TPN Basics...there are times when a patient will not should not, cannot eat.

There are times when a patient can not eat, will not eat or should not eat.  There are also times when a patient is taking in an insufficient number of calories.  Examples of these situations are chronic illness, short term illness or post surgery.  Patients in these situations have to be fed because no matter what our physical state is, in order to sustain life, our bodies require a certain amount of calories each day.  We need these calories in order to maintain our weight and nourish our cells.

The abbreviation TPN actually stands for Total Parenteral Nutrition and depending on the practice setting, the term can be used to describe all IV feedings or it can be used specifically to say that only IV feedings that are administered through a central line are called TPN.  It depends on the institution.  Your institution may use terms such as PPN which tands for Partial or Peripheral Parenteral Nutrition.  Your institution may even use terms like 3 in 1 solution or Total Nutrient Admixture  abbreviated, TNA.

For purposes of this discussion, we are going to consider all of these to be fundamentally the same.  The difference between TPN and PPN are the concentration of dextrose and as a result the site of administration.  The difference between TPN and TNA is that the total nutrient admixture has an extra base solution, etc.  As far as the calculations are concerned, they are basically the same.  In other words, once you can do the calculations for one, you can do the calculations for the others.

So let’s break this topic down into its elemental parts.  There are two major components of these formulations.  They are Base solutions and then Additives.

The base solutions for TPN are Dextrose and Amino Acids.  The base solutions for TNA are Dextrose, Amino Acids and Lipids.  Think about it, in order to sustain life, our diets must have carbohydrates, fats and protein.  Dextrose is a crbohydrate; Amino acids are the building blocks of protein and Lipids are fats.  These base solutions are stated as percentages for the most part.  The only exception is the TNA where there is a percentage of Lipid Emulsion (either 10% or 20%) followed by a volume.

When we are calculating for the amount of base solution to add, we can use either quantity times strength or the alligation method.  So to calculate for each base solution, we would set up an independent quantity times strength problem or allegation problem to solve for the volume to be added.

Then there are the additives.  Examples of additives are as follows:

Electrolytes (ex: KCl, NaCl, KPO₄, etc)

Insulin (Regular only)

MVI (Multivitamins)

Trace minerals

H2 antagonist (ex: ranitidine, famotadine)

Vitamin K

Heparin

Barriers to Medication Use

I always like to talk to dynamic people who are making a difference in their communities. Since most of my career has been spent helping people with their medicines, I know that medication can not work if a patient doesn't take it.  In that vein,  I recently had a great interview with Ursula Chizhik of FLAVORx.  See the highlights of our talk:

What are the barriers to patients being compliant with their medication regimens?

 One of the barriers is the taste of the medication.  There are some meds that are notorious for having a bad taste and the pharmaceutical industry goes to great lengths in order to mask their flavor/smell.  Two good examples of this are ibuprofen and metformin...

What do you do if it is a child that has to take a medication during the short term (three to ten days)?  Well most people just grin and bear it and believe that medication is supposed to taste bad! 

But what happens when the child has to take a medication for a chronic condition and the medication has an unappealing taste?   I can remember when I was a child and my mom would give me medicine when I was sick.  She would either give everything with honey or give me the medicine with an "orange chaser" (that's when she would peel an orange before giving me the spoon, so I could eat that orange immediately after taking my medicine).  It didn't always work, I still tasted the bitterness of the meds that I had to take. 

What if you had a flavoring option for your child's medication?  Please know that does exist and that there is hope for patients and their parents/caregivers!

  I recently was able to sit down with Ursula Chizhik who is Director of Pharmacy Programs at FLAVORx and we had a really great discussion about this issue.  We talked about it from two perspectives, you see we are moms who are also pharmacists.  In Ursula's own words,

" As a pharmacist and a mom, I understand the difficulty and the stress related to medication-time for children and parents from behind the counter, as well as in front of the counter.  This dual perspective encourages me to empathize more with sick children and better understand and support frustrated parents.  My unique position here at FLAVORx enables me to educate other health care providers about the importance of recognizing taste and palatability as a barrier to medication adherence in the pediatric population, and to understand how we can better support caregivers to ensure that they follow through with administering medication to their children."

If you are challenged in giving medication to your child, know that you are not alone.  Did you know that:

·         Studies suggest that adherence rates for pediatric medications are typically between 50-60%. 

·         79% of children complain about bad tasting medicine or taste that is “too yucky.”

·         7 in 10 parents report a moderate to severe struggle giving a child medicine because of how it tastes

·         Studies have shown that adherence with liquid medicine improves to 90% or higher when children choose the taste of their medicine.

·         Finally, 72.4 % of parents would find a custom medication flavoring service very valuable.

What is FLAVORx?

FLAVORx was founded over 15 years ago by a man named Kenny Kramm whose family owned a pharmacy in the Washington D.C. area.  He had a simple idea that that the taste of medicine should never come between a child and his or her good health.  It started at his family owned community pharmacy with one flavor, banana.  It was developed for a child having serious difficulty taking anti-seizure medication. The condition was life-threatening and the fact that this little girl wouldn’t take her awful-tasting medicine was making things much worse.

 After much experimentation, they hit on a successful formula.  That little girl was able to take her banana- flavored medicine without any problems, her seizures subsided, and that’s when they had their “Aha” moment.  In 2007, the  current CEO of FLAVORx,  Stuart Amos, took over the company, but the mission remains the same.  Now the company has several flavoring options and even has a product that makes it easier for patients that have difficulty swallowing, take their solid dosage forms (tablets, capsules).

Their mission is founded on the idea that medicines can't work if people don't take them.  This is so true and it is good to know that there is a company that desires to improve medication adherence by making a potentially stressful situation become less daunting for both parents and children.

This is how FLAVORx helps patients:

·         They help people take their medicine so they can get better faster.

·         FLAVORx offers personalization and choice (There are over 21 unique flavor options available for parents and children to choose from).

·         FLAVORx  reduces stress commonly associated with the medicine time experience (By improving the taste of medicine, and giving kids a choice of flavor options, FLAVORx turns medicine time into a more pleasant experience for everyone).

·         FLAVORx improves health outcomes and wellness.

·         FLAVORx is safe and effective (FLAVORx flavors are sugar-free, non-allergenic, dye-free, sodium-free, phosphate-free, gluten-free, and casein-free) and again it is important to reiterate that our flavors are being used in over 45,000 pharmacies and we have flavored over 60,000,000 liquid medicines to date without compromising safety or efficacy.

In my practice, I have come across the use of flavoring agents to mask the taste of certain medicines but when I spoke with Ursula, her passion and enthusiasm really shined through.  The fact is that in the world that we are a part of, people want to have everything customized.  It says that this is mine, it was made just for me and there is a movement to do this with medications. 

This was a great interview!  I got to learn more about this great company!    This is exciting to me this  option was not present when I was a child and I am glad that this option is available now.  I wish them much success! 

Thank you Ursula!

Ursula Chizhik, PharmD was a retail pharmacist for 11 years before making the switch to join the FLAVORx team nearly 4 years ago. FLAVORx has been helping children take their medicine since 1994. She is now the resident pharmacist and Director of Pharmacy Programs at FLAVORx Inc.  In her current position, she is able to integrate her many years of practical pharmacy experience to bring an element of “real world pharmacy” to FLAVORx.  Having experienced the peaks and valleys of being a pharmacist behind the counter, coupled with being a mom on the other side of the counter, she is able to tap into those experiences every day as she explores effective ways to reach out to and educate  parents and providers.  Improving the child-parent-provider encounter to facilitate more positive medication experiences and subsequent positive health outcomes is her primary focus.   Ursula lives in West Friendship, Maryland with her husband and 2 sons. She welcomes you to contact her via email at uchizhik@flavorx.com or via telephone at 1-800-884-5771 ext. 238.

Spring Is Here

Don't you just love the Spring?

It is cold where I am and we just had another snow storm on Friday.  But I'm not going to complain about it...I'm just glad to see winter go and Spring come in!  I found a great article about what to look forward to in Spring and here is the link:

Six things to look forward to...

Some people may suffer with allergies during this season!  This is when our old friend, pollen comes into the fray.  If you haven't done so already and you suffer from allergies, like me, this may be a good time to get prepared for the coming season.  the earlier, the better.  I know the later I wait to manage the allergies, the worse it is for me during this season.

Did you know that for every disease, there is a foundation that serves those that are afflicted with that disease.  So, regarding allergies, there is The Allergy and Asthma Foundation of America, their website is aafa.org.  Take a look around, there is some really good content there.

Click here to view website

Allergy and Asthma Foundation of America