Medication Administration and Drug Nutrient Interactions

Question 1

Mechanisms of drug-nutrient interactions

Answer 1

Drug-nutrient
Drug-nutrition status
Drug-metabolic status
Nutrition status-drug
Nutrient-drug
Food component-drug
Food-drug

Question 2

Consequences of drug-nutrient interactions

Answer 2

Loss of feeding access and drug administration, inappropriate response to drugs, altered nutrient absorption

Question 3

Prevention/mitigation of drug-nutrient interactions

Answer 3

Utilize an appropriate dosage form, practice best administration techniques

Question 4

Route of administration preferred for meds and an enteral access device

Answer 4

PO administration preferred

Question 5

Where should you NOT add meds to?

Answer 5

Feeds

Question 6

How to administer IR formulations enterally

Answer 6

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

Question 7

Prepping the feeding tube for med administration

Answer 7

Flush with 15-30ml of warm water before and after administration

Question 8

How to administer multiple meds via enteral access device

Answer 8

Administer ALL medications SEPARATELY, flushing the tube with water between each medication

Question 9

How to prepare liquids/suspensions/elixirs

Answer 9

Dilute them first before administering

Viscous solutions could occlude the tube

Question 10

What happens if a patient has an enteral feeding tube but is taking an ER formulation?

Answer 10

Switch to IR if possible

Question 11

What should you NOT do to EC tablets?

Answer 11

CRUSH THEM

Question 12

What happens if medication absorption is impaired by continuous enteral feeding?

Answer 12

Hold feeding for 1-2 hours before and after dose

Question 13

Phenytoin administration via enteral access device

Answer 13

Reduced absorption –> higher doses are needed

Question 14

Phenytoin management

Answer 14

Escalate dose, hold feeds 2 hours before and after administration, dilution of suspension, use IV formulation enterally

Question 15

Carbamazepine administration via enteral access device

Answer 15

Improved bioavailability with slow gastric emptying

Question 16

Fluoroquinolone administration via enteral access device

Answer 16

Bioavailability reduced and binds multi-talent cations

Question 17

Quinolones affected by reduced bioavailability

Answer 17

Cipro > Levo > Moxi > Ofloxacin

Question 18

Route you shouldn’t give ciprofloxacin in

Answer 18

J-tube

Question 19

Quinolone and multivalent cation management

Answer 19

Give 2 hours before or 4 hours after antacids, dairy/calcium sources; separate from enteral nutrition by at least 2 hours

Question 20

Amiodarone administration via enteral access device

Answer 20

Absorption improved with food

Question 21

Route of administration for amiodarone

Answer 21

GASTRIC ADMINISTRATION

Question 22

Digoxin administration via enteral access device

Answer 22

Bioavailability may be reduced and absorption may be reduced when administered with fiber-containing enteral feeds

Question 23

Levothyroxine administration via enteral access device

Answer 23

Absorption improved in the fasting state but reduced with CaCO3, Mg, Fe, walnuts, grapefruit juice, soy protein, and fiber

Question 24

Continuous enteral feeds may do what to levothyroxine’s efficacy?

Answer 24

Reduce it; hold feeds for an hour before and after administering

Question 25

PPI administration via enteral access device

Answer 25

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

Question 26

Warfarin administration via enteral access device

Answer 26

Resistance to warfarin demonstrated with concurrent administration with enteral feeds

Question 27

What vitamin interferes with warfarin absorption via enteral access device

Answer 27

Vitamin C

Question 28

Warfarin administation management

Answer 28

Hold feeds 1 hour before administration, administer the solution rapidly, increase dose to target INR, monitor PT/INR closely

Question 29

Itraconazole administration via enteral access devices

Answer 29

Poor bioavailability requires administration in the fasted state; doubling dose required but not well tolerated

Question 30

Sevelamer administration via enteral access device

Answer 30

Capsule formulation may clog the tube; use the powder packets

Question 31

Sucralfate administration via enteral access device

Answer 31

Complexes with protein and may clog tube or cause bezoar formulation; binds phosphate

Question 32

DOAC administration: Xarelto

Answer 32

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

Question 33

DOAC administration: Eliquis

Answer 33

NG/GT: crush and mix in 60ml of water or D5W; administer within 4 hours

Question 34

DOAC administration: dabigatran

Answer 34

DO NOT CRUSH!

Question 35

DOAC administration: edoxaban

Answer 35

NG/GT: crush and mix in 60-90ml of water, administer IMMEDIATELY

Question 36

Medications that aren’t impacted by administration via enteral access device

Answer 36

Atovaquone
Azole antifungals (fluconazole, posaconazole, voriconazole)
Linezolid
Metronidazole
H2RAs
Levetiracetam
Pantoprazole
Tacrolimus