Medication Administration and Drug Nutrient Interactions Flashcards
Mechanisms of drug-nutrient interactions
Drug-nutrient Drug-nutrition status Drug-metabolic status Nutrition status-drug Nutrient-drug Food component-drug Food-drug
Consequences of drug-nutrient interactions
Loss of feeding access and drug administration, inappropriate response to drugs, altered nutrient absorption
Prevention/mitigation of drug-nutrient interactions
Utilize an appropriate dosage form, practice best administration techniques
Route of administration preferred for meds and an enteral access device
PO administration preferred
Where should you NOT add meds to?
Feeds
How to administer IR formulations enterally
Crush tablets to a fine powder; capsules should be opened. IR soft gelatin capsules can be dissolved directly in 15-30ml of water
Mix all with water to form a slurry
Prepping the feeding tube for med administration
Flush with 15-30ml of warm water before and after administration
How to administer multiple meds via enteral access device
Administer ALL medications SEPARATELY, flushing the tube with water between each medication
How to prepare liquids/suspensions/elixirs
Dilute them first before administering
Viscous solutions could occlude the tube
What happens if a patient has an enteral feeding tube but is taking an ER formulation?
Switch to IR if possible
What should you NOT do to EC tablets?
CRUSH THEM
What happens if medication absorption is impaired by continuous enteral feeding?
Hold feeding for 1-2 hours before and after dose
Phenytoin administration via enteral access device
Reduced absorption –> higher doses are needed
Phenytoin management
Escalate dose, hold feeds 2 hours before and after administration, dilution of suspension, use IV formulation enterally
Carbamazepine administration via enteral access device
Improved bioavailability with slow gastric emptying
Fluoroquinolone administration via enteral access device
Bioavailability reduced and binds multi-talent cations
Quinolones affected by reduced bioavailability
Cipro > Levo > Moxi > Ofloxacin
Route you shouldn’t give ciprofloxacin in
J-tube
Quinolone and multivalent cation management
Give 2 hours before or 4 hours after antacids, dairy/calcium sources; separate from enteral nutrition by at least 2 hours
Amiodarone administration via enteral access device
Absorption improved with food
Route of administration for amiodarone
GASTRIC ADMINISTRATION
Digoxin administration via enteral access device
Bioavailability may be reduced and absorption may be reduced when administered with fiber-containing enteral feeds
Levothyroxine administration via enteral access device
Absorption improved in the fasting state but reduced with CaCO3, Mg, Fe, walnuts, grapefruit juice, soy protein, and fiber
Continuous enteral feeds may do what to levothyroxine’s efficacy?
Reduce it; hold feeds for an hour before and after administering
PPI administration via enteral access device
Requires alkaline pH for stability; administer with alkaline solution or as one of the powder formulations
Be sure to flush the tube to prevent tube clogging
Warfarin administration via enteral access device
Resistance to warfarin demonstrated with concurrent administration with enteral feeds
What vitamin interferes with warfarin absorption via enteral access device
Vitamin C
Warfarin administation management
Hold feeds 1 hour before administration, administer the solution rapidly, increase dose to target INR, monitor PT/INR closely
Itraconazole administration via enteral access devices
Poor bioavailability requires administration in the fasted state; doubling dose required but not well tolerated
Sevelamer administration via enteral access device
Capsule formulation may clog the tube; use the powder packets
Sucralfate administration via enteral access device
Complexes with protein and may clog tube or cause bezoar formulation; binds phosphate
DOAC administration: Xarelto
NG/GT: crush and mix in 50ml of water; administer within 4 hours and follow with enteral feeding of the 15 and 20mg tablets
Avoid administration distal to the stomach
DOAC administration: Eliquis
NG/GT: crush and mix in 60ml of water or D5W; administer within 4 hours
DOAC administration: dabigatran
DO NOT CRUSH!
DOAC administration: edoxaban
NG/GT: crush and mix in 60-90ml of water, administer IMMEDIATELY
Medications that aren’t impacted by administration via enteral access device
Atovaquone Azole antifungals (fluconazole, posaconazole, voriconazole) Linezolid Metronidazole H2RAs Levetiracetam Pantoprazole Tacrolimus
