medications and enteral feedings Flashcards
what types of insulin are used to manage blood sugars in enterally fed patients
regular/basal insulin and shot acting insulin
what types of medications are preferred for enteral tubes
liquid
enterically coated, controlled released and sustained released meds should not be
crushed
what medications require stopping the tube feeding pre/post administration
Fluoroquinolones: Ciprofloxacin, Levaquin (2 hrs)
Penicillin, Phenytoin, Theophylline
all fluoroquinolones interact with _____ products by causing chelation causing the antibiotic to not work properly
multivalent cations (tums, calcium iron, zinc)
the formation of a binding complex with divalent cations causing a decreased of absorption of a drug or nutrient
chelation
hypomagnesemia or hyperkalemia following an organ transplant is likely due to these types of antibiotics
cyclosporine (penicillin, ceftriaxone)
what medication potentially causes carnitine deficiency
Valproic Acid (anti-eleptic)
this medication can provide a significant amount of calories
Propofol
Sulfasalazine will increase requirements for____ which is used as an anti inflammatory med for ulcerative colitis/rheumatoid arthritis
folic acid
loop diuretics cause urinary losses of
calcium/potassium
in the kidney, spironolactone can modulate the excretion of which ions
sodium/potassium
iron shouldn’t be provided via jejunal access because
an acidic environment is necessary to facilitate absorption and reduction of dietary iron
the drug used in the treatment of tuberculosis forms a complex with pyridoxine is
isoniazid
the addition of aluminum hydroxide based medications by lower this element
phosphorous
a medication that will decrease folate levels
methotrexate
____ used in the treatment of rheumatoid arthritis and leukemia disrupts normal folate and choline metabolism by inhibition of dihydrofolate reductase
methorexate
a low albumin may be concerning when providing this medication
phenytoin
narcotics may cause
constipation
magnesium products such as antibiotics and kayexalate may cause
diarrhea
cyproheptadine is a(n)
appetite stimulant
medications with anorexic effects
narcotics, h2 receptor antagonists, anti hypertensive meds
digoxin toxicity and PN is associated with
hypercalcemia
IV____ is contraindicated when a patient is on parenteral nutrition with a digoxin toxicity
calcium
this diuretic is known for conserving potassium
Aldactone
grapefruit juice is metabolized by cytochrome P4502a4, the most abundant P450 enzyme and inhibits these types of medications
tacrolimus, sirolimus, Depakote, cyclosporine
diluting enteral nutrition formulas increases the risk of
microbial contamination
physical interactions between medications and enteral nutrition formulas can be best avoided by
not allowing drugs to mix with EN
to avoid mixing EN formulas and medications (if possible) would to be provide medications via
sublingual, rectal, intramuscular, subcutahnous, IV
avoid ___ beverages in the feeding tube to avoid degradation of the formula including
acidic
cranberry juice, carbonated beverages
enteric coated medications require ___ for digestion/absorption so cannot be given a ____ tube
acidic stomach pH
jejunal tube
if an enteric coated medication must be given in the jejunum be sure to mix it with ____ and wait 34-45 minutes as can occlude the tube
bicarbonate
if a medication is appropriate to crush to be given via an enteral tube it should be
fine powder and mixed with warm water
_____ medications should not be crushed as it will alter their pharmacodynamics and cause inadequacy or toxicity of the medication
extended release
____ medications are high in osmolarity and can cause diarrhea
sorbitol/liquid medications
what methods are available to limit medication interactions with EN
use immediate release medications
avoid enteric coated or sublingual
use proper tube flushing
____ studies the time course for drug absorption, distribution, metabolism and execution of medications
pharmacokinetics
_____ occurs during light exposure to medications which affects mostly opaque formulas including ILE’s and EN formulas
photo-degradation
______ is the interaction between the amino group of amino acids and carbonyl portion of carbohydrates causing browning
maillard reaction
these medications will slow down gastric emptying and GI motility
anticholinergic agens, narcotics and opioids
holding EN administration for 1-2 hours every 6-8 hours for medication administration is likely to result in
inadequate nutrition and deterioration of nutrition status unless a volume based protocol is used
what is recommended to produce the most consistent results when administering phenytoin during enteral nutrition administration
hold tube feeding for at least 1 hour and possibly 2 hours pre and post administration
carbamazepine slows gastric emptying and EN infusion should be held ____ hours pre/post administration
2 hours
Fluoroquinolones (levaquin, ciprofloxacin) are a class of antibiotics that should be he’d for ___ hours pre, ___ hours post TF administration as they bond with divalent/trivalent cations such as iron and calcium
1 hour pre
2 hours post
____ controls the legal definition of dietary supplements under the FDA Federal Food, Drug and Cosmetic ACT stating supplements must be labeled as a dietary supplement
DSHEA
a product that is not represented for use as a conventional food or sole item of a meal/diet is called
supplement
a group of diverse medical and healthcare systems, practices and products that are not generally considered part of conventional medicine
complimentary medicine
a ____ food is food that moves beyond the necessity to provide additional health benefits that may reduce disease risk and or promote optimal healthy
function food
a ______ claim is a statement that a product is not intended to prevent or cure a disease
structure/function claim
an explicit or implied characterization of a relationship between a substance and.a disease or a health related condition
health claim
“calcium may reduce the risk of osteoporosis” is known as a ___ claim
health claim
