medications and enteral feedings

Question 1

what types of insulin are used to manage blood sugars in enterally fed patients

Answer 1

regular/basal insulin and shot acting insulin

Question 2

what types of medications are preferred for enteral tubes

Answer 2

liquid

Question 3

enterically coated, controlled released and sustained released meds should not be

Answer 3

crushed

Question 4

what medications require stopping the tube feeding pre/post administration

Answer 4

Fluoroquinolones: Ciprofloxacin, Levaquin (2 hrs)

Penicillin, Phenytoin, Theophylline

Question 5

all fluoroquinolones interact with _____ products by causing chelation causing the antibiotic to not work properly

Answer 5

multivalent cations (tums, calcium iron, zinc)

Question 6

the formation of a binding complex with divalent cations causing a decreased of absorption of a drug or nutrient

Answer 6

chelation

Question 7

hypomagnesemia or hyperkalemia following an organ transplant is likely due to these types of antibiotics

Answer 7

cyclosporine (penicillin, ceftriaxone)

Question 8

what medication potentially causes carnitine deficiency

Answer 8

Valproic Acid (anti-eleptic)

Question 9

this medication can provide a significant amount of calories

Answer 9

Propofol

Question 10

Sulfasalazine will increase requirements for____ which is used as an anti inflammatory med for ulcerative colitis/rheumatoid arthritis

Answer 10

folic acid

Question 11

loop diuretics cause urinary losses of

Answer 11

calcium/potassium

Question 12

in the kidney, spironolactone can modulate the excretion of which ions

Answer 12

sodium/potassium

Question 13

iron shouldn’t be provided via jejunal access because

Answer 13

an acidic environment is necessary to facilitate absorption and reduction of dietary iron

Question 14

the drug used in the treatment of tuberculosis forms a complex with pyridoxine is

Answer 14

isoniazid

Question 15

the addition of aluminum hydroxide based medications by lower this element

Answer 15

phosphorous

Question 16

a medication that will decrease folate levels

Answer 16

methotrexate

Question 17

____ used in the treatment of rheumatoid arthritis and leukemia disrupts normal folate and choline metabolism by inhibition of dihydrofolate reductase

Answer 17

methorexate

Question 18

a low albumin may be concerning when providing this medication

Answer 18

phenytoin

Question 19

narcotics may cause

Answer 19

constipation

Question 20

magnesium products such as antibiotics and kayexalate may cause

Answer 20

diarrhea

Question 21

cyproheptadine is a(n)

Answer 21

appetite stimulant

Question 22

medications with anorexic effects

Answer 22

narcotics, h2 receptor antagonists, anti hypertensive meds

Question 23

digoxin toxicity and PN is associated with

Answer 23

hypercalcemia

Question 24

IV____ is contraindicated when a patient is on parenteral nutrition with a digoxin toxicity

Answer 24

calcium

Question 25

this diuretic is known for conserving potassium

Answer 25

Aldactone

Question 26

grapefruit juice is metabolized by cytochrome P4502a4, the most abundant P450 enzyme and inhibits these types of medications

Answer 26

tacrolimus, sirolimus, Depakote, cyclosporine

Question 27

diluting enteral nutrition formulas increases the risk of

Answer 27

microbial contamination

Question 28

physical interactions between medications and enteral nutrition formulas can be best avoided by

Answer 28

not allowing drugs to mix with EN

Question 29

to avoid mixing EN formulas and medications (if possible) would to be provide medications via

Answer 29

sublingual, rectal, intramuscular, subcutahnous, IV

Question 30

avoid ___ beverages in the feeding tube to avoid degradation of the formula including

Answer 30

acidic | cranberry juice, carbonated beverages

Question 31

enteric coated medications require ___ for digestion/absorption so cannot be given a ____ tube

Answer 31

acidic stomach pH | jejunal tube

Question 32

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

Answer 32

bicarbonate

Question 33

if a medication is appropriate to crush to be given via an enteral tube it should be

Answer 33

fine powder and mixed with warm water

Question 34

_____ medications should not be crushed as it will alter their pharmacodynamics and cause inadequacy or toxicity of the medication

Answer 34

extended release

Question 35

____ medications are high in osmolarity and can cause diarrhea

Answer 35

sorbitol/liquid medications

Question 36

what methods are available to limit medication interactions with EN

Answer 36

use immediate release medications avoid enteric coated or sublingual use proper tube flushing

Question 37

____ studies the time course for drug absorption, distribution, metabolism and execution of medications

Answer 37

pharmacokinetics

Question 38

_____ occurs during light exposure to medications which affects mostly opaque formulas including ILE's and EN formulas

Answer 38

photo-degradation

Question 39

______ is the interaction between the amino group of amino acids and carbonyl portion of carbohydrates causing browning

Answer 39

maillard reaction

Question 40

these medications will slow down gastric emptying and GI motility

Answer 40

anticholinergic agens, narcotics and opioids

Question 41

holding EN administration for 1-2 hours every 6-8 hours for medication administration is likely to result in

Answer 41

inadequate nutrition and deterioration of nutrition status unless a volume based protocol is used

Question 42

what is recommended to produce the most consistent results when administering phenytoin during enteral nutrition administration

Answer 42

hold tube feeding for at least 1 hour and possibly 2 hours pre and post administration

Question 43

carbamazepine slows gastric emptying and EN infusion should be held ____ hours pre/post administration

Answer 43

2 hours

Question 44

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

Answer 44

1 hour pre | 2 hours post

Question 45

____ 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

Answer 45

DSHEA

Question 46

a product that is not represented for use as a conventional food or sole item of a meal/diet is called

Answer 46

supplement

Question 47

a group of diverse medical and healthcare systems, practices and products that are not generally considered part of conventional medicine

Answer 47

complimentary medicine

Question 48

a ____ food is food that moves beyond the necessity to provide additional health benefits that may reduce disease risk and or promote optimal healthy

Answer 48

function food

Question 49

a ______ claim is a statement that a product is not intended to prevent or cure a disease

Answer 49

structure/function claim

Question 50

an explicit or implied characterization of a relationship between a substance and.a disease or a health related condition

Answer 50

health claim

Question 51

"calcium may reduce the risk of osteoporosis" is known as a ___ claim

Answer 51

health claim