Stoma stoma patients and their medicines
description
Transcript of Stoma stoma patients and their medicines
Stoma Patients and their Medicines
Alan Timmins MSc MRPharmSPrincipal Pharmacist – Clinical ServicesQueen Margaret Hospital, Dunfermline
•How do medicines affect stomas?
•How do stomas affect medicines?
Ileum → Ileostomy
Colon → Colostomy
Ileum → Ileostomy
Dehydration
Colon → ColostomyConstipation
Maintaining the Balance
• Reduce gut motility
• Dry up secretions
• Provide more bulk
• Provide supplements of electrolytes etc
Other Scenarios
•Urostomy
•Short Bowel
How Drugs Affect Gut Function
• Autonomic nervous system Cholinergic Adrenergic
• Direct effect Laxatives Analgesics
• Indirect Effect Diuretics
Parasympathetic stimulation
• ↑ Peristalsis
• ↑ Secretions
• Relaxation of sphincters
Parasympathetic blockade
• ↓ Peristalsis• ↓Secretions• Contraction of sphincters
• ANTICHOLINERGICS
Anticholinergics
• Tricyclics• Antipsychotics• Antiarrhythmics• Sedating antihistamines• Oxybutynin/ tolterodine• Dicyclomine/ Hyoscine/
propantheline/ atropine
Laxatives
• Bulk – Fibre
– lactulose
• Stimulants – Senna/ bisacodyl
–Glycerin
Analgesics
• Opioids- receptors in gut
LoperamideCodeine
Antibiotics
• Upset gut flora
• Most cause diarrhoea
• Macrolides - prokinetic
Antacids
• Aluminium – constipation
• Magnesium - diarrhoea
Choice of Formulation
• Should all medicines for stoma patients be given as liquids?
Formulations
• Solutions• Suspensions• Plain tablets/ capsules• E/C tablets/ capsules• S/R tablets/ capsules
S/R Preps
• Mechanism of S/R action
• Release profile
• Absorption profile
Remember…
• There could be a problem with efficacy
• There may be an impact on stoma function
• MONITOR
May need to…
• Increase dose• Increase frequency• Change formulation• Change treatment