The Role of the Pharmacist in Selecting the Best Choice of Medication Formulation in Dysphagic Patients

Abstract

Usually, the administration of drugs by feeding tube in dysphagic patients involves handling of marketing licenses outside their term, due to the lack of suitable formulations. This circumstance has put health professionals in the dilemma of choosing the formulation whose manipulation possibly does not alter the effectiveness of the drug. In this regard, a practical guide providing indications on the prescription, handling, and administration of drugs through enteral feeding tube could be of paramount utility. For this purpose, we have considered the 1047 solid oral pharmaceutical forms included in the formulary of San Paolo Hospital (Savona, Italy). From our analysis, it emerges that 95% of medicinal products are worryingly used off-label and 40% have to be managed by the hospital pharmacists without having suitable indications by either the manufacturers or by literature studies. To fill this gap, we have compiled a detailed table containing missing indications derived from pharmacist expertise and evidence-based practices, with the aim that the sharing of our procedures will contribute to make uniform pharmacological therapies from one hospital to another. This study will allow doctors to have easy access to information on drugs that can be prescribed and nurses to become familiar only with the pharmaceutical forms that can be administered.

Perfil Dos Erros De Medicamentos Por Sonda Enteral Em Terapia Intensiva:

“…Nesse estudo, verificou-se a trituração de três doses de cápsulas de liberação prolongada, outras vias de administração (17) .…”

“…Quanto maior a osmolalidade, maior o volume de diluente necessário. Valores de osmolalidade próximos aos das secreções intestinais são mais bem tolerados (100-400 mOsm/kg H2O) (17) . Desta forma, as suspensões com alta viscosidade também necessitam de diluição prévia da formulação antes da administração para facilitar a sua administração pela sonda (25) .…”

“…Quando a osmolaridade dos medicamentos não é conhecida, é aconselhável diluir o medicamento com pelo menos 30 mL de água para tornar a administração no estômago compatível, evitando assim fenômenos diarreicos por efeito osmótico. Além disso, algumas suspensões e xaropes podem ser muito viscosos e levar à obstrução do tubo (17) .…”

“…O sorbitol é um excipiente comum de formulações líquidas, frequentemente usado como estabilizador e adoçante. Quantidades elevadas (>10 g/dia) podem causar produção intraluminal de gás e tensão abdominal e, em doses mais altas (>15 g/dia), efeitos secundários importantes, como espasmos abdominais e diarreia (17) .…”

Hospital Variation in Feeding Jejunostomy Policy for Minimally Invasive Esophagectomy: A Nationwide Cohort Study

“…Historically, the nil-per-mouth policy has been used to reduce the risk of anastomotic leakage and aspiration pneumonia [ 5 ]. ERAS protocols, however, stress the need for good nutritional support by early feeding, with enteral feeding as the superior choice [ 6 , 7 ]. Malnutrition greatly increases the rate of postoperative complications and subsequently slows postoperative recovery [ 8 , 9 ].…”