DNI & Supplements

Question 1

Alteration of a specialized dosage form or administration by a different route than designed is an example of what type of interaction?

Answer 1

pharmaceutical

Question 2

What type of interaction occurs before the drug or nutrient reaches the site of action and may cause altered absorption/metabolism?

Answer 2

pharmacokinetic

Question 3

What type of interaction occurs at site of action and binding sites of receptors are usually involved?

Answer 3

pharmacodynamic

Question 4

Minimum G-tube size for intact pellet/beads to be administered through

Answer 4

16 French

Question 5

Post pyloric administration of carbamazepine may cause…

Answer 5

decreased bioavailability

Question 6

How do di/tri-valent minerals impact certain drugs (such as tetracycline and ciprofloxacin)?

Answer 6

Ca, Mag, Fe are known to form complexes with these drugs which results in insufficient drug absorption

Question 7

How should EN be manipulated in a patient on phenytoin?

Answer 7

EN should only be stopped for time needed to properly administer the med (including adequately flushing enteral access device before/after administration; phenytoin dose should be diluted with 30 mL before administration)

Question 8

Does slow or fast gastric emptying improve bioavailability of carbamazepine?

Answer 8

slow improves bioavailability b/c carbamazepine is insoluble and acid-stable

Question 9

EN interaction with fluoroquinolones

Answer 9

bioavailability of some fluoroquinolones antibiotics seems to be reduced by EN

Question 10

What should be considered with a patient on EN who is receiving ciprofloxacin?

Answer 10

it is a fluoroquinolone
-holding feeds is potential method of mitigating EN interactions
-separate administration from most antacids and mineral supplements (Ca, Fe, Zn, Mag)

Question 11

What should be considered with a patient on EN who is receiving norfloxacin?

Answer 11

it is a fluoroquinolone
-holding feeds is potential method of mitigating EN interactions
-separate administration from most antacids and mineral supplements (Ca, Fe, Zn, Mag)

Question 12

What should be considered with a patient on EN who is receiving levofloxacin?

Answer 12

it is a fluoroquinolone
-holding feeds is potential method of mitigating EN interactions
-separate administration from most antacids and mineral supplements (Ca, Fe, Zn, Mag)

Question 13

How should EN be adjusted in a patient receiving warfarin therapy?

Answer 13

1 hour separation between EN and warfarin administration

Question 14

Legal regulation of dietary supplements

Answer 14

-Manufacturers are responsible for ensuring a dietary supplement is safe before it is marketed under DSHEA
-Manufacturers do not need to register dietary supplement products with FDA or obtain FDA approval before producing or selling dietary supplements unless it contains a new dietary ingredient (NDI = any ingredient not previously marketed in the US before enactment of DSHEA in 1994)

Question 15

Who is responsible for taking action against an unsafe product (ie dietary supplement) and its manufacturer after it reaches the market?

Answer 15

FDA

Question 16

Technology assisted administration of nutrients when a patient is unable to swallow or unable to absorb nutrients via GI tract

Answer 16

AANH (artificially administered nutrition and hydration)

Question 17

how does slowed gastric emptying impact carbamazepine?

Answer 17

improves bioavailability as carbamazepine is insoluble and acid-stable

Question 18

how should EN be adjusted for pt on carbamazepine?

Answer 18

adequate dilution of suspension (1:1 dilution, preferably 3:1) or slurry from crushed tablet prior to administration and adequate flushing after dose can reduce drug loss to the tube

Question 19

what types of foods should not be taken with ciprofloxacin?

Answer 19

milk, dairy products, calcium-fortified juices
(but can be taken with meals containing these foods)

Question 20

how should drugs in microencapsulated bead or pellet form be administered via large bore feeding tubes?

Answer 20

mixed with acidic juice as the vehicle to reduce risk of coating on pellets/beads softening and sticking to the tube