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Pharmaceutics > Feeding Tubes > Flashcards

Feeding Tubes Flashcards

1
Q

Enteral feeding tubes:

A
  • used to provide nutritional support to pt’s who cannot eat by mouth
  • possess sufficient functioning GIT
  • enteral access can be safely achieved

ex’s:
- stroke
- altered mental status
- organ dysfunction
- or even some specific GI disease critically ill pt

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2
Q

Enteral feeding tubes in contrast to parental feeding?

A
  • maintains integrity of the GI tract by preventing changes due to atrophy
  • less expensive & risky
  • avoids bacterial translocation, systemic infection
  • since bile flow is maintained, development of cholestasis is avoided
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3
Q

Short-term:

A

4-6 weeks
- orogastric
- nasogastric
- orojejunal
- nasojejunal
- occasionally in the duodenum

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4
Q

Long-term:

A
  • gastrostomy
    – PEG
    – PRG
    – G-tube
  • jejunostomy
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5
Q

When are tubes into the stomach appropriate?

A

only when there is a NORMAL functioning GI tract form the lower esophagus down

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6
Q

______ usually more convenient & able to tolerate hypertonic formulas

A

STOMACH

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7
Q

______ feedings may cause abdominal cramping & diarrhea

A

JEJUNAL

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8
Q

When is the Upper duodenum or jejunum appropriate?

A
  • when there is gastric emptying problems, a non-functional upper GI tract & in pt’s at sign. risk of aspiration
    – i.e. when there’s a problem w/ the stomach
  • for pt’s w/ pancreatitis, gastroparesis (delayed gastric emptying) or severe reflux disease
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9
Q

For SHORT-term nutritional support…

A

ORAL or NASAL placement is used

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10
Q

For LONG-term tx or when nasal or oral placement is not possible…

A

use PERCUTANEOUS placement such as gastronomy, jejunostomy

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11
Q

______ bore tubes more comfort but _____ risk of clogging

A

SMALL

GREATER

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12
Q

What are the enteral formulations?

A
  • COMMERCIAL products contain vitamin & mineral supplementation & are sterile
  • HOME-prepared feedings NOT STERILE & may not be nutritionally complete
  • use of ELEMENTAL (pre-digested) formulations should be reserved for pt’s w/ severe nutrient absorption dysfunction

Admin may be intermittent or continuous

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13
Q

Ideally:

A
  • medication should NOT be mixed w/ formula
  • feeding should be interrupted for medication admin. & the tube should be flushed before & after medication admin.
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14
Q

Care should be taken w/ drugs having a ______ therapeutic window when the feeding tube is placed in the ________

A

NARROW

JEJUNUM

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15
Q

_______ access preferred over _______

A

GASTRIC > JEJUNAL

  • tubes usually LARGER & less prone to clogging
  • stomach is more TOLERANT of HYPERTONIC medications
  • gastric feedings usually INTERMITTENT so feeding & medication may be given at separate times
  • drug ABSORPTION is MORE PREDICTABLE w/ gastric placement
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16
Q

______ are preferred for enteral admin b/c…

A

LIQUIDS

they’re readily absorbed & are less likely to cause tube occlusions

BUT may be a challenge b/c they are usually meant for children

17
Q

Large amounts of sorbitol in liquid preps:

A
  • NOT well tolerated when delivered into the SI (duodenum, jejunum)
  • stomach able to dilute hypertonic solutions before transferring into the duodenum
  • BUT if given too rapidly it may be “dumped” into the small bowel resulting in osmotic diarrhea
18
Q

Hypertonic medications should NOT be administered directly…

A

into the SMALL INTESTINE UNLESS they are diluted w/ water
- protective acid barrier of stomach by-passed so sterile water used for dilution to reduce risk of infective diarrhea
- admin of hypertonic medication into the small intestine may result in bloating, nausea, cramping & diarrhea

19
Q

Must ensure that the ______ & ______ do NOT come into contact

A

feeding formula & syrup

as the tube may become clogged or even blocked

20
Q

________ tablets including those that are sugar or film-coating may be crushed

A

immediate-release

21
Q

Special care should be taken w/ _____________ capsules that contain beads or pellets

A

enteric, extended or controlled-release

22
Q

Enteric-coating products should NOT be crushed:

A
  • AE’s may occur or the drug’s effectiveness may be reduced
  • crushing extended or CR tablets destroys delivery mechanism & may result in potentially toxic peaks & low troughs (may lead to erratic absorption)
  • sublingual preps not designed for GI absorption & enteral admin may result in reduced drug absorption & lack of efficacy
23
Q

Some injectable formulations may be used…

A

orally

24
Q

Drug-nutrient interactions:

A

ex: Phenytoin showed a 70% decrease in bioavail when admin w/ enteral feeding
- possibly due to binding of phenytoin w/ components in the feeding & not be absorbed

  • therefore, hold EN for 1 hour before & 2 hours after medication dosing (instead of 30 mins)
25
Q

________ problematic as highly unstable in an acidic environment & inactivated by gastric acid

A

PPI’s

26
Q

Bedsite modification problems:

A

taste, acid stability & over-dosing when CR products are used

Pharmaceutics (4 decks)

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