Medication Administration and Probiotics in Clinical Settings

Probiotics

• The American Thoracic Society recommends the use of Lactobacillus species, Bifidobacterium, and Saccharomyces boulardii as probiotics 1

Emergency Medications

• The American Thoracic Society suggests that epinephrine, naloxone, atropine, and lidocaine can be administered via tracheostomy tubes in emergency situations, with a dose of 2-3 times the usual IV dose, diluted to 3-5 mL 2

Medication Administration through Feeding Tubes

• Medication administration through nasogastric tubes (NGT) requires careful consideration of patient factors, medication properties, and administration techniques to ensure safe and effective delivery, as recommended by the American Society for Parenteral and Enteral Nutrition and Clinical Nutrition guidelines 3, 4
• The American Society for Parenteral and Enteral Nutrition recommends avoiding nasogastric tube administration of medications in patients with severe functional disturbances of the bowel, gastrointestinal obstruction, gastrointestinal tract bleeding, or severe malabsorption or metabolic imbalances 4
• Patients with significant GI tract resections may experience compromised drug absorption, as reported by the Journal of the National Comprehensive Cancer Network 5
• The following table outlines special considerations for medication administration through feeding tubes:

Administration Techniques

• Flush the tube with at least 30 mL of water before and after medication administration to clear any residual formula and prevent tube occlusion, as recommended by Clinical Nutrition guidelines and the American Society for Parenteral and Enteral Nutrition 3, 4
• Use appropriate ENFit syringes that comply with ISO 80369-3 standards to avoid misconnection errors, according to Clinical Nutrition guidelines and the International Organization for Standardization (ISO) standards 3, 4
• Administer medications individually, not mixed with other drugs, to prevent drug interactions, as suggested by Clinical Nutrition guidelines 3, 4
• Liquid formulations are generally preferred for administration through feeding tubes when available, and should be administered directly through the tube without mixing with other medications, as recommended by Clinical Nutrition guidelines 3
• For tablet formulations, crush thoroughly until it becomes a fine powder, mix with 15-30 mL of water, and ensure complete dissolution before administration, to prevent tube occlusion, as implied by Clinical Nutrition guidelines 3

Monitoring and Precautions

• Potential adverse effects of medication administration through NGT include bradycardia, hypotension, sleep disturbances, and bronchial irritation, as reported by the Pediatrics society 8
• Reduced drug efficacy may occur if administered with enteral formula, and consider pausing feeds, as warned by the Clinical Nutrition society 4
• Avoid using carbonated beverages or acidic juices to dissolve medications, as this may affect drug stability and efficacy, and avoid hypertonic preparations, which may cause gastrointestinal disturbances 7
• Thyroid function tests should be monitored regularly in patients receiving levothyroxine through feeding tubes, with baseline tests performed before starting concurrent therapy, and weekly monitoring for the first 2-3 weeks of concurrent therapy 3, 4
• Consider consulting with a pharmacist before crushing and administering medications through feeding tubes to ensure proper drug delivery and prevent tube occlusion 3, 4