Warfarin resistance and enteral feedings: 2 Case reports and a supporting in vitro study

Penrod, Louis E.; Allen, Joanne B.; Cabacungan, Leonard R.

doi:10.1053/apmr.2001.23848

Cited by 50 publications

(34 citation statements)

References 15 publications

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“…One study postulated that the protein of some enteral feeding products appears to bind with warfarin, decreasing its bioavailability and resulting in subtherapeutic anticoagulation levels. 100 The use of enteral nutrition should be evaluated by guest on http://circ.ahajournals.org/ Downloaded from carefully before a decision is made to incorporate it into a child's medical regimen. The number of drugs that have been reported in the literature to interact with warfarin continues to increase.…”

Section: Food and Drug Interactionsmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

297

245

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Section: Food and Drug Interactionsmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

297

245

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“…11 Another drug administered without any EN pause was warfarin sodium. In one study 12 , a reduction in the anticoagulant effect of warfarin sodium was found, caused by the increased absorption of vitamin K from enteral formulae when the drug is administered together with the EN, and also by the possible union between the warfarin sodium and the protein component of the enteral formulae. 12 In that sense, patients who receive EN and who use warfarin sodium, when compared to patients who receive oral feeding, need a dose twice as high to maintain the therapeutic prothrombin time.…”

mentioning

confidence: 99%

“…In one study 12 , a reduction in the anticoagulant effect of warfarin sodium was found, caused by the increased absorption of vitamin K from enteral formulae when the drug is administered together with the EN, and also by the possible union between the warfarin sodium and the protein component of the enteral formulae. 12 In that sense, patients who receive EN and who use warfarin sodium, when compared to patients who receive oral feeding, need a dose twice as high to maintain the therapeutic prothrombin time. 12 The sodium levothyroxine was also administered without any pause and there is evidence that its administration together with EN, mainly with fibers, can reduce its absorption.…”

mentioning

confidence: 99%

“…12 In that sense, patients who receive EN and who use warfarin sodium, when compared to patients who receive oral feeding, need a dose twice as high to maintain the therapeutic prothrombin time. 12 The sodium levothyroxine was also administered without any pause and there is evidence that its administration together with EN, mainly with fibers, can reduce its absorption.…”

mentioning

confidence: 99%

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Investigation of medication administration through catheters in intensive care

Lisboa¹,

Silva

Matos

2014

Texto contexto - enferm.

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ABSTRACT:This study aims to identify errors in medication administration through probes and characterize the interruption or not of nutrition in the case of drugs that require relative fasting. This is an epidemiological, cross-sectional and observational study in intensive care with a sample of 350 doses of drugs administered by 56 nursing technicians. The results showed no pause between the drug administration and the infusion of enteral feeding in 116 (33.14%) doses of drugs that required relative fasting, including captopril, sodic warfarin, sodic levothyroxine, sodic digoxin and sodic phenytoin. The irrigation of probes did not occur (94.28%) in most cases. It is concluded that the serum bioavailability of the drugs mentioned may have been reduced, compromising their therapeutic efficacy; and that the lack of probe irrigation with sterile water before administering drugs shows the absence of a specific and fundamental care to prevent probe clogging. DESCRIPTORS:Medication error. Nursing. Security measures. INVESTIGAÇÃO DA ADMINISTRAÇÃO DE MEDICAMENTOS POR CATETERES EM TERAPIA INTENSIVARESUMO: Pesquisa com os objetivos de identificar falhas na administração de medicamentos por sondas e caracterizar a interrupção ou não da nutrição no caso de medicamentos que exigem jejum relativo. Estudo epidemiológico, transversal, observacional numa terapia intensiva, com amostra de 350 doses administradas por 56 técnicos de enfermagem. Os resultados mostraram que não houve pausa entre a administração do medicamento e a infusão de dieta enteral em 116 (33,14%) doses de medicamentos que necessitavam de jejum relativo, entre os quais captopril, varfarina sódica, levotiroxina sódica, digoxina e fenitoína sódica. A irrigação das sondas não ocorreu na maioria dos casos (94,28%). Conclui-se que é possível que os medicamentos citados tenham tido sua biodisponibilidade sérica reduzida, comprometendo sua eficácia terapêutica e que a falta da prática de irrigar sondas com água estéril, antes de administrar medicamentos, configura-se como a ausência de um cuidado específico fundamental para evitar a obstrução das mesmas. DESCRITORES:Medicamentos. Enfermagem. Nutrição enteral. INVESTIGACIÓN DE LA TÉCNICA DE ADMINISTRACIÓN DE MEDICACIONES POR CATETERES EN TERAPIA INTENSIVARESUMEN: Estudio con objetivos de identificar errores en el manejo de catéteres y evaluar la interrupción de la dieta durante medicaciones que exijan ayuno. Investigación transversal, observacional en terapia intensiva. Se observaron 350 dosis administradas por 56 técnicos de enfermería. Los resultados muestran que no hubo pausa entre la administración del fármaco y la infusión de dieta enteral en 116 dosis (33,14%) que necesitaban de ayuno relativo, como el captopril, varfarina sódica, levotiroxina sódica, digoxina y fenitoína sódica. Con relación a la irrigación de los catéteres, esta no ocurrió en la mayoría de los casos (94,28%) antes de la administración del medicamento. Se concluye que es posible que los fármacos citados hayan presentado su biodisponibilidad sér...

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“…The levels were normalised after taking crushed levothyroxine tablets (Yamamoto, 2003). However, for medications with a low therapeutic index such as digoxin, or warfarin, even a minor fluctuation in bioavailability can result in sub-therapeutic or toxic drug levels (Penrod et al, 2001). …”

Section: Dosage Form Modificationmentioning

confidence: 99%

Oral medication dose form alteration: patient factors and the effect of adding thickened fluids

Radhakrishnan¹

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Solid oral dosage forms such as tablets and capsules are often crushed and mixed with foods or fluids to aid drug delivery for those who cannot or prefer not to swallow them whole. Some people have a physiological problem limiting swallowing (dysphagia), and their fluids are thickened to ensure safe swallowing; these thickened fluids are also used to deliver crushed medication in replacement of water. This thesis explores the issues surrounding the swallowing of whole tablets and capsules, their modification by crushing and the influence of coadministration with thickened fluids on absorption pharmacokinetics. The literature review (Chapter 1) examines the physiology and pathophysiology of swallowing and considers the particular issues surrounding swallowing tablets and capsules. It also explores the possible consequences of crushing the medications and mixing the powder with vehicles such as jam, honey, yoghurt and thickened water.This thesis contains two sections. In Section A (Chapter 2), the potential influence of psychological issues, oral sensation, sensory effect and motor ability of an individual on swallowing pills was investigated. It is hypothesised that swallowing tablets and capsules will be an issue in people with a memory of gagging on food and medication, strong gag reflex, heightened taste sensation, or who tend to chew their food for extended periods.Volunteers (153) completed a written survey and one-on-one assessments. Psychological issues were addressed by questions on memory of choking incidents on food or medication, and regularity of medication use. Sensory effects were assessed by measuring the person's gag reflex, taste receptor density, size of the mouth (mallampati classification), and on food neophobia. Motor effects were assessed as efficiency in chewing a jelly snake. Finally, the volunteers were observed swallowing a capsule and the quantity of water used, and head position was recorded.In the survey, 33% of the population reported that they have had trouble swallowing medication.These people were more likely to have choked on medication in the past, have a smaller mouth cavity, and a medium or high taste receptor density. There was no relationship between trouble swallowing medication and gag reflex, food neophobia, chewing efficiency, quantity of water used to swallow, and head position.In Section B (Chapters 3, 4, and 5), the effect of crushing medication and mixing with water thickened with a commercial thickening agent on absorption pharmacokinetics was studied.ii Paracetamol tablets were used as the model drug, and saliva samples were used to measure the PK profile. Chapter 3 assessed the inter-and intra-individual variability as the coefficient of variation of paracetamol in saliva. Volunteers took whole tablets of paracetamol (2 x 500 mg) on two different days separated by a week. Saliva production was stimulated using citric acid and paracetamol levels in the saliva were measured using high-performance liquid chromatography. Non-compartmental pharmacokinetic analy...

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Warfarin resistance and enteral feedings: 2 Case reports and a supporting in vitro study

Cited by 50 publications

References 15 publications

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Investigation of medication administration through catheters in intensive care

Oral medication dose form alteration: patient factors and the effect of adding thickened fluids

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