Question about Medications and NG Tubes

MomRN0913 · Feb 9, 2012

I think your professor made a mistake.

KelRN215, BSN, RN · Feb 9, 2012

I had a pharmacology exam last week and I am puzzled by the answer to one of the questions. The question was...
Which of the following medications would not be administered through a nasogastric tube?
A. liquid antibiotics
B. enteric coated tablets
C. finely crushed tablets
D. liquid stool softener
At the exam review session, the majority of us marked the answer as "enteric coated tablets," yet our professor (who wasn't present) said that the correct answer is "finely crushed tablets." Can someone please explain to me why this is the answer? I want to be able to understand the rationale, which the TA was unable to provide. We can contest the answer if we have reliable resources to back it up. I recall reading that you CANNOT crush enteric coated tablets and I don't believe that it is possible to deliver a whole pill through an NG tube. I thought that if it was indicated that it was safe to crush a medication, it can be dissolved in water and then delivered through the NG tube followed by the tube being flushed.
Thanks a bunch,
A First-Year Nursing Student

In response to your question, it is not the answer. You and your classmates are correct. Enteric coated tablets are not supposed to be crushed and you cannot administer a pill via NG tube unless it is crushed. (That said, I work in an environment where we crush enteric coated tablets and give them via enteral tubes on a daily basis. Doctors get excited when a new anti-epileptic is released and sometimes the brand name version only comes as an enteric coated tablet and there is no other way to give it to a G-tube dependent patient other than to crush it and administer via G-tube.) Why wouldn't you be able to administer "finely crushed tablets" via NG? You crush it, you mix it with water and you put it down the tube. The answer your professor gave is incorrect.

loriangel14, RN · Feb 9, 2012

Finely crushed tablets would clog the tube.Finely crushed and then dissolved in warm water would work.You could deliver enteric coated tabs that were crushed and dissolved,it's just not recommended.But it is possible.You have to read questions carefully.

ckh23, BSN, RN · Feb 10, 2012

How else could you administer finely crushed tablets unless they were mixed in water? I could also deliver SR tablets by crushing them, but it doesn't make it the right answer. The tablets are coated for a reason.

My vote goes to the enteric coated tablets.

dudette10, MSN, RN · Feb 10, 2012

Finely crushed tablets would clog the tube.Finely crushed and then dissolved in warm water would work.You could deliver enteric coated tabs that were crushed and dissolved,it's just not recommended.But it is possible.You have to read questions carefully.

Your rationale for not choosing "finely crushed tablets," i.e. we cannot infer that the tablets are then dissolved in water, can also apply to the "enteric coated tablet" answer, i.e. we cannot infer that we are crushing the enteric-coated ones then dissolving them in water.

I also think the instructor was wrong.

nurseprnRN, BSN, RN · Feb 10, 2012

"enteric-coated" means that they are made such that they will not dissolve until after they leave the stomach; they aren't supposed to dissolve until they get out of the stomach. therefore if they were going down a gtube, crushing them first is a no-no. the question did specify "nasogastric tube," right?

your professor may have been thinking of tablets that were merely crushed and then put down the tube dry (don't laugh, i've seen it done, and it ain't pretty). that is obviously not something we would do.

so i would have the department do the item analysis on this, and i'd bet the stats would come up that it had a very low p value, and therefore should be reworded for the next exam. badly-worded question. give her my regrets.

classicdame, MSN, EdD · Feb 10, 2012

get the instructor to give you a rationale so this can be a learning experience for all. The REAL lesson is to check with pharmacy or a drug reference before administration if you are not famililar with the medication. Just because if CAN be crushed does not mean it SHOULD be crushed.

mercurysmom · Feb 10, 2012

i had a pharmacology exam last week and i am puzzled by the answer to one of the questions. the question was...
which of the following medications would not be administered through a nasogastric tube?
a. liquid antibiotics
b. enteric coated tablets
c. finely crushed tablets
d. liquid stool softener
at the exam review session, the majority of us marked the answer as "enteric coated tablets," yet our professor (who wasn't present) said that the correct answer is "finely crushed tablets." can someone please explain to me why this is the answer? i want to be able to understand the rationale, which the ta was unable to provide. we can contest the answer if we have reliable resources to back it up. i recall reading that you cannot crush enteric coated tablets and i don't believe that it is possible to deliver a whole pill through an ng tube. i thought that if it was indicated that it was safe to crush a medication, it can be dissolved in water and then delivered through the ng tube followed by the tube being flushed.
thanks a bunch,
a first-year nursing student

this is from the american society for parenteral and enteral nutrition (aspen) http://www.nutritioncare.org//professional_resources/guidelines_and_standards/guidelines/2009_enpr_-_section_vii_medication_administration/

"some tablets are very small, very hard, or film-coated, making them difficult to crush. enteric- and film-coatings do not crush well and tend to aggregate in clumps when diluted in water, thereby increasing the risk of clogging. modified-release dosage forms should not be crushed for administration via feeding tubes^5,29; this runs the risk of destroying the protective coating on a drug making it much less effective, or it may result in an excessive dose of the drug being released at one time, as occurred in a recent case fatality.19 instead, a more appropriate dosage form or therapeutic equivalent should be considered. interfering with the integrity of intact liquid-filled gel capsules poses another level of complexity as it is difficult to assure accurate doses, so these are also best avoided in enterally fed patients. injectable dosage forms are generally not considered appropriate for administration through a feeding tube because they are designed for a physiologic site with different characteristics. except for tablets that disperse easily when placed in an oral syringe with water, contents of an appropriate tablet or capsule should be crushed/pulverized to a fine powder before being dispersed, dissolved, or suspended in an appropriate volume of sterile water.²⁸ "

in order to use the link, you need to create an account (free.) aspen is a great resource for clinicians. the oley foundation (www.oley.org) is a great resource for patients and families as well. good luck! :nurse:

mm