Do I give the med or hold?

Nurses Medications

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I work in LTC, my resident is given gabapentin (time release capsule) along with a lot of other tablets. This resident chews all meds and will not listen that gabapentin states "swallow whole, do not chew, or crush". I see all the other nurses give this med and not worry about this.

Specializes in retired LTC.

Brandon - without an explicit MD order or documented note, I'd still hesitate to admin a med NOT as recommended. I mean a maybe/ MIGHT, but I'd have to be real sure about it to proceed. I HAVE done so in the past.

By the way, what were those meds you admin rectally???

Do not worry what others are doing you know better....do what is right for your pt and let MD of pt condition a.s.a.p....Hold the med because the pt can not swallow.

Brandon - without an explicit MD order or documented note, I'd still hesitate to admin a med NOT as recommended. I mean a maybe/ MIGHT, but I'd have to be real sure about it to proceed. I HAVE done so in the past. By the way, what were those meds you admin rectally???
I've given pain narcotics rectally to hospice pts. Very rare. They didn't want the pt to have anything PO or SL. Not even roxanol.
Do not worry what others are doing you know better....do what is right for your pt and let MD of pt condition a.s.a.p....Hold the med because the pt can not swallow.

I don't think the OP said the pt

can't swallow. He just chews on his meds, thus breaking down the enteric coating (or whatever) before it has a chance to dissolve in the GI tract. Not ideal, but not a choking hazard or anything. The best solution would be to find a non time release version of the med. But there's a thousand reasons why this may not be feasible. Maybe that version isn't available. Maybe the resident has been taking his pills like this for so long that the chewed neurontin IS the patient's baseline therapeutic dose that controls his neuropathy pain. To mess with this at this point would be pointless. If it ain't broke don't fix it.

And don't be so quick to assume the other nurses are sloppy or lax. I'm sure everyone (including the doc) is aware of what's going on and have deemed it to pose no threat to the pt. If he's been chewing on his pills forever and still getting the therapeutic effect safely, where's the harm? We don't wake people up at the crack of dawn to give them a synthroid or a prilosec because it's just not necessary. Our residents are still getting the full therapeutic effect. Be careful not to become blind slaves to some drug handbook. Look at the RESULTS.

Brandon lpn this med come in other forms..........this med right now is being given in the enteric coated form is suppose to dissolve in the intestines.......I do not think other nurses are being sloppy or lax ..... just stating because other people do something does not make it right........"Be careful not to become blind slaves to some drug handbook. Look at the RESULTS". what do you document what you actually did or what you want....be careful this is someone's life.

Specializes in Hospice / Psych / RNAC.

Gabapentin absorption: effect of mixing wit... [Ann Pharmacother. 1998] - PubMed - NCBI

Anyone whose taken prob/stats knows you can find stats for whatever you want to prove. I always ask people what is the harm of opening the extended release capsule and putting it in applesauce (or whatever) as opposed to having it swallowed whole.

When the capsule gets to the stomach it opens up anyway. As long as they don't chew it and just swallow it's the same thing IMO (it's the tiny beads that are time released not the capsule itself). You just need to figure out what is the best nutrient vehicle to serve the med with.

Specializes in ortho, hospice volunteer, psych,.

I take Neurontin as an anticonvulsant. I use a combination of 100 mg. and 300 mg.

capsules. Except for color and size (100's are white and smaller, while the 300's are

tannish-gold and larger) they look pretty much the same.

The 100's are harder to swallow despite being smaller, taste bitter, stick to the back

of my tongue, and frequently begin to dissolve. Blecck!

,.

The 300's just slide right down and have virtually no taste. I think if I had to chew either

one, I'd refuse it.

That med does come in other forms and I would check with his MD, because I have two

friends who did open the timed-release Neurontins, despite the warnings not to, and they

both have ulcers because of it now.

Are you discouraged from calling up the Pharmacist that handles your medication orders and asking him what would be the best solution to this problem and then recommending the solution to the doctor? Your Pharmacist is one of your best resources when it comes to medications and administration.

I also agree that if the resident has been taking this medication this way for some time, it might not be worth the risk to mess with the administration, as the medication is going to be at a baseline therapeutic level for him. Why would you hold a medication that he has been taking for a while without any apparent problem so far, just because he isn't doing it the way he is supposed to?

Specializes in pediatrics, orthopedics.

Gabapentin does come in a liquid suspension, I would try that!

Gabapentin absorption: effect of mixing wit... [Ann Pharmacother. 1998] - PubMed - NCBI

[h=4]CONCLUSIONS:[/h]Opening and mixing the contents of gabapentin capsules does not significantly impair drug absorption. This may be a viable administration option for patients who are unable to swallow intact capsules. Dietary macronutrient composition (i.e., protein) may favorably influence gabapentin oral absorption.:up:

If you still feel uneasy about mixing it in applesauce, explain the situation to the doc and suggest that he change it to a liquid form.

consult with pharmacy and doc

this resident is chewing it, today I mixed it into applesauce and it went down without chewing

I do plan to consult the doc on monday

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