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PPS 946 > Enteral Access and Drug Administration > Flashcards

Enteral Access and Drug Administration Flashcards

1
Q

What is a NG tube used for?

A

It is primarily used to remove gastric secretions to prevent aspiration, not for feeding.

It can be used to deliver drugs to the stomach.

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2
Q

What is a G-tube used for?

A

It is used to deliver drugs and food and remove gastric content.

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3
Q

Why can you not deliver fiber through J-tubes?

A

It can clog them.

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4
Q

How can you deliver medications if a patient has a J-tube?

A

Use an oral syringe if possible.

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5
Q

What must you do when establishing enteral access?

A

Use prokinetic agents (metoclopramide) and lay the patient on their right side.

Use an abdominal X-ray to confirm the GI location and make sure it’s not in the lung.

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6
Q

What are the feeding techniques for EN?

A

Bolus=480mL 4 times during the day

Intermittent=240mL 8 times during the day

Continuous=80mL/hr

Feeding pumps

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7
Q

What is the initiation speed of feeding techniques?

A

~10mL/hr to determine tolerance. You want to them advance the rate by 10-25mL/hr every 6-8hr if continuous.

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8
Q

What can we dilute the isotonic formulas to for EN?

A

Don’t dilute them.

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9
Q

What kind of protein is in EN?

A

Casein (intact proteins)
Small peptides
Free AAs

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10
Q

What kind of carbohydrate products can be used for EN?

A

Simple (single sugars)
More complex (maltodextrin/corn starch)
Lactose free-for lactase free elderly and stressed
Soy or oat fiber, regulates bowel function

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11
Q

What do long chain fatty acids require for absorption?

A

Lipase and bile salts.

Medium chains do not require lipase, but there is better absorption if lipase is present.

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12
Q

What kind of fat enteral products are there?

A

Optimal ratio: 55%, which causes diarrhea

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13
Q

Most EN products are ____ in sodium.

A

Low

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14
Q

Renal product= __ electrolytes

A

no electrolytes or low electrolytes

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15
Q

Heptic product=low ____

A

Low sodium

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16
Q

For EN electrolyte products what does the product depend on?

A

The disease state the patient is in.

17
Q

Why do vitamin K amounts vary drastically in EN products?

A

Warfarin resistance has developed.

18
Q

If a patient has CHF or a traumatic brain injury how much EN volume do they need compared to normal patients?

A

They need less EN volume

19
Q

The more calories the ___ viscous the EN product.

A

more

High protein formulas are very thick.

20
Q

What is fibers role in EN products?

A

It regulates the large bowel.

21
Q

What is the free water content of EN Products?

A

50-85%

22
Q

What is Medicare Part B’s Reimbursement for EN?

A

Units=100 calories.

They base it off of the units given.

23
Q

How do you prevent tracheobronchial aspiration?

A

Elevate the bed 30 degrees
Use pump for accurate infusion rates
Observe for vomiting or excessive gastric residuals

24
Q

What can sorbitol cause?

A

Diarrhea

25
Q

What can cause diarrhea?

A

Hyperosmolar EN
Sorbitol
Long-term use of antibiotics
Hypoalubinemia

26
Q

Can you add drug to the EN product?

A

No

27
Q

What happens when digoxin is delivered to the small bowel via FT?

A

There are higher levels so you need to decrease the dose.

28
Q

For EN administration where do we prefer to put cipro?

A

In the duodenum.

29
Q

What type medications cannot go down a FT?

A 
Viscous, hypertonic, and things with an osmotic gap of >100mOsm/kg
Acidic Medication (curdles intact protein)
30
Q

What happens when you put potassium chloride or guaifenesin down a FT?

A

It curdles the intact protein and can clog the FT.

31
Q

What happens when you mix elixirs with EN?

A

The alcohol in the elixirs can precipitate inorganic salts in the enteral formula.

32
Q

How can you give microencapsulated drugs?

A

Mix with water or acid and flush down the FT, do NOT CRUSH!

33
Q

How do you administer phenytoin using a FT?

A

Hold the TF 1 hour before and after each dose.

34
Q

How do you administer carbamazepine using a FT?

A

Dilute the suspension and monitro for efficacy

35
Q

How do you administer Itraconazole using a FT?

A

Hold TF one hour before and after each dose.

Double the dose, but that increases chance of diarrhea

36
Q

How do you administer Tetracyclines using a FT?

A

They complex with di and trivalent cations.

Separate dose from EN or hold EN for an hour before and after and flush FT

37
Q

What drugs have physical incompatibilities with EN products?

A

Phenytoin, carbamazepine, itraconazole, tetracyclines, fluroquinolones, levothyroxin, and warfarin

38
Q

How do you prepare omeprazole for EN administration?

A

Dissolve it in bicarb and make it into a liquid preparation.

PPS 946 (22 decks)

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