Re: GT meds when pt eats PO
When compliance is an issue, the meds might be given via GT to ensure the patient gets them. We will often give kids meds via NG or NJ even though they're feeding orally because we know they'll refuse them or spit them out because they taste bad, or just because we know we won't get them to swallow them. I work with kids who have heart conditions and kids who have had transplants; they take lots of vital meds for long periods of time and we can't horse around with cajoling, pleading, threatening and trickery. The tube is often literally a life-saver! Kids have told me that when they get their meds via tube, they sometimes feel nauseated or they gag, or they have stomach upset... if the meds are given too fast! This is especially the case when we use an NJ for meds, but what they feel then is cramping, because the jejunum isn't meant for rapid instillation of anything. When they get the meds (and the flush too) trickled in and are distracted a little while the meds are going in, they don't seem to have these issues. As for mixing them all together, there are few oral meds that have physical interactions, unlike the huge number of parenteral meds that precipitate or neutralize others. And of course, if you're giving 10 meds one after the other by the same route, they are all going to mix anyway.
Valproic acid is an anticonvulsant that is used for seizure disorders unresponsive to more commonly prescribed drugs. Changing from it to something else takes quite some time, so although this patient has pancreatitis, perhaps the physician chose to continue with it because the risks with making a switch were higher than those of continuing.
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