Crushing K-Dur

Home Health Columnist / Guide · Jun 23, 2006

in final few days, many drugs given po are given per rectum to maintain drug levels, control symptoms if patient unable to swallow. if patient had hypokalemia with muscle cramping as hx if k+ not taken or dose too low, then med would be continued to prevent muscle cramps. diuretics continued if patient with chf to minimize rales/third shift spacing.

knowing the reason behind need for med important in final days; want to usually give only the necessary meds to prevent worsening symptoms/pain control etc. if k+ and diuretics being used for hx of kidney stones, then they are often discontinued. no need for kayexelate enema if cheyne stokes respiration, etc....

all meds would be previewed with attending doctor during team conference or phone call then orders are written to d/c unnecessary ones and any route change.

some hospice place a med kit in refrig that contain few doses of meds in rectal form to be used if patient unable to swallow/unconscious while others do not.

i've admitted patients to hospice at 10 am only to be called at 9 pm they can't swallow and slow respirations. no time to have pharmacy prepare pain meds in another form so med given rectally.

helpful info:

symptomcontrol.info: the practical steps

symptomcontrol.info: the rectal route

equianalgesic dosing

jebrn2 · Jun 23, 2006

The k-dur that we have turns into a dust, well the 20 meq kdur we have turns into a powder, the 10 meq k-dur turns has the little microballs in it.

So I'm guessin that it depends on the drug company by which it is made.

BUt i have also given liquid K before.

chelsea_j · Jun 23, 2006

why not call the pharmacy and get it changed to liquid! DUH!!!!!!

jebrn2 · Jun 23, 2006

It isn't always available.

PCUSheryl · Jun 23, 2006

After reading these posts, I'm feeling a little worried, because I have been crushing KDur for one of my patients recently who is on aspiration precautions, can swallow smaller pills, but cannot swallow the KDur, even broken in half. The form we have for 20meq is a large white oval shaped pill, scored down the middle, easily broken, very easily crushed. When I crush it, I cannot see any "microcapsules" - the pill seems to crushe completely, I mix it with applesauce. I have never been told not to crush this particular pill. We never see the package inserts for most of the meds we dispense. If there is uncertainty, we look it up in our nurse drug guides or call pharmacy.

Does this pill I've been crushing sound like the same ones you all are saying should not be crushed? We also give a 10meq that is a capsule with obvious microcapsules, this med is well known as extended release. I am so concerned about this patient now, he's been doing this for awhile now. I am not the only nurse administering it this way, all of his nurses do it. Could we all be so ignorant? I was never taught not to crush "potassium" in nursing school. I was taught not to crush enteric coated or extended release pills. I didn't know that this form of potassium was extended release, because it doesn't have a coating or in a capsule.

In response to the previous poster who wrote "how do these idiots make it through nursing school?": I thought this was a forum for open discussion and support, not a place to be ridiculed. And I'm glad that you're so perfect, you've never made a mistake.

UM Review RN, ASN, RN · Jun 23, 2006

After reading these posts, I'm feeling a little worried, because I have been crushing KDur for one of my patients recently who is on aspiration precautions, can swallow smaller pills, but cannot swallow the KDur, even broken in half. The form we have for 20meq is a large white oval shaped pill, scored down the middle, easily broken, very easily crushed. When I crush it, I cannot see any "microcapsules" - the pill seems to crushe completely, I mix it with applesauce. I have never been told not to crush this particular pill. We never see the package inserts for most of the meds we dispense. If there is uncertainty, we look it up in our nurse drug guides or call pharmacy.
Does this pill I've been crushing sound like the same ones you all are saying should not be crushed? We also give a 10meq that is a capsule with obvious microcapsules, this med is well known as extended release. I am so concerned about this patient now, he's been doing this for awhile now. I am not the only nurse administering it this way, all of his nurses do it. Could we all be so ignorant? I was never taught not to crush "potassium" in nursing school. I was taught not to crush enteric coated or extended release pills. I didn't know that this form of potassium was extended release, because it doesn't have a coating or in a capsule.
In response to the previous poster who wrote "how do these idiots make it through nursing school?": I thought this was a forum for open discussion and support, not a place to be ridiculed. And I'm glad that you're so perfect, you've never made a mistake.

Get the liquid form, mix it in a little orange juice, thicken the mixture with thickener, and spoon it to the patient.

Hope that helps. I have no idea why the liquid form doesn't cause the same GI upset. Anyone care to enlighten me?

Beary-nice · Jun 23, 2006

in final few days, many drugs given po are given per rectum to maintain drug levels, control symptoms if patient unable to swallow. if patient had hypokalemia with muscle cramping as hx if k+ not taken or dose too low, then med would be continued to prevent muscle cramps. diuretics continued if patient with chf to minimize rales/third shift spacing.
knowing the reason behind need for med important in final days; want to usually give only the necessary meds to prevent worsening symptoms/pain control etc. if k+ and diuretics being used for hx of kidney stones, then they are often discontinued. no need for kayexelate enema if cheyne stokes respiration, etc....
all meds would be previewed with attending doctor during team conference or phone call then orders are written to d/c unnecessary ones and any route change.
some hospice place a med kit in refrig that contain few doses of meds in rectal form to be used if patient unable to swallow/unconscious while others do not.
i've admitted patients to hospice at 10 am only to be called at 9 pm they can't swallow and slow respirations. no time to have pharmacy prepare pain meds in another form so med given rectally.
helpful info:
symptomcontrol.info: the practical steps
symptomcontrol.info: the rectal route
equianalgesic dosing

thank you nurse karen...this is what i was wanting to know and i was hoping you would come along!

PumpkinButt · Jun 23, 2006

*thud*

Beary-nice · Jun 23, 2006

I have no idea why the liquid form doesn't cause the same GI upset. Anyone care to enlighten me?

I think it can cause the same GI issues...but by diluting it...which you should...this can lessen the chances of that happening. A pt should never drink that stuff straight-up and I dilute it before putting it down a tube as well.

Beary-nice · Jun 23, 2006

After reading these posts, I'm feeling a little worried, because I have been crushing KDur for one of my patients recently who is on aspiration precautions, can swallow smaller pills, but cannot swallow the KDur, even broken in half. The form we have for 20meq is a large white oval shaped pill, scored down the middle, easily broken, very easily crushed. When I crush it, I cannot see any "microcapsules" - the pill seems to crushe completely, I mix it with applesauce. I have never been told not to crush this particular pill. We never see the package inserts for most of the meds we dispense. If there is uncertainty, we look it up in our nurse drug guides or call pharmacy.
Does this pill I've been crushing sound like the same ones you all are saying should not be crushed? We also give a 10meq that is a capsule with obvious microcapsules, this med is well known as extended release. I am so concerned about this patient now, he's been doing this for awhile now. I am not the only nurse administering it this way, all of his nurses do it. Could we all be so ignorant? I was never taught not to crush "potassium" in nursing school. I was taught not to crush enteric coated or extended release pills. I didn't know that this form of potassium was extended release, because it doesn't have a coating or in a capsule.
In response to the previous poster who wrote "how do these idiots make it through nursing school?": I thought this was a forum for open discussion and support, not a place to be ridiculed. And I'm glad that you're so perfect, you've never made a mistake.

The K-Dur is an extended release tablet though it doesn't appear that way like say the Micro K capsule does. K-Dur does have a coating though it isn't a very pronounced one. It does crush easily but then when you do that, you have altered it's release system. I never remember being taught in nursing school what meds to crush or not crush other than the ones that were obviously capsules or obviously enteric coated. We are in the same boat there. I have had numerous pharmacists and pharm MD's tell me not to crush the K-Dur...so that is what I stick by. I can tell you want to do what is right for your pts and you have my support. We all make mistakes...that is how I have learned allbeit the hard way sometimes.

Home Health Columnist / Guide · Jun 23, 2006

I think it can cause the same GI issues...but by diluting it...which you should...this can lessen the chances of that happening. A pt should never drink that stuff straight-up and I dilute it before putting it down a tube as well.

:yeahthat:

In the good old days of only liquid potassium, many patients died or repeatedly hospitalized cause the liquid is so nasty, needed to be mixed in beverage, usually OJ. My FIl & I learned lesson needing to take entire mixed med and OJ the hard way: he passed out 30 seconds after we said "I DO" at our wedding in '75. K+ was below 3.0 ...he was hospitalized entire honeymoon week.

He had been dumping last bit of beverage in glass down the drain week prior. Also had an ulcer form liquid stuff... Not many hospitalized pts get visit from bride and groom on the Wedding Day. Should have realized from that start my life would be a rollar coaster adventure!

ShemRN · Jun 27, 2006

I was told by another nurse to break the "bind" of the drug by soaking it in cola for a bit. It disolves the binding agent of the sustained release particles, but doesn't release them --- is the gist of it.