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Pharmaceutics Year 2 > Section 5b - Feeding Tubes > Flashcards

Section 5b - Feeding Tubes Flashcards

1
Q

What are feeding tubes used for?

A

To provide nutritional support to patients who cannot eat by mouth

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2
Q

How are parenteral and enteral feeding different?

A
  • Enteral feeding maintains both structural and functional integrity of the GI tract by preventing changes due to atrophy
  • Enteral feeding is less expensive and risky
  • Enteral feeding voids possible bacterial translocation and development of cholestasis is avoided since bile flow is maintained
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3
Q

What determines the type of feeding tube that is used?

A
  • Why the patient requires tube feeding

- Expected duration of treatment

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4
Q

Where can a feeding tube be placed?

A
  • Stomach
  • Jejunum
  • Occasionally duodenum
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5
Q

What are the locations of dual lumens?

A
  • One in stomach for passive decompression

- Other in the small bowel for nutrition

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6
Q

What is a tube placed through the mouth called?

A

Orogastric

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7
Q

What is a tube placed through the nose called?

A

Nasogastric

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8
Q

Tubes that are placed surgically are called _____

A

Percutaneous

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9
Q

When would a tube be placed in the stomach?

A

For patients who have a normal functioning GI tract from lower esophagus down

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10
Q

When would a tube be placed in the upper duodenum or jejunum?

A

For patients w/

  • Gastric emptying problems (gastroparesis)
  • Non-functional upper GI tract
  • Pancreatitis
  • Severe gastroesophageal reflux disease
  • At significant risk of aspiration
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11
Q

What is important to note if the patient has a tube in their jejunum?

A

Need to provide food that is partly digested already

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12
Q

What is the most common location for a feeding tube and why?

A

Stomach b/c more convenient and is able to tolerate enteral formulas which are hypertonic

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13
Q

What is a side effect of jejunal feedings?

A

Abdominal cramping and diarrhea

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14
Q

Which type of feeding tubes are used for short-term nutritional support?

A

Oral or nasal (percutaneous when these options are not possible)

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15
Q

Which type of feeding tubes are used for long-term nutritional support?

A

Percutaneous

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16
Q

What determines the size of feeding tube that is used?

A
  • Nature of access
  • Feeding supplement
  • Patient
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17
Q

What is the size of a small-bore?

A

Outer diameter is 5-12 French units

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18
Q

What does 1 French unit equal?

A

0.33 mm

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19
Q

What is the size of a large-bore?

A

Outer diameter is greater than 12 French units

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20
Q

Which size of feeding tube is more common?

A

Small-bore, but has a greater risk of clogging

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21
Q

What is the advantage to commercial products over home-prepared?

A

Commercial products contain vitamin and mineral supplementation and are sterile

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22
Q

When should elemental (pre-digested) formulations be used?

A

Patients w/ severe small bowel absorptive dysfunction

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23
Q

What determines feeding schedule?

A

Condition of the patient

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24
Q

What are the 3 types of administration?

A
  • Feeding syringe
  • Gravity bag system
  • Pump
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25
Q

Can medications be given through enteral feeding tubes?

A

Yes if alternative drug delivery routes are not possible

26
Q

Should medication be mixed with formula?

A

No

27
Q

Should feeding and medication administration occur together?

A

No, feeding should be interrupted for medication administration and tube should be flushed w/ 15-30 mL of water before and after medication administration

28
Q

Is absorption better on an empty stomach?

A

Yes

29
Q

What should be done if medication needs to be taken on an empty stomach?

A
  • Stop feeding 30 mins before administering drug to allow gastric emptying
  • Wait 30 mins after medication is given to allow time for drug absorption
  • *Only applicable to gastric feeding
30
Q

Can placement site affect drug absorption?

A

Yes

31
Q

What will occur if an opioid is given through a jejunal tube?

A

Will undergo extensive first-pass hepatic metabolism, and may show greater systemic effects

32
Q

Is gastric or jejunal access preferred?

A

Gastric

33
Q

Stomach is more tolerant than jejunum of ____ medications

A

Hypertonic

34
Q

Are liquid dose forms or enteral administration preferred and why?

A
  • Liquid dose forms

- Readily absorbed and less likely to cause tube occlusion

35
Q

Drugs should be drawn up and dispensed only in ____ syringes

A

Oral (not parenteral)

36
Q

What are disadvantages to liquid dose forms?

A
  • Usually made for children, so large volumes of product are needed for adult dosage and volume may not be tolerated by patient
  • Adjustments in dose and frequency may be necessary especially when switching from extended or controlled-release product to liquid preparation which is usually immediate release
37
Q

Many liquid preparations are _____ or contain large amounts of ______

A
  • Hypertonic

- Sorbitol

38
Q

Why are hypertonic medications better tolerated in stomach?

A
  • Stomach can dilute hypertonic substances w/ gastric juices before transferring contents into duodenum
  • If given too rapidly may be “dumped” into small intestine resulting in osmotic diarrhea
39
Q

When can hypertonic medications be administered into the small intestine?

A

When diluted w/ 10-30 mL STERILE water

40
Q

What are some side effects to adminstration of hypertonic medication into small intestine?

A
  • Bloating
  • Nausea
  • Cramping
  • Diarrhea
41
Q

What is sorbitol used for and what are some side effects?

A
  • Sweetening agent

- 10-20 g daily may cause an osmotic laxative effect => cramping and diarrhea

42
Q

Why aren’t syrup dose forms frequently used w/ feeding tubes?

A

Usually acidic, and most enteral feeding formulas will coagulate if exposed to acidic environment

43
Q

When can syrup dose forms be used w/ feeding tubes?

A

If the feeding formula and syrup do not come into contact b/c tube may become clogged or blocked

44
Q

What can be done w/ immediate-release tablets that need to be administered through a feeding tube?

A

May be crushed, including those that are sugar or film coated, then mixed w/ 15-30 mL water

45
Q

What can be done w/ hard gelatin capsules that need to be administered through a feeding tube?

A

Opened and contents are dispersed in 10-15 mL of water

46
Q

What can be done w/ liquid-filled soft gelatin capsules that need to be administered through a feeding tube?

A
  • Pierced w/ needle and contents squeezed out

- May result in under-dosing

47
Q

Can enteric-coated products be crushed and why?

A

No b/c adverse effects may occur or drugs effectiveness may be reduced

48
Q

What happens if extended or controlled-release tablets are crushed?

A

It destroys delivery mechanism and may result in potentially toxic peaks and low troughs

49
Q

What happens if a sublingual preparation is administered enterally?

A

May result in reduced drug absorption and lack of efficacy

50
Q

Can injectable formulations be used orally?

A

Yes, but must consider stability in gastric acid (hypertonic products may induce osmotic diarrhea and cost is usually high)

51
Q

What are some side effects to adding medication directly to an enteral formula?

A
  • Physical incompatibilities
  • Decreased drug absorption
  • Increased risk of tube occlusions
  • Potential microbial contamination
52
Q

Which type of formulas will be more affected if medication is added?

A

Formulas containing protein will be more affected than those containing free aa’s or hydrolyzed protein

53
Q

What should be done if multiple medications need to be given through a feeding tube?

A
  • Give each separately

- Feeding tube should be irrigated w/ 5-10 mL of water (sterile if into jejunum) btwn each medication

54
Q

Why should the tube be flushed?

A
  • To reduce risk of tube occlusion

- Ensures total drug delivery and avoidance of contact btwn feeding formula and medication

55
Q

Should liquid medications that are highly concentrated or viscous by diluted and why?

A

Yes to reduce medication osmolality and prevent tube occlusions

56
Q

What is an example of a drug that is not very compatible w/ enteral feeding?

A
  • Phenytoin
  • Showed a 70% decrease in bioavailability when administered w/ enteral feeding
  • Drug may bind w/ components in the feeding and avoid absorption
57
Q

What can be done if phenytoin must be administered through a feeding tube?

A

Hold feeding formulas for 1 hour before and 2 hours after medication dosing

58
Q

Why are proton-pump inhibitors prolembatic to feeding tubes?

A

Are highly unstable in acidic environments and are inactivated by gastric acid

59
Q

What should capsule contents be mixed w/?

A
  • Apple or orange juice b/c they protect the enteric-coated granules so they remain intact in stomach until reaching the small intestine
  • Mixing w/ water causes clumping
60
Q

What are some problems associated w/ bedside modification?

A
  • Taste
  • Acid stability
  • Over-dosing when controlled-release products are used

Pharmaceutics Year 2 (17 decks)

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