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  • Image not available. Enteral feeding access site and tube characteristics influence which drug administration and enteral feeding techniques will be used to optimize pharmacotherapy.
  • Image not available. The drug formulation often guides the medication administration protocol for patients receiving enteral nutrition (EN).
  • Image not available. Potential physical incompatibilities of liquid, elixir, and suspension medication formulations with enteral feeding necessitate the use of alternative dosage forms, changes in the route of administration, changes in the medication administration protocol, or selection of a different medication.
  • Image not available. Many medication formulations, particularly delayed-release and enteric-coated products, should not be crushed.
  • Image not available. Gastrointestinal (GI) intolerance to liquid and suspended medication forms are usually related to either the hypertonicity or the sorbitol content of the drug product.
  • Image not available. It is important that the clinician closely evaluate every enterally administered medication for efficacy as well as toxicity for those patients receiving EN, given the particular characteristics of drug absorption, the location of the feeding tube within the GI tract, and the potential adsorption to the feeding.
  • Image not available. A critical part of evaluating parenteral nutrition (PN) medication admixtures is understanding the difference between stability and compatibility.
  • Image not available. It is important to determine if the PN is either a two-in-one or three-in-one admixture when considering adding a medication, as the presence of an intravenous (IV) lipid emulsion can markedly change the stability characteristics of the PN.
  • Image not available. IV Y-site administration of calcium, potassium phosphate, sodium phosphate, and magnesium with PN admixtures must be avoided.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Describe the impact of enteral feeding access site and enteral tube characteristics upon enteral nutrition delivery and drug administration techniques.
  • 2. Develop a safe and effective medication administration protocol for patients receiving enteral nutrition.
  • 3. Differentiate the types of liquid medications that are most likely to cause tube clogging when mixed with liquid nutrition formulations.
  • 4. Identify those medications that should not be crushed.
  • 5. Analyze and interpret stool osmotic gap for a patient with diarrhea receiving enteral feeding and liquid medications.
  • 6. Justify a plan of action based on the risks and benefits of intermittent holding of enteral feeding for drug administration.
  • 7. Differentiate between stability and compatibility as it applies to concurrent intravenous medication and PN administration.
  • 8. Evaluate whether the PN formulation can be used as a drug delivery system for a given medication.
  • 9. Describe the effect of trivalent and divalent cations from medications and electrolytes upon intravenous lipid emulsion stability
  • 10. Identify common medications that should not be given via Y site with either a 2-in-1 or 3-in-1 PN admixture.

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The use of parenteral and enteral nutrition requires a high level of clinical expertise and careful attention to ensure that patient outcomes are optimized and that untoward events are minimized. This chapter provides a foundational framework for the identification and management of drug–nutrient interactions associated with enteral nutrition (EN) and parenteral nutrition (PN). Issues related to EN include feeding tube access site factors, medication administration techniques, dosage ...

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