can blood perfusion of the intestines be decreased?

A

Dx states
Edema
Surgery
Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What factors can alter medication absorption?

A 
Presence of other drugs
Gastric emptying rate
Route of administration
Location of the distal tip of the enteral tube
Presence of food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can we enhance absorption

A

Use liquid medications to bypass dissolution step. Administer liquid medications or pulverized tablets with adequate fluid.
Administer additional free water flushes in conjunction with scheduled medications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does administering liquid medications or pulverized tablets with adequate fluid enhance absorption?

A

Expands stomach and enhances gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If we need to enhance absorption and the medication is a tablet, what should we do?

A

Pulverize it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What factors may inhibit itraconazole absorption?

A

Placement of distal tip of enteral tube.
Tablets require acidic environment for dissolution (poor absorption with post pyloric administration).
Liquid form already dissolved (Amenable to post pyloric administration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What factors may inhibit Cipro absorption?

A

Main site of absorption is upper part of intestinal tract.
Mixed results with absorption via feeding tubes
Treatment failure seen when administered via jejunostomy tube.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which medications are better taken on an empty stomach?

A

PCNs
Tetracyclines
Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we adjust feedings for medications better taken on empty stomachs?

A

Hold feeds 30-60 minutes before medication administration.
Hold feeds 30 minutes after medication administration.
Re-adjust feeding schedule to ensure patient receives 24-hr nutritional needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What GI intolerances may inhibit absorption during tube feedings?

A 
Nausea
Vomiting
Diarrhea
Cramping
Increased gastric residuals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What medications decrease gastric transit time?

A

Prokinetic agents:
Metoclopramide
Erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What medications delay gastric emptying or decrease GI motility?

A

Anticholinergics
Al-containing antacids
Narcotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some anticholinergics

A

Antihistamines
Tricyclic antidepressants
Phenothiazines
Medications for Parkinson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do anticholinergics work?

A

Cause smooth muscle relaxation and inhibit gastric motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do aluminum-containing antacids inhibit absorption?

A

Delay gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do narcotics inhibit absorption?

A

Interfere with normal peristalsis and delay gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What factors affect distribution?

A

Protein binding

Solubility and tissue distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does protein binding affect distribution?

A

May increase half-life of drug

Decreases hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does solubility and tissue distribution affect distribution?

A

Hydrophilic substances principally distributed within fluid compartments of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What factors affect Metabolism?

A

CYP450 enzyme system

Inducers of CYP1A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does CYP3A4 affect metabolism?

A

Involved in metabolism of most currently marketed drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What other isoenzymes are commonly associated with drug metabolism?

A

CYP1A2
CYP2C9
CYP2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some nutritional inducers of CYP1A2?

A

Broccoli
Brussel sprouts
Charcoal-broiled meats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do nutritional inducers of CYP1A2 affect metabolism?

A

May decrease bioavailability and effectiveness of some drugs.
May lead to toxicity of other drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does grapefruit juice affect metabolism?

A

Inhibits CYP1A2 and CYP3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does cranberry juice affect metabolism?

A

Inhibits CYP2C9
Warfarin metabolism
Results in increased INR and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is enterohepatic cycling?

A

Drugs may be reabsorbed back into the bloodstream and return to the liver by the enterohepatic circulation. The drug then undergoes further metabolism or is secreted back into the bile.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What drugs undergo enterohepatic cycling?

A

Macrolides
Ceftriaxone
Nafcillin
Doxycycline

32
Q

What is the major elimination pathway for most water-soluble drugs and metabolites?

A

Urinary (renal)

33
Q

What method of excretion is mediated by protein transporters?

A

Gastrointestinal (bile)

34
Q

How do drugs enter the duodenum?

A

Via the common bile duct

35
Q

What are the five types of enteral incompatibilities?

A 
Physical
Pharmaceutical 
Physiologic
Pharmacologic
Pharmacokinetic
36
Q

What is physical incompatibility?

A

Chemical instability that occurs when two susceptible substances are mixed together

37
Q

What is the result of physical incompatibility?

A

Results in a physical change between two substances

38
Q

What are precipitates that are formed from physical incompatibility?

A

Curdling
Focculation
Altered enteral formulation consistency
Viscosity

39
Q

How does pharmaceutical incompatibility alter the drug?

A

It interferes with:
Efficacy
Potency
Tolerance

40
Q

What medication forms are not amenable to feeding tube administration?

A

Enteric coated
Sustained release
Sublingual

41
Q

What is the result of physiologic incompatibility?

A

Result of non-pharmacologic action incurred by the medication or by the suspending medium

42
Q

What types of medications does physiologic incompatibility typically occur with?

A

High osmolality liquid medications.

Sorbitol containing medications.

43
Q

What do patients typically experience with physiologic incompatibility?

A 
Nausea
Bloating
Increased gastric residuals
Cramping
Diarrhea
44
Q

What is the result of pharmacologic incompatibility?

A

When a medication alters tolerance of the EN or PN regimen because of its MOA

45
Q

What does pharmacologic incompatibility generally lead to?

A

A greater than expected pharmacologic effect of medication (prokinetic agents).
Unintended side effects of medications.

46
Q

How does pharmacokinetic incompatibility affect nutrition regimens?

A

EN or PN regimen alters the bioavailability, absorption, distribution, metabolism, and/or elimination of a medication

47
Q

What are some common medications that alter pharmacokinetic compatibility?

A

Phenytoin
Warfarin
Cipro
Meds that should be taken on an empty stomach

48
Q

How should medications be administered via enteral feeding tubes?

A 
IR formulations:
Oral tablets
Hard gelatin capsules
Soft gelatin capsules
Liquid formulations
49
Q

What should you do before and after each medication is administered via a feeding tube?

A

Flush the tube with water

50
Q

How are solid tablets administered via a feeding tube?

A

Crushed to a fine powder

Mix with water before administration

51
Q

How are hard gelatin capsules administered via a feeding tube?

A

Open and mix thoroughly with water

52
Q

How are soft gelatin capsules administered via a feeding tube?

A

Empty by creating a pin-hole in one end of the capsule

Squeeze contents out and mix with water

53
Q

What is the preferred administration via enteral tubes?

A

Liquid medications

54
Q

Why are liquid medications preferred via enteral tubes?

A

Better absorption.
Decreased potential for enteral tube occlusion.
Potential for producing adverse effects.

55
Q

Where can sorbitol be found?

A

In all liquids except tunctures and emulsions

56
Q

What are the advantages of hyperosmolar liquids?

A

Stomach more tolerant.

57
Q

How should administration of hyperosmolar liquids be adjusted?

A

More diluent if administered in small intestines vs stomach

58
Q

What are advantages of suspensions?

A

Present few incompatibility concerns.
Does not contain sorbitol,
May be hyperosmolar.
Antibiotics often available in suspension

59
Q

What are some granular-type medications?

A

Psyllium hydrophilic mucilloid

Cholestyramine resin

60
Q

What is the use of cholestyramine resin?

A

May be added to control diarrhea.

Can be added as hypercholesterolemia agent.

61
Q

When should granular-type medications not be used?

A

With small-bore feeding tubes

62
Q

Why are enteric coated medications not recommended for administration via tube?

A

May induce a pharmaceutical incompatibility.

Therapeutic equivalent or alternative administration should be considered.

63
Q

What is the purpose of enteric coating?

A

Protects the stomach lining

Protect from destruction of acidic environment

64
Q

Why are SL or buccal medications not recommended for administration via tube?

A

Placed under cheek or tongue and absorbed into systemic circulation.

65
Q

Why are sustained-release tablets or capsules not recommended for administration via tube?

A

High peaks and low troughs.
Capsules containing beads can lead to occlusion.
Dissolving in water or saline can affect integrity of beads.

66
Q

Why are syrups not recommended for administration via tube?

A

Physical incompatibility.
pH less than or equal to 4 denatures protein in enteral formulation.
Be aware of protein source of EN.
Physical incompatibilities cannot be avoided by diluting the syrup.

67
Q

What type of drugs cause drug-nutrient interactions?

A

PPIs
Phenytoin
Warfarin

68
Q

How are PPI capsules containing enteric coated beads administered to avoid drug-nutrient interactions

A

Mix with acidic juice (orange or apple).

Dissolve beads in 8.4% sodium bicarbonate solution

69
Q

How are enterc coated PPI tablets administered to avoid drug-nutrient interactions?

A

Dissolve tablets in 4.2% sodium bicarbonate solution

70
Q

What are some strategies to maintain therapeutic phenytoin levels?

A

Hold tube feeding 2 hours before and after phenytoin dose.
Dilute phenytoin with 30-60mL water before administration.
Monitor blood levels more frequently when changing from established parenteral dose to suspension form.

71
Q

What type of feedings are considered with warfarin to avoid drug-nutrient interactions?

A

Bolus or cyclic feedings

72
Q

What influences compatibility of PN infusions?

A

Exposure time between nutrients

Additives present

73
Q

What source is a great reference for parenteral incompatibility?

A

Trissel’s Handbook on Injectable Drugs

74
Q

Is admixing PN with medications advised?

A

No

75
Q

What two medications are safe to add to PN?

A

Insulin and famotidine

76
Q

What line should PN be administered by?

A

Via dedicated line at all times

77
Q

What lines should never be used for PN?

A

Y sites

Nutrition Final (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions