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Stoma stoma patients and their medicines

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Presenter: Alasdair Macintyre …

Presenter: Alasdair Macintyre
Date: 04/11/2007
Target Audience: All

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  • 1. Stoma Patients and their Medicines Alan Timmins MSc MRPharmS Principal Pharmacist – Clinical Services Queen Margaret Hospital, Dunfermline
  • 2.
    • How do medicines affect stomas?
    • How do stomas affect medicines?
  • 3.
    • Ileum -> Ileostomy
    • Colon -> Colostomy
  • 4.
    • Ileum -> Ileostomy
    • Dehydration
    • Colon -> Colostomy
    • Constipation
  • 5. Maintaining the Balance
    • Reduce gut motility
    • Dry up secretions
    • Provide more bulk
    • Provide supplements of electrolytes etc
  • 6. Other Scenarios
    • Urostomy
    • Short Bowel
  • 7. How Drugs Affect Gut Function
    • Autonomic nervous system
    • Cholinergic
    • Adrenergic
    • Direct effect
    • Laxatives
    • Analgesics
    • Indirect Effect
    • Diuretics
  • 8. Parasympathetic stimulation
    • ↑ Peristalsis
    • ↑ Secretions
    • Relaxation of sphincters
  • 9. Parasympathetic blockade
    • ↓ Peristalsis
    • ↓ Secretions
    • Contraction of sphincters
    • ANTICHOLINERGICS
  • 10. Anticholinergics
    • Tricyclics
    • Antipsychotics
    • Antiarrhythmics
    • Sedating antihistamines
    • Oxybutynin/ tolterodine
    • Dicyclomine/ Hyoscine/ propantheline/ atropine
  • 11. Laxatives
    • Bulk – Fibre
          • lactulose
    • Stimulants – Senna/ bisacodyl
          • Glycerin
  • 12. Analgesics
    • Opioids- receptors in gut
    • Loperamide
    • Codeine
  • 13. Antibiotics
    • Upset gut flora
    • Most cause diarrhoea
    • Macrolides - prokinetic
  • 14. Antacids
    • Aluminium – constipation
    • Magnesium - diarrhoea
  • 15. Choice of Formulation
    • Should all medicines for stoma patients be given as liquids?
  • 16. Formulations
    • Solutions
    • Suspensions
    • Plain tablets/ capsules
    • E/C tablets/ capsules
    • S/R tablets/ capsules
  • 17. S/R Preps
    • Mechanism of S/R action
    • Release profile
    • Absorption profile
  • 18. Remember…
    • There could be a problem with efficacy
    • There may be an impact on stoma function
    • MONITOR
  • 19. May need to…
    • Increase dose
    • Increase frequency
    • Change formulation
    • Change treatment
  • 20.  

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