Achievement of Therapeutic International Normalized Ratio Following Adjustment of Tube Feeds

Krajewski, Kristin C.; Butterfoss, Kirsten

doi:10.1177/0091270010374469

Cited by 5 publications

(12 citation statements)

References 8 publications

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“…An in vitro study revealed that a physicochemical interaction, likely due to the macromolecular fraction of EN, was the mechanism resulting in lower warfarin availability and clinical failure 180 . This finding seemed to be confirmed by patient case reports in which separating warfarin from EN administration by 1–3 hours mitigated the interaction 181,182,183 . Another in vitro study indicated that warfarin binds with the large, unfilterable component of EN, a problem that is seemingly worse in the presence of formulas with intact protein than with an amino acid–based formula 182 .…”

Section: Enteral Drug‐use Processmentioning

confidence: 87%

Enteral Medication for the Tube‐Fed Patient: Making This Route Safe and Effective

Boullata

2020

Nut in Clin Prac

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The administration of medication through an enteral access device requires important forethought. Meeting a patient's therapeutic needs requires achieving expected drug bioavailability without increasing the risk for toxicity, therapeutic failure, or feeding tube occlusion. Superimposing gut dysfunction, critical illness, or enteral nutrition–drug interaction further increases the need for a systematic approach to prescribing, evaluating, and preparing a drug for administration through an enteral access device. This review will explain the fundamental factors involved in drug bioavailability through the gut, address the influencing considerations for the enterally fed patient, and describe best practices for enteral drug preparation and administration.

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Section: Enteral Drug‐use Processmentioning

confidence: 87%

Enteral Medication for the Tube‐Fed Patient: Making This Route Safe and Effective

Boullata

2020

Nut in Clin Prac

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“…Achieving therapeutic levels of this drug may be difficult because of its wide range of interactions with food. (15) Resistance to warfarin associated with food intake was originally attributed to the large amounts of vitamin K present in the formulations. (19) The initial administration of the usual dose of warfarin (5 mg) did increase the international normalized ratio (INR) when the drug was administered simultaneously with continuous enteral nutrition.…”

Section: Discussionmentioning

confidence: 99%

“…(19) The mechanism of interaction, in addition to the obvious administration of vitamin K (antidote for the drug), occurs because the constituents of the enteral diet reduce the absorption of warfarin via a protein-binding mechanism. (11,15) Another possibly related mechanism involves elevated levels of albumin caused by a high protein diet, which increases binding of the drug to these proteins and reduces the therapeutic effect. (11,37) …”

Section: Discussionmentioning

confidence: 99%

Drug-nutrient interactions in the intensive care unit: literature review and current recommendations

Heldt¹,

Loss²

2013

Revista Brasileira De Terapia Intensiva

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ObjectiveTo describe the interactions between drugs and nutrients and their frequency in the intensive care unit and to assess the professional team's awareness regarding this subject.MethodsThe keywords "drug interactions" and "nutrition therapy" were searched in the PubMed (specifically MeSH) electronic database. The studies were systematically reviewed for descriptions of the types of interactions between drugs and nutrients, including their frequency and consequences. ResultsSixty-seven articles were found. Among these, 20 articles were appropriate for the methodology adopted and accomplished the objectives of the study. Of these 20 articles, 14 articles described interactions between drugs and enteral nutrition, three described interactions between drugs and parenteral nutrition, and three described the importance and care required to avoid such interactions.ConclusionsThe literature about drug and nutrient interactions is limited and suggests the inability of health care teams to recognize the potential for these interactions. Possibly, the elaboration of a protocol to evaluate drug-nutrient interactions will increase the safety and efficacy of therapeutics.

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“…Interações/ Preparos/ Incompatibilidades/ Recomendações Varfarina (Comprimido) Forma de preparo e administração: alguns autores sugerem interromper a administração de nutrição enteral por uma hora antes e uma hora depois da administração de varfarina (Boullata, 2009;Boullata & Armenti, 2010;Dickerson, 2008;Dickerson, Garmon, Kuhl, Minard, & Brown, 2008;Guenter & Boullata, 2013;Krajewski & Butterfoss, 2011;L. D. da Silva et al, 2010;L.…”

Section: Medicamento/ Fármaco (Forma Farmacêutica)unclassified

“…A administração de medicamentos via sondas e ostomias envolve riscos consideráveis, podendo aumentar a morbidade e mortalidade (Phillips & Nay, 2008). Algumas das consequências da administração de medicamentos via sonda incluem: alteração da forma farmacêutica original (trituração de comprimidos); oclusão da sonda e possível necessidade de sua repassagem; desconhecimento da localização da ponta distal da sonda, ou deslocamento dessa, e consequente liberação do medicamento em local diferente do sítio de absorção indicado; e interação do fármaco com os componentes da NE ou com a própria sonda (DRUG-REAX®, 2018;Kozeniecki & Fritzshall, 2015;Krajewski & Butterfoss, 2011;Miller, McClave, Kiraly, Martindale, & Benns, 2014;Phillips & Endacott, 2011;Reis et al, 2014;Silva & Lisboa, 2011;Zhuang et al, 2013).…”

Section: Introductionunclassified

Administração de medicamentos via sonda enteral no pós-operatório gastrointestinal

Santos

Araújo

Rezende

2021

RSD

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Pacientes submetidos a operações do trato gastrointestinal são complexos e frequentemente recebem medicamentos via sondas enterais (SE). O objetivo desse estudo foi analisar o perfil e fatores associados às limitações da administração via SE de medicamentos prescritos para pacientes submetidos a operações do trato gastrointestinal e parede abdominal. Para tal, analisou-se todas as prescrições eletrônicas de pacientes sob uso de nutrição enteral (NE) em pós-operatório em um hospital universitário geral (01/05 a 05/12/2017). Medicamentos prescritos para administração via SE foram identificados e realizou-se uma revisão da literatura acerca de limitações para sua administração por esta via. Determinou-se a prevalência dessas limitações e fatores associados por meio de análises uni (qui-quadrado de Pearson) e multivariada (regressão logística - nível de significância estatística de 5%). Foram analisadas 341 prescrições de 40 pacientes. Identificou-se 725 medicamentos prescritos via SE (44 medicamentos diferentes). Na revisão, recuperou-se 33 artigos para construção de uma base de dados, que permitiu a identificação de 188 limitações quanto à administração via SE entre os medicamentos prescritos, e uma prevalência de pelo menos uma limitação de 57,5% (n=23), que mostrou-se associada positivamente à idade igual ou superior a 60 anos (OR 4,67; IC95% 1,07-20,40). Devido à escassez de referências voltadas para administração de medicamentos via SE, esse estudo configura uma importante ferramenta para o cuidado farmacoterapêutico ao paciente sob uso de NE. O número de limitações identificado foi reduzido, mas sua associação com idade avançada e a gravidade da população estudada reforçam a importância da priorização de seu manejo.

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Achievement of Therapeutic International Normalized Ratio Following Adjustment of Tube Feeds

Cited by 5 publications

References 8 publications

Enteral Medication for the Tube‐Fed Patient: Making This Route Safe and Effective

Enteral Medication for the Tube‐Fed Patient: Making This Route Safe and Effective

Drug-nutrient interactions in the intensive care unit: literature review and current recommendations

Administração de medicamentos via sonda enteral no pós-operatório gastrointestinal

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