Podcast
Questions and Answers
Which of the following statements about coeliac disease is NOT true?
Which of the following statements about coeliac disease is NOT true?
- The only effective treatment is a strict, gluten-free diet supplemented with over-the-counter vitamins and mineral supplements. (correct)
- It is caused by the presence of gluten proteins in wheat, barley, and rye.
- The treatment aims to eliminate symptoms and reduce the risk of complications.
- It is an autoimmune condition characterized by chronic inflammation of the small intestine.
Which of the following is NOT a risk associated with coeliac disease?
Which of the following is NOT a risk associated with coeliac disease?
- Osteoporosis and active bone disease.
- Malabsorption of key nutrients, such as calcium and vitamin D.
- Nutrient malabsorption due to chronic inflammation of the small intestine.
- Increased risk of developing type 2 diabetes. (correct)
What is the recommended treatment for refractory cases of coeliac disease?
What is the recommended treatment for refractory cases of coeliac disease?
- Strict, lifelong, gluten-free diet.
- Supplementation of key nutrients, such as calcium and vitamin D.
- Referral to a specialist center, with prednisolone. (correct)
- Over-the-counter vitamins and mineral supplements.
Which of the following statements about the treatment of coeliac disease is correct?
Which of the following statements about the treatment of coeliac disease is correct?
Which of the following statements about the gluten-free products for coeliac disease is correct?
Which of the following statements about the gluten-free products for coeliac disease is correct?
What is the advised action if tuberculosis is diagnosed during vedolizumab treatment?
What is the advised action if tuberculosis is diagnosed during vedolizumab treatment?
What is a common side effect of Vedolizumab?
What is a common side effect of Vedolizumab?
What is the advised period for effective contraception during and after Vedolizumab treatment?
What is the advised period for effective contraception during and after Vedolizumab treatment?
When should patients be brought up to date with their immunisation schedule?
When should patients be brought up to date with their immunisation schedule?
Which organization has recommended Vedolizumab for treating moderately to severely active Crohn's disease after prior therapy?
Which organization has recommended Vedolizumab for treating moderately to severely active Crohn's disease after prior therapy?
What should be done after each administration of Vedolizumab according to the text?
What should be done after each administration of Vedolizumab according to the text?
How should intravenous infusion of Entyvio® be given?
How should intravenous infusion of Entyvio® be given?
What monitoring requirements are recommended during Vedolizumab treatment?
What monitoring requirements are recommended during Vedolizumab treatment?
What is the advisory regarding pregnancy during Vedolizumab treatment?
What is the advisory regarding pregnancy during Vedolizumab treatment?
What action is advised in relation to breastfeeding while taking Vedolizumab?
What action is advised in relation to breastfeeding while taking Vedolizumab?
Which of the following is NOT considered a psychological factor contributing to constipation?
Which of the following is NOT considered a psychological factor contributing to constipation?
Which of the following is the LEAST common symptom of constipation described in the Rome I criteria?
Which of the following is the LEAST common symptom of constipation described in the Rome I criteria?
Which of the following best explains why the prevalence of constipation is difficult to determine?
Which of the following best explains why the prevalence of constipation is difficult to determine?
Which of the following is the MOST significant risk factor for constipation according to the text?
Which of the following is the MOST significant risk factor for constipation according to the text?
What is the primary therapeutic strategy for constipation mentioned in the text?
What is the primary therapeutic strategy for constipation mentioned in the text?
Which of the following is a key diagnostic criteria for functional constipation?
Which of the following is a key diagnostic criteria for functional constipation?
What is the primary factor contributing to slow transit constipation?
What is the primary factor contributing to slow transit constipation?
Which of the following is NOT a factor contributing to constipation?
Which of the following is NOT a factor contributing to constipation?
What is the primary characteristic of functional constipation?
What is the primary characteristic of functional constipation?
What is a significant minority of patients with chronic constipation likely to become reliant on?
What is a significant minority of patients with chronic constipation likely to become reliant on?
What is the primary advantage of polyethylene glycol (PEG) as a laxative?
What is the primary advantage of polyethylene glycol (PEG) as a laxative?
Which of the following statements about osmotic laxatives is NOT true?
Which of the following statements about osmotic laxatives is NOT true?
For functional constipation without a known cause, what is the recommended therapy?
For functional constipation without a known cause, what is the recommended therapy?
Which of the following fiber supplements is considered the most effective for treating chronic constipation?
Which of the following fiber supplements is considered the most effective for treating chronic constipation?
What is the primary limitation of fiber supplementation in treating chronic constipation?
What is the primary limitation of fiber supplementation in treating chronic constipation?
What is a major source of demand for laxative drugs from a public health perspective?
What is a major source of demand for laxative drugs from a public health perspective?
What is the primary goal of the AED tool featuring structured open-ended questions?
What is the primary goal of the AED tool featuring structured open-ended questions?
What is the primary focus of the studies on erectile dysfunction across six Asian countries?
What is the primary focus of the studies on erectile dysfunction across six Asian countries?
What is the primary interpersonal effect on male sexual function mentioned in the text?
What is the primary interpersonal effect on male sexual function mentioned in the text?
What is the primary psychological problem associated with ED mentioned in the text?
What is the primary psychological problem associated with ED mentioned in the text?
What is the primary advantage of patient-centered and self-directed care for patients with ED?
What is the primary advantage of patient-centered and self-directed care for patients with ED?
What is the primary reason education and counseling are important clinical strategies for patients with ED?
What is the primary reason education and counseling are important clinical strategies for patients with ED?
What percentage of men reported ED onset while using medications for hypertension?
What percentage of men reported ED onset while using medications for hypertension?
What is the success rate of suppositories in treating ED?
What is the success rate of suppositories in treating ED?
What is the primary advantage of oral drug therapy in treating ED?
What is the primary advantage of oral drug therapy in treating ED?
What is the success rate of injection therapy in treating various forms of ED?
What is the success rate of injection therapy in treating various forms of ED?
What is the purpose of the constriction ring in Vacuum Suction Devices (VSD)?
What is the purpose of the constriction ring in Vacuum Suction Devices (VSD)?
What is the number of patients reported to undergo procedures for penile prosthesis implantation between July 1993 and November 2009?
What is the number of patients reported to undergo procedures for penile prosthesis implantation between July 1993 and November 2009?
What is a crucial primary and adjunctive therapy in various disease states?
What is a crucial primary and adjunctive therapy in various disease states?
What is a lifeline for patients with permanent loss of the GI tract?
What is a lifeline for patients with permanent loss of the GI tract?
What can result from improperly prepared and administered PN formulations?
What can result from improperly prepared and administered PN formulations?
What led to a FDA Safety Alert?
What led to a FDA Safety Alert?
What was misinterpreted on the label of a PN formulation used in homecare?
What was misinterpreted on the label of a PN formulation used in homecare?
What was the consequence of the misinterpretation in homecare?
What was the consequence of the misinterpretation in homecare?
What was the consequence of pharmacy-compounding operations for pediatric dextrose solutions?
What was the consequence of pharmacy-compounding operations for pediatric dextrose solutions?
What is a characteristic of PN formulations?
What is a characteristic of PN formulations?
What is a common error related to the preparation of Parenteral Nutrition (PN) admixtures?
What is a common error related to the preparation of Parenteral Nutrition (PN) admixtures?
What is the primary benefit of standardized PN order forms?
What is the primary benefit of standardized PN order forms?
What is the most common PN component associated with errors?
What is the most common PN component associated with errors?
What is a potential consequence of misinterpretation of a PN label?
What is a potential consequence of misinterpretation of a PN label?
What is a common source of contamination in PN admixtures?
What is a common source of contamination in PN admixtures?
What is a benefit of standardized PN order forms in terms of cost?
What is a benefit of standardized PN order forms in terms of cost?
What is a common error related to the administration of PN?
What is a common error related to the administration of PN?
What is the primary goal of the 'Safe Practices for Parenteral Nutrition' document?
What is the primary goal of the 'Safe Practices for Parenteral Nutrition' document?
What is a common consequence of PN-associated errors?
What is a common consequence of PN-associated errors?
What is the primary benefit of physician education related to PN therapy?
What is the primary benefit of physician education related to PN therapy?
What is the primary purpose of standardizing PN solutions?
What is the primary purpose of standardizing PN solutions?
What is a common factor associated with the majority of PN prescribing errors?
What is a common factor associated with the majority of PN prescribing errors?
What is the recommended frequency for reviewing and updating PN order forms?
What is the recommended frequency for reviewing and updating PN order forms?
What is the primary benefit of using a standardized PN order form?
What is the primary benefit of using a standardized PN order form?
What is the recommended time frame for submitting PN orders for pharmacy processing?
What is the recommended time frame for submitting PN orders for pharmacy processing?
What is the recommended maximum preparation and hang time for PN solutions that are not refrigerated?
What is the recommended maximum preparation and hang time for PN solutions that are not refrigerated?
What is the primary purpose of including contact information for the person writing the PN order on the PN order form?
What is the primary purpose of including contact information for the person writing the PN order on the PN order form?
What is the recommended approach to reducing errors in PN prescribing?
What is the recommended approach to reducing errors in PN prescribing?
What is the primary benefit of using a standardized PN order form as an educational tool for prescribers?
What is the primary benefit of using a standardized PN order form as an educational tool for prescribers?
What is the recommended approach to minimizing errors in PN prescribing?
What is the recommended approach to minimizing errors in PN prescribing?
What is the primary reason for including the location of the venous access device on the PN order form?
What is the primary reason for including the location of the venous access device on the PN order form?
What is the estimated osmolarity of a PN formulation containing 170g of dextrose, 60g of amino acids, 20g of fat emulsion, and 243mEq of electrolytes?
What is the estimated osmolarity of a PN formulation containing 170g of dextrose, 60g of amino acids, 20g of fat emulsion, and 243mEq of electrolytes?
Why is it essential to specifically address calcium and phosphorus compatibility on the PN order form?
Why is it essential to specifically address calcium and phosphorus compatibility on the PN order form?
What is the purpose of including a general statement warning of the potential for PN formulation incompatibilities on the PN order form?
What is the purpose of including a general statement warning of the potential for PN formulation incompatibilities on the PN order form?
What is the primary benefit of including institutional policy for maximum or minimum nutrient hang times on the PN order form?
What is the primary benefit of including institutional policy for maximum or minimum nutrient hang times on the PN order form?
Why is knowledge of patient dosing weight vital in assessing nutrient needs?
Why is knowledge of patient dosing weight vital in assessing nutrient needs?
What is the primary purpose of including guidelines for stopping or tapering of PN on the order form?
What is the primary purpose of including guidelines for stopping or tapering of PN on the order form?
What is the primary benefit of including example calculations to guide prescribers in determining patient-specific total calories, protein, fluid, and electrolyte requirements?
What is the primary benefit of including example calculations to guide prescribers in determining patient-specific total calories, protein, fluid, and electrolyte requirements?
What is the primary purpose of including specific guidelines for the use of insulin on the PN order form?
What is the primary purpose of including specific guidelines for the use of insulin on the PN order form?
What is the primary benefit of including institutional policy for maximum dextrose infusion rate or IVFE infusion rate on the PN order form?
What is the primary benefit of including institutional policy for maximum dextrose infusion rate or IVFE infusion rate on the PN order form?
What is the primary purpose of identifying persons involved in reviewing the order, other than the prescriber and the pharmacist?
What is the primary purpose of identifying persons involved in reviewing the order, other than the prescriber and the pharmacist?
What is the recommended duration of PN therapy in acute care institutions?
What is the recommended duration of PN therapy in acute care institutions?
What is the purpose of including guidelines for nutrient restriction or supplementation in various disease states?
What is the purpose of including guidelines for nutrient restriction or supplementation in various disease states?
What is the primary advantage of using grams of base components per liter in PN labeling?
What is the primary advantage of using grams of base components per liter in PN labeling?
What is the consequence of misinterpretation of a PN label?
What is the consequence of misinterpretation of a PN label?
What is the primary reason for standardizing PN labeling?
What is the primary reason for standardizing PN labeling?
What is the primary benefit of guidelines for long-term PN administration?
What is the primary benefit of guidelines for long-term PN administration?
What is the purpose of providing guidelines for the use of specialty amino acids?
What is the purpose of providing guidelines for the use of specialty amino acids?
What is the primary advantage of pharmacist-to-pharmacist interaction when patients are transferred between healthcare environments?
What is the primary advantage of pharmacist-to-pharmacist interaction when patients are transferred between healthcare environments?
What is the primary benefit of using the percent of final concentration of dextrose, amino acids, or IVFE in PN labeling?
What is the primary benefit of using the percent of final concentration of dextrose, amino acids, or IVFE in PN labeling?
What is the unit of measurement for phosphorus content in PN formulations?
What is the unit of measurement for phosphorus content in PN formulations?
What is the recommended range for daily protein intake in catabolic patients?
What is the recommended range for daily protein intake in catabolic patients?
What is the purpose of the auxiliary label in PN formulations?
What is the purpose of the auxiliary label in PN formulations?
What is the recommended range for daily energy intake in adult patients?
What is the recommended range for daily energy intake in adult patients?
Why is pharmacist-to-pharmacist communication important during patient transfer?
Why is pharmacist-to-pharmacist communication important during patient transfer?
What is the primary goal of providing standard nutrient ranges in PN formulations?
What is the primary goal of providing standard nutrient ranges in PN formulations?
What is the recommended range for daily fluid intake in adult patients?
What is the recommended range for daily fluid intake in adult patients?
What information is required on the label of PN formulations?
What information is required on the label of PN formulations?
What is the primary advantage of using grams per total volume in a 24-hour nutrient infusion system?
What is the primary advantage of using grams per total volume in a 24-hour nutrient infusion system?
Why is it important to determine individual nutrient requirements for each patient?
Why is it important to determine individual nutrient requirements for each patient?
What is the primary consideration for implementing practice guidelines in alternative healthcare settings?
What is the primary consideration for implementing practice guidelines in alternative healthcare settings?
Why is it useful to express additives as quantity per liter on the PN label?
Why is it useful to express additives as quantity per liter on the PN label?
What is the purpose of the 'amount per day' column on the PN label?
What is the purpose of the 'amount per day' column on the PN label?
Why is it important to include the administration date and time on the PN label?
Why is it important to include the administration date and time on the PN label?
What is the primary benefit of using automated compounding devices in PN compounding?
What is the primary benefit of using automated compounding devices in PN compounding?
Why is it important to include the dosing weight on the PN label?
Why is it important to include the dosing weight on the PN label?
What is the purpose of the supplemental label template for IVFE?
What is the purpose of the supplemental label template for IVFE?
Why is it important to include the route of administration on the PN label?
Why is it important to include the route of administration on the PN label?
What is the primary benefit of using the 24-hour nutrient infusion system in PN compounding?
What is the primary benefit of using the 24-hour nutrient infusion system in PN compounding?
What is the recommended fat content of the PN formulation per kilogram of body weight in adult patients?
What is the recommended fat content of the PN formulation per kilogram of body weight in adult patients?
What is the primary purpose of the PN label template?
What is the primary purpose of the PN label template?
What is the minimum percentage of total caloric intake as linoleic acid required to prevent essential fatty acid deficiency?
What is the minimum percentage of total caloric intake as linoleic acid required to prevent essential fatty acid deficiency?
What is the primary reason for adjusting the standard distribution of nonprotein calories in obese patients?
What is the primary reason for adjusting the standard distribution of nonprotein calories in obese patients?
What is the primary benefit of hypocaloric feeding in patients receiving fat-free PN?
What is the primary benefit of hypocaloric feeding in patients receiving fat-free PN?
What is the primary factor influencing the need for continued provision of IVFE in patients receiving home PN?
What is the primary factor influencing the need for continued provision of IVFE in patients receiving home PN?
What is the primary characteristic of essential fatty acid deficiency syndrome?
What is the primary characteristic of essential fatty acid deficiency syndrome?
What is the recommended carbohydrate content of the PN formulation per kilogram of body weight in adult patients?
What is the recommended carbohydrate content of the PN formulation per kilogram of body weight in adult patients?
What is the primary application of topical EFA in preventing essential fatty acid deficiency?
What is the primary application of topical EFA in preventing essential fatty acid deficiency?
What is the primary limitation of protein restriction in patients with liver disease?
What is the primary limitation of protein restriction in patients with liver disease?
What is the primary difference between commercial IVFE available in the US and structured lipid products available in Europe?
What is the primary difference between commercial IVFE available in the US and structured lipid products available in Europe?
What is the primary reason for restricting potassium, phosphate, or magnesium in patients with renal disease?
What is the primary reason for restricting potassium, phosphate, or magnesium in patients with renal disease?
What is the recommended approach to maintain acid-base balance in PN formulation?
What is the recommended approach to maintain acid-base balance in PN formulation?
Why is it necessary to state the specific amino acid product name used in compounding on the PN label?
Why is it necessary to state the specific amino acid product name used in compounding on the PN label?
What is the recommended daily dose of vitamin K in parenteral vitamin preparations for adults?
What is the recommended daily dose of vitamin K in parenteral vitamin preparations for adults?
Why should patients who are to receive the anticoagulant warfarin be monitored more closely when receiving vitamin K?
Why should patients who are to receive the anticoagulant warfarin be monitored more closely when receiving vitamin K?
What is the recommended supplementation of thiamin in PN patients who have a history of alcohol abuse?
What is the recommended supplementation of thiamin in PN patients who have a history of alcohol abuse?
What was the consequence of the parenteral vitamin shortages in the 1990s in the US?
What was the consequence of the parenteral vitamin shortages in the 1990s in the US?
What is the purpose of using commercially available amino acid injection products in PN formulation?
What is the purpose of using commercially available amino acid injection products in PN formulation?
Why is it not recommended to list the electrolyte components of the amino acid solution on the PN label?
Why is it not recommended to list the electrolyte components of the amino acid solution on the PN label?
What is the recommended daily dose of ascorbic acid (vitamin C) in parenteral vitamin preparations for adults?
What is the recommended daily dose of ascorbic acid (vitamin C) in parenteral vitamin preparations for adults?
What is the recommended approach to providing vitamins during a parenteral vitamin shortage?
What is the recommended approach to providing vitamins during a parenteral vitamin shortage?
What is the primary concern when providing long-term PN therapy?
What is the primary concern when providing long-term PN therapy?
What is the recommended approach to providing iron supplementation during PN therapy?
What is the recommended approach to providing iron supplementation during PN therapy?
What is the recommended maintenance iron dose for patients receiving PN therapy?
What is the recommended maintenance iron dose for patients receiving PN therapy?
Why should iron dextran not be added to TNA?
Why should iron dextran not be added to TNA?
What is the recommended approach to providing trace elements during PN therapy?
What is the recommended approach to providing trace elements during PN therapy?
What is the primary concern when providing PN therapy to pediatric patients?
What is the primary concern when providing PN therapy to pediatric patients?
What is the primary goal of monitoring serum ferritin concentrations during PN therapy?
What is the primary goal of monitoring serum ferritin concentrations during PN therapy?
What is the primary concern when adding iron sucrose or sodium ferric gluconate to PN formulations?
What is the primary concern when adding iron sucrose or sodium ferric gluconate to PN formulations?
What is the primary advantage of using individualized trace element preparations during PN therapy?
What is the primary advantage of using individualized trace element preparations during PN therapy?
What is the recommended dose of L-cysteine hydrochloride per gram of amino acids in neonatal/infant amino acid formulations?
What is the recommended dose of L-cysteine hydrochloride per gram of amino acids in neonatal/infant amino acid formulations?
What percentage of nonprotein calories from fat is typically derived in the enteral diet of neonates or infants?
What percentage of nonprotein calories from fat is typically derived in the enteral diet of neonates or infants?
What is the recommended limit for IVFE administration in small for gestational age neonates and preterm neonates less than 32 weeks gestational age?
What is the recommended limit for IVFE administration in small for gestational age neonates and preterm neonates less than 32 weeks gestational age?
How early can neonates develop biochemical signs of EFAD after fat-free PN?
How early can neonates develop biochemical signs of EFAD after fat-free PN?
What is the primary difference in calcium and phosphorus requirements between neonates and infants compared to older children and adults?
What is the primary difference in calcium and phosphorus requirements between neonates and infants compared to older children and adults?
What is the recommended age for using adult multivitamins in pediatric PN formulations?
What is the recommended age for using adult multivitamins in pediatric PN formulations?
What is the concern with the long-term use of multiple trace element products at recommended doses?
What is the concern with the long-term use of multiple trace element products at recommended doses?
What is the primary advantage of using 20% IVFE compared to 10% product in neonates and infants?
What is the primary advantage of using 20% IVFE compared to 10% product in neonates and infants?
What is the primary reason for the difference in time in which EFAD syndrome may occur in neonates and infants compared to adults?
What is the primary reason for the difference in time in which EFAD syndrome may occur in neonates and infants compared to adults?
What is the recommended weight for using adult electrolyte dosage guidelines in pediatric PN formulations?
What is the recommended weight for using adult electrolyte dosage guidelines in pediatric PN formulations?
What is the primary responsibility of a pharmacist when reviewing a PN prescription?
What is the primary responsibility of a pharmacist when reviewing a PN prescription?
What is essential to assess when reviewing a PN prescription?
What is essential to assess when reviewing a PN prescription?
What is defined as the presence of the proper proportion of calories, protein, fluid, electrolytes, vitamins, and trace elements?
What is defined as the presence of the proper proportion of calories, protein, fluid, electrolytes, vitamins, and trace elements?
What should be optimized and validated as a safe and efficacious method when compounding PN?
What should be optimized and validated as a safe and efficacious method when compounding PN?
What should be reviewed with the manufacturer when using automated compounding devices?
What should be reviewed with the manufacturer when using automated compounding devices?
What type of analysis can be readily applied in the pharmacy practice setting to assess the accuracy of PN compounding?
What type of analysis can be readily applied in the pharmacy practice setting to assess the accuracy of PN compounding?
What is an alternative method to assess the final concentration of PN additives?
What is an alternative method to assess the final concentration of PN additives?
Why is in-process or end-product testing of PN formulations recommended?
Why is in-process or end-product testing of PN formulations recommended?
What should be visually inspected for signs of gross particulate contamination, particulate formation, and/or phase separation?
What should be visually inspected for signs of gross particulate contamination, particulate formation, and/or phase separation?
What is the primary goal of quality assurance in PN compounding?
What is the primary goal of quality assurance in PN compounding?
What is the recommended daily fluid requirement for a pediatric patient weighing 1500g?
What is the recommended daily fluid requirement for a pediatric patient weighing 1500g?
What is the daily protein requirement for a preterm neonate?
What is the daily protein requirement for a preterm neonate?
What is the recommended daily energy requirement for a pediatric patient aged 1-7 years?
What is the recommended daily energy requirement for a pediatric patient aged 1-7 years?
What is the primary concern when using parenteral iron preparations in pediatric patients?
What is the primary concern when using parenteral iron preparations in pediatric patients?
Why is it important to monitor patients receiving PN therapy for iron deficiency?
Why is it important to monitor patients receiving PN therapy for iron deficiency?
What is the primary goal of screening the PN order?
What is the primary goal of screening the PN order?
What is the consequence of omitting parenteral vitamins from PN formulations?
What is the consequence of omitting parenteral vitamins from PN formulations?
Why is it important to choose PN components with the lowest aluminum content?
Why is it important to choose PN components with the lowest aluminum content?
What is the primary concern when using individual trace element products in PN therapy?
What is the primary concern when using individual trace element products in PN therapy?
What is the recommended frequency of administering a parenteral vitamin preparation to patients receiving PN therapy?
What is the recommended frequency of administering a parenteral vitamin preparation to patients receiving PN therapy?
Study Notes
Causes and Effects of Erectile Dysfunction (ED)
- Organic factors like vascular disease and diabetes can lead to ED, causing patients to lose confidence in their ability to achieve an erection.
- Psychological problems associated with ED include depressive symptoms, with overt depression often seen in older patients.
Interpersonal Effects on Male Sexual Function
- Interpersonal effects on male sexual function include sexual problems with a partner, perceived lack of support from the partner, sexual abuse in childhood, and problems with sexual orientation.
Study Findings and Tools
- The International Index of Erectile Function (IIEF) was used to obtain findings across six countries, marking the first in-depth qualitative work on ED in diverse Asian populations.
- The AED tool features a qualitative component with structured open-ended questions, allowing patients to express how ED affects them in their own words.
Treatment and Management of ED
- Education and counseling are important clinical strategies towards improving self-management of ED.
- Effective clinical practice must consider factors in the wider environment, including life stresses and psychosocial losses.
- Oral drug therapy is a treatment option that could significantly improve a patient's quality of life.
- Penile prosthesis is known as a highly effective means of erectile re-establishment.
- Injection therapy has been shown to be effective in treating various forms of erectile dysfunction, with success rates between 35 and 75%.
- Vacuum Suction Devices (VSD) are a mechanical way of producing an erection for men who do not want or cannot use drug treatments.
Prevalence and Drug Non-Responsiveness
- The prevalence of drug non-responsive ED is unknown, but a survey found that 7% of men reported ED onset while using medications for hypertension.
- Up to 2000 patients underwent procedures for penile prosthesis implantation between July 1993 and November 2009.
Parenteral Nutrition (PN)
- PN has become a crucial therapy in various disease states over the past four decades
- PN formulations benefit patients with significant disruption in gastrointestinal function and are a lifeline for those with permanent loss of the GI tract
Importance of Proper Preparation and Administration
- Improperly prepared and administered PN formulations have resulted in serious harm and death
- Early PN programs focused on minimizing complications, and an interdisciplinary approach was found to improve efficacy, reduce complications, and facilitate efficient, cost-effective PN therapy
Errors in PN Preparations
- Two deaths occurred due to errors in PN compounding, leading to a FDA Safety Alert
- Errors led to infusion of incorrect formulas, leading to patient deaths and harm
- Errors were related to pharmacy practices, misinterpretation of labels, and improper preparation of PN formulations
Ordering PN
- Life-threatening errors continue to occur in the preparation and delivery of PN admixtures to patients
- Errors are related to the ordering process, including lack of uniformity, incorrect units of measure, and errors of omission
- Standardized PN order forms can reduce prescribing errors by 9% to 82%
Benefits of Standardized PN Order Forms
- Provide more precise guidelines for PN prescribing
- Educate physicians on PN therapy
- Reduce prescribing errors
- Improve efficiency and productivity of nutrition support
- Allow comprehensive nursing and dietary care of the patient
- Reduce pharmacy inventory and costs
Common Factors Associated with PN Prescribing Errors
- Inadequate knowledge regarding PN therapy
- Certain patient characteristics related to PN therapy
- Calculation of PN dosages
- Specialized PN dosage formulation characteristics and prescribing nomenclature
Principles for Creating a PN Order Form
- Mandatory components: data to be collected on the form, information to be communicated to the clinician, and contact information
- Strongly recommended components: basic PN education tools, example calculations, guidelines for ordering laboratory tests, and guidelines for stopping or tapering PN
- Worthy of consideration components: additional guidelines for nutrient restriction, specialty amino acids, and long-term PN administration
Labeling PN Formulations
- Lack of standardization in labeling PN ingredients causes confusion
- Standardized labels are essential for patient safety and to avoid misinterpretation
- Labels should express clearly and accurately what the patient is receiving
- Methods of labeling: percent of original concentration, percent of final concentration, grams per liter, and grams per total volume### PN Label Requirements
- The PN label should express components as amount/kg/day, in addition to amount/day, for neonatal and pediatric patients.
- The label may include an additional column expressing components as amount/liter or amount/100 ml in parenthesis.
- The label should specify the route of administration, administration date and time, and beyond-use date and time.
- The dosing weight should be provided so that anyone evaluating the contents of the label may determine if the doses of nutrients are appropriate.
- The inorganic phosphorus content should be provided as both the mmol quantity of phosphorus and the mEq quantity of the additive salt's cation (potassium or sodium).
- If the PN formulation includes overfill, it should be clearly stated on the label.
- Rate should be expressed in mL/hour over 24 hours, and if the PN formulation is cycled, the infusion duration and rates should be expressed on the label.
Auxillary Labels
- Auxillary labels may be used to list individual electrolytes as mEq and phosphorus content as mmol provided per day.
- The auxillary label could also express the total calories provided per day, as well as the percent of total calories provided by carbohydrate and fat.
Practice Guidelines
- The labels for PN formulations should be standardized and include the amount per day as the only column required on the label for the base formula, electrolyte additives, micronutrients, and medications.
- Auxillary labels or information may be used.
- Patient transfer between healthcare environments requires pharmacist-to-pharmacist communication and documentation to ensure the accurate transfer of the PN prescription.
- The PN label should be compared with the PN order and for beyond-use date before administration.
Nutrient Requirements
Adults
- Protein requirements:
- Maintenance: 0.8-1 g/kg
- Catabolic patients: 1.2-2 g/kg
- Chronic renal failure (renal replacement therapy): 1.2-1.5 g/kg
- Acute renal failure + catabolic: 1.5-1.8 g/kg
- Energy requirements: 20-30 kcal/kg
- Fluid requirements: 30-40 mL/kg
- Fat content of the PN formulation should not exceed 2.5 g/kg/day and carbohydrate content should not exceed 7 g/kg/day.
- Essential fatty acid deficiency (EFAD) may occur if fat content is less than 2% to 4% of total caloric intake as linoleic acid and 0.25% to 0.5% of total caloric intake as alpha linolenic acid.
Pediatrics
- Standard nutrient ranges for infants and children receiving PN have been established.
- Requirements for fluids, protein, and energy are substantially higher on a unit-of-weight basis for children than for adults.
- Careful monitoring of growth is necessary to assess adequacy of nutrient provision.
- Above 18 years of age, estimated nutritional requirements should be established using nutrient ranges suggested for the adult population.
- Protein restriction in certain disease states such as hepatic and renal failure should be done with caution and in consideration of the need for adequate protein to support growth in the pediatric population.
Electrolytes, Vitamins, and Trace Elements
- Standard ranges for electrolytes, vitamins, and trace elements for infants and children with normal organ function are provided.
- Calcium and phosphorous requirements of the neonate and infant are substantially different from those of the older child and adult.
- Guidelines for vitamin and trace element additions to PN solutions for pediatric patients up to age 11 have been published.### Pediatric Parenteral Nutrition
- Long-term use of multiple trace element products at recommended doses can lead to excessive serum concentrations of chromium.
- The ratio of trace elements in commercially available pediatric multiple trace element products can result in excessive intake of manganese if recommended doses of zinc are given.
Iron Needs in Pediatric Patients
- Iron needs in pediatric patients can be dramatically lower compared to adults.
- Vigilance is necessary regarding iron doses administered to pediatric patients.
Fluid Requirements for Pediatric Patients
- Daily fluid requirements for pediatric patients vary based on body weight:
- 1500 g: 130-150 mL/kg
- 1500-2000 g: 110-130 mL/kg
- 2-10 kg: 100 mL/kg
- 10-20 kg: 1000 mL for 10 kg + 50 mL/kg for each kg > 10
- 20 kg: 1500 mL for 20 kg + 20 mL/kg for each kg > 20
Protein Requirements for Pediatric Patients
- Daily protein requirements for pediatric patients vary based on age and weight:
- Preterm neonates: 3-4 g/kg
- Infants (1-12 months): 2-3 g/kg
- Children (10 kg or 1-10 years): 1-2 g/kg
- Adolescents (11-17 years): 0.8-1.5 g/kg
Energy Requirements for Pediatric Patients
- Daily energy requirements for pediatric patients vary based on age:
- Preterm neonate: 90-120 kcal/kg
- 6 months: 85-105 kcal/kg
- 6-12 months: 80-100 kcal/kg
- 1-7 years: 75-90 kcal/kg
- 7-12 years: 50-75 kcal/kg
- 12-18 years: 30-50 kcal/kg
Practice Guidelines
- Determine protein, calorie, fluid, electrolyte, vitamin, and trace element components of a PN formulation based on standard nutrient requirements.
- Provide IVFE in a dose sufficient to prevent EFAD in adults and pediatric patients who are NPO.
- Provide a parenteral vitamin preparation on a daily basis to all patients receiving PN.
- Choose PN components with the lowest aluminum content when possible.
- Use individual trace element products when necessary to prevent toxicity or deficiency states.
- Limit parenteral iron supplementation to conditions of iron deficiency when oral iron supplementation fails.
Sterile Compounding of Parenteral Nutrition Formulations
- Review each PN prescription for appropriateness of dose and adequacy of nutrient composition.
- Assess each PN component for appropriateness of dose and potential compatibility or stability problems.
- Question and clarify any dose of a nutrient outside a normal range not explained by a specific patient condition or history.
PN Compounding Practice Guidelines
- Optimize and validate the additive sequence in compounding as a safe and efficacious method.
- Review the compounding method if it has not been recently reviewed or if the contract with a manufacturer is about to change.
- Ensure the safety and support of the automated compounding device and avoid splitting PN contracts unless combinations have adequate physicochemical data.
Quality Assurance of the Compounding Process
- Perform gravimetric analyses to assess the accuracy of individual additives delivered or the final contents of the PN.
- Incorporate chemical analyses to directly measure the final content of individual additives.
- Use refractometric analysis as an alternative or indirect measure of final additive concentration.
- Perform in-process or end-product testing of PN formulations daily to assure a safe final formulation is dispensed to the patient.
- Adhere to the USP (797) Pharmaceutical Compounding-Sterile Preparations Chapter and the ASHP Guideline on Quality Assurance for Pharmacy-Prepared Sterile Products.
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Learn about coeliac disease, an autoimmune condition that causes chronic inflammation in the small intestine due to gluten proteins. Discover the importance of a strict, lifelong, gluten-free diet as the primary treatment to manage symptoms and reduce complications.
