Transcript Solid Dosage Forms

How does the enteral feed
affect medication delivery?
Types of Drug Formulations:
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Liquid solutions
Solid immediate release tablets & capsules
Enteric coated tablets
Sustained release tablets & capsules
Hard gelatin capsules
Others
Liquid Preparations
• All liquid formulation will be suitable ?.
• Elixirs or suspensions or syrup(clumping)?
• Advantages:
• allows accurate dosing, ready to use
• Easily measured.
Disadvantages, Co-solvents like sorbitol,
large amount(child formulations), higher
osmolarity (not written on bottle),viscosity
Medications That Have an
Osmolality of ≥ 3000
mOsm/kg
Liquid Medications That
Contain Considerable
Amounts of Sorbitol With
Typical Daily Dosing
Medications Physically
Incompatible With Most
Enteral Nutrition
Solid Dosage Forms
Solid Dosage Forms
Medication Delivery Systems(1)
• Began as simple extract of plants made into
powders
• Present day: complex delivery systems
Solid Dosage Forms
To Crush or Not to Crush?
• Extended release products- suffixes for
sustained-release, controlled-release, or
controlled-delivery products include: 12-hour,
24-hour, CC, CD, CR, ER, LA, Retard, SA,
Slo-, SR, XL, XR, or XT.
• Enteric coated tablets
To Crush or Not to Crush?
Extended-Release formulations
• Capsules- opened, sprinkled,…
• Lansoprazole
• Diltiazem
• Duloxetine
• Tablets• K-Dur
• Tegretol CR
To Crush or Not to Crush?
Enteric Coated tablets
• No
• Enteric coating will
not dissolve
• Switch to regular
tablet
To Crush or Not to Crush?
Taste
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Altered texture of medication
Local anesthetic effect
Stain teeth
Irritate mouth, esophageal mucosa or stomach
lining
• Coating on tablets or capsules to mask bitter
or unpleasant taste
To Crush or Not to Crush?
Risk to Nurse
• Crushing some potential
teratogenic/carcinogenic/allergenic
medications can put nurse at risk.
• Drugs:
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Bosentan
Methotrexate
Dutasteride
Mycophenolate
Raloxifene
Finasteride
Types of Drug Formulations:
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Solid immediate release tablets & capsules
Enteric coated tablets
Sustained release tablets & capsules
Liquid solutions
Buccal or sublingual preparations
carcinogenic, teratogenic, or cytotoxic
properties should also not be crushed.
Best Practice Guidelines from ASPEN:Methods of
Administering Medications via Enteral Feed Tubes (1)
• Do not add medication directly to an enteral feeding formula.
• Administer each medication separately through an appropriate
access site.
• Liquid dosage forms should be used when available and if
appropriate.
• Only immediate-release solid dosage forms may be substituted.
• Grind simple compressed tablets to a fine powder and mix with sterile water.
• Open hard gelatin capsules and mix the powder with sterile water.
• Avoid mixing together medication intended for administration
through an enteral feeding tube, given the risks of physical and
chemical incompatibilities, tube obstruction, and altered drug
responses.
Best Practice Guidelines from ASPEN:Methods of
Administering Medications via Enteral Feed Tubes (1
• Before administering medicatoin, stop feeding and flush the tube
with at least 15ml of sterile water.
• Dilute the solid or liquid medication as appropriate and administer
using a clean oral syringe that’s 30ml or larger.
• Flush the tube again with at least 15ml of sterile water, taking into
account the patient’s volume status.
• Repeat the previous three steps before administering the next
medication.
• After all the medications have been administerd , flush the tube one
final time with at least 15ml of sterile water.
• Restart feeding in a timely manner to avoid compromising the
patient’s nutritional status. Feeding may be delayed for 30minutes
or longer, when appropriate, to avoid altering the bioavailability of
the drug.
• Consult with a pharmacist as needed.
Methods to Unclog Feeding Tubes:
• Flushes before and after medication
administration
• Use a syringe of greater than 30mls to
avoid rupture of tube
• Warm Water flushes, CB or Cra. JUICE
• Sodium Bicarbonate 325mg tab and
Pancreatic Enzyme capsule
• mechanical declogging device
Specific Medications:
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Phenytoin (70% less abs.)
Carbamazepine
Fluoroquinolones
Warfarin
Proton Pump Inhibitors
Methods of crushing:
• Mortar and pestle
• Silent knight
• Crushing syringe
Interdisciplinary Team
• Communication
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Physician
Nurse
Pharmacist
Dietician
• Medication Administration Record
• Links to resources
Conclusions
• Reduce drug therapy to the minimum
necessary.
• Transfer QD formulations with a long halflife where possible (not modified- slowrelease formulations).
• Determine alt. formulations and routes
available where possible.
• Effectively monitored with each change.