ASPEN ch 15 - PN formulation

Question 1

less frequently used CHO energy substrate is ___ that provides __kcal/g

Answer 1

glycerol; 4.3

Question 2

modified a.a. formulation designed for use in _____ contains increased amts ___ and decreased amts ____

Answer 2

hepatic encephalopathy; BCAAs; AAA

Question 3

why BCAA thought be beneficial for severe stress?

Answer 3

^ skel muscle catabolism

Question 4

__ content higher in more concentrated products but ____ may be used to balance ratio and avoid acid base probs

Answer 4

acetate; chloride salts

Question 5

why less use of 10% lipid now?

Answer 5

higher phospholipid:triglyceride ratio compared to 20%, so ^ presence free phospholipids which interfere with lipoprotein lipase activity (v lipid clearance)

Question 6

what does SMOF stand for?

Answer 6

soybean, medium chain RG, olive oil, fish oil

Question 7

SMOFlipid good for these pt:

Answer 7

don’t tolerate soy well, if have carnitine deficiency (MCT is carnitine independent)

Question 8

causes of PNALD?

Answer 8

omega 6s pro-inflam, IV admin phytosterols, ox stress

Question 9

ILE infusion rate should NOT exceed ___g/kg/h

Answer 9

0.11

Question 10

why not higher ILE infusion rate?

Answer 10

hypertriglyceridemia, infectious complication, fat overload syndrome

Question 11

fat overload syndrome characterized by:

Answer 11

headaches, seizures, fever, jaundice, hepatosplenomegaly, ab pain , resp distress, pancytopenia, shock

Question 12

in critically ill, limit ILE to ___ g/kg/d

Answer 12

1

Question 13

advantages of olive oil based ILE?

Answer 13

decreased peroxidation, lack of lymphocyte function inhibition, preserve hepatic function

Question 14

use of ____ based ILE associated with faster termination of mech vent and less time to ICU discharge

Answer 14

olive oil and fish oil

Question 15

preferred forms of calcium and magnesium in PN:

Answer 15

calcium gluconate and magnesium sulfate

Question 16

why these forms of Ca and Mg?

Answer 16

less likely produce physicochemical incompatibilities compared to others

Question 17

PN formulations for single vits not available for :

Answer 17

biotin, pantothenic acid, riboflavin, vit a, vit d, vit e

Question 18

common trace elements in PN:

Answer 18

zinc, copper, chromium, manganese, selenium

Question 19

a.a. thought to have role in intestinal integrity, immune fxn, pro synth during stress

Answer 19

glutamine (not actually recommended to be supplemented)

Question 20

quarternary amine necessary for proper transport/metabolism of LCFA into mito for beta-ox

Answer 20

carnitine

Question 21

ILE in 2-in-1 is administered in a ___ infusion

Answer 21

piggyback

Question 22

advantage of TNA:

Answer 22

convenience, cost, more sanitary, efficient, tolerance may be better, better in fluid restricted, fat clearance better

Question 23

why limit hang time ILE to max 12 hours?

Answer 23

cuz has potential support bacterial/fungal growth

Question 24

disadvantages of TNA

Answer 24

larger particle size, less stable (prone to separation), compatibility and solubility of ca and na/k less, lower pH a.a., difficult visualize precipitate, some meds incompatible, > risk catheter occlusion, shorter catheter lifespan

Question 25

what does ILE stand for?

Answer 25

injectable lipid emulsion

Question 26

success in v thrombophlebitis thru addition of ____ and/or small amt ____ to PPN

Answer 26

heparin; hydrocortisone

Question 27

technique to minimize thrombophlebitis includes use of ___ patch at venous insertion site

Answer 27

nitroglycerin

Question 28

3 different risk levels of contamination?

Answer 28

low (simple closed system aseptic), medium (reconstitution to transfer or large vol PN prep), high (preparation from bulk, nonsterile ingredients or prep from sterile ingredients exposed to < ISO Class 5 standards)

Question 29

what are ISO class 5 standards?

Answer 29

no circulating particles 0.5 micrometre or larger to exceed 100 particles/cubic food

Question 30

what is in-use time?

Answer 30

time before which a conventionally manufactured product used to make CSP must be used once opened/punctured

Question 31

Category 1 CSPs?

Answer 31

assigned max beyond-use-date = / < 12 hrs controlled rm temp or =/< 24 hr refrigerated

Question 32

category 2 CSP?

Answer 32

BUD > 12 hr temp or > 24 hr fridge

Question 33

what is BUD:

Answer 33

date/time after which CSP should NOT be stored/transported/admin and determined from date/time prep was compounded

Question 34

what are ACDs

Answer 34

automated compounding devices

Question 35

main advantage of ACD?

Answer 35

accuracy ^ of dosage form (also more safe)

Question 36

disadvantage ACD?

Answer 36

cost and space

Question 37

major methods used for verifying accuracy of compounding process by ACDs are ______ and _____ analysis

Answer 37

volumetric; gravimetric

Question 38

___ used to determine whether PN formulations compounded properly

Answer 38

refractometry (doesn't work w/ TNA)

Question 39

why internal membrane to separte macronutr into diff chambers?

Answer 39

prevent Maillard rxn that alters integrity of dextrose and a.a.

Question 40

advantages of using standard commercially available PN?

Answer 40

reduce cost, v comp time, less risk for errors, less infections, shelf stable and heat sterilized

Question 41

stability in PN refers to ___ and compatibility refers to ____

Answer 41

degradation of nutr components that changes original characteristics (eg. maillard rxn) and ability maintain chem integrity and activity; formation of precipitates

Question 42

polar regions on fat droplet create ___ charge (called ___ potential) on surface of fat drop that promotes repulsion between neighboring lipid particles of same charge

Answer 42

negative; zeta

Question 43

factors that alter electric charge on fat drop surface include:

Answer 43

v in pH, addition of electrolyte salts

Question 44

what is a cracked ILE?

Answer 44

oil phase separates from water

Question 45

most critical factor influencing pH of PN formulation is _____ used

Answer 45

crystalline amino acid

Question 46

why add cysteine hydrochloride?

Answer 46

although it is destabilizing, can request cuz have taurine and L-cysteine HCl can be added to ^ ca phosphate solubility

Question 47

why a.a. with dextrose?

Answer 47

buffers acidity of dextrose

Question 48

low osmolarity PN formulations (eg. PPN) pose high threat for _____ precipitation

Answer 48

calcium phosphate

Question 49

___ indicates that fusion of fat droplets has occurred and the individual droplet size has increased

Answer 49

coalescence

Question 50

how to reduce likelihood that ca and P will precipitate?

Answer 50

lower pH, ^ a.a. concentration. ^ dextrose concentration

Question 51

TNA is discouraged from use in these populations:

Answer 51

neonatal and pediatric

Question 52

^ risk of ca p precipitation cuz:

Answer 52

^ Ca / P concentration, CaCl use, ^ temp

Question 53

risk of ____ must be considered when Ca provision < 10-15 mEq/d

Answer 53

metabolic bone disease

Question 54

trace element contamination include:

Answer 54

arsenic, Al, Cr, Zn, Mn, Cu

Question 55

max Al load permitted?

Answer 55

25mcg/L

Question 56

why store in plastic instead of glass?

Answer 56

less Al content at expiration

Question 57

pt at risk of Al toxicity:

Answer 57

1) significant renal dysfunction 2) high intake PN 3) Fe deficiency

Question 58

why filters used now?

Answer 58

ca p precipitation risk minimization, v pathogenic microorgs

Question 59

can't use filters with:

Answer 59

ILE

Question 60

if 2 in 1 used, 2 filters required:

Answer 60

0.22 (inline) and 1.2

Question 61

inline filter can ^ incidence of ____

Answer 61

occlusion alarms

Question 62

dextrose ____ or ____% should be used for compounding PN in fluid restriction

Answer 62

50; 70