Artificial Nutrition

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Artificial Nutrition
2013-04-22 16:21:08

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  1. if patient gets diarrhea when on enteral feeding, what do we blame?
    don't blame the enteral feeding until all other options (i.e. C. diff) are ruled out
  2. prokinetic agent examples
    • metoclopramide: DA agonist
    • erythromycin: motilin receptor agonist
  3. drugs that slow gi motility
    • codeine
    • diphenoxylate/atroine
    • loperamide
    • tincture of opium
  4. which is best for enteral feeding - elixir and suspension vs. syrup
    elixir and suspension
  5. preparations not appropriate for enteral administration
    • lansoprazole granules
    • sucralfate suspesnion
    • syrups
  6. what do do with bead filled capsules
    empty into apple sauce or apple juice, but don't crush
  7. meds not to crush to put into a EN
    • enteric coated
    • carcinogenic or teratogenic drugs (cytotoxic)
    • ER tabs
  8. how to give the meds when using an EN tube
    • stop feeding
    • flush with 15-30 ml before and after med administration
    • with multiple meds, flush 5-10 ml between each
  9. medication administration timing with EN feeding (including when empty stomach needed)
    • qd preferred
    • adjust feeding rate for interruptions
    • empty stomach - stop 30 min before, restart 30 min after
  10. phenytoin and EN
    • liquid is preferred
    • absorption reduced 70% with EN; maybe bc of tube absorption or binding to EN components (Ca, protein)

    • Possible Solutions:
    • stop EN 2hrs before and after and flush with 60 ml of water after
    • BID vs. TID dosing
    • inc phenytoin dose to compensate
  11. warfarin and EN
    warfarin resistance possible because of high Vit. K content in EN and protein binding

    • solutions:
    • monitor
    • alternate anticoagulation
    • hold EN 1 hr before/after
  12. FQs and EN
    bioavailability goes down because of complexing with ions (Ca, Mg, Al, Fe)

    • Solutions:
    • hold EN 1 hr before, 2 hr afters
    • inc dose
    • change to IV
  13. PPIs and EN
    acid-klabile, formulated to maintain integrity until duodenem

    • Alternatives:
    • G - omep/lansop + acidic juice
    • J - Esomep granules + H20 OR
    • granules + bicarb