Stoma Patients and their Medicines Alan Timmins MSc MRPharmS Principal Pharmacist – Clinical Services Queen Margaret Hospi...
<ul><li>How do medicines affect stomas? </li></ul><ul><li>How do stomas affect medicines? </li></ul>
<ul><li>Ileum  -> Ileostomy </li></ul><ul><li>Colon -> Colostomy </li></ul>
<ul><li>Ileum  -> Ileostomy </li></ul><ul><li>Dehydration </li></ul><ul><li>Colon -> Colostomy </li></ul><ul><li>Constipat...
Maintaining the Balance <ul><li>Reduce gut motility </li></ul><ul><li>Dry up secretions </li></ul><ul><li>Provide more bul...
Other Scenarios <ul><li>Urostomy </li></ul><ul><li>Short Bowel </li></ul>
How Drugs Affect Gut Function <ul><li>Autonomic nervous system </li></ul><ul><li>Cholinergic </li></ul><ul><li>Adrenergic ...
Parasympathetic stimulation <ul><li>↑  Peristalsis </li></ul><ul><li>↑  Secretions </li></ul><ul><li>Relaxation of sphinct...
Parasympathetic blockade <ul><li>↓  Peristalsis </li></ul><ul><li>↓ Secretions </li></ul><ul><li>Contraction of sphincters...
Anticholinergics <ul><li>Tricyclics </li></ul><ul><li>Antipsychotics </li></ul><ul><li>Antiarrhythmics </li></ul><ul><li>S...
Laxatives <ul><li>Bulk – Fibre </li></ul><ul><ul><ul><ul><li>lactulose </li></ul></ul></ul></ul><ul><li>Stimulants – Senna...
Analgesics <ul><li>Opioids- receptors in gut </li></ul><ul><li>Loperamide </li></ul><ul><li>Codeine </li></ul>
Antibiotics <ul><li>Upset gut flora </li></ul><ul><li>Most cause diarrhoea </li></ul><ul><li>Macrolides - prokinetic </li>...
Antacids <ul><li>Aluminium – constipation </li></ul><ul><li>Magnesium - diarrhoea </li></ul>
Choice of Formulation <ul><li>Should all medicines for stoma patients be given as liquids? </li></ul>
Formulations <ul><li>Solutions </li></ul><ul><li>Suspensions </li></ul><ul><li>Plain tablets/ capsules </li></ul><ul><li>E...
S/R Preps <ul><li>Mechanism of S/R action </li></ul><ul><li>Release profile </li></ul><ul><li>Absorption profile </li></ul>
Remember… <ul><li>There could be  a problem with efficacy </li></ul><ul><li>There may be an impact on stoma function </li>...
May need to… <ul><li>Increase dose </li></ul><ul><li>Increase frequency </li></ul><ul><li>Change formulation </li></ul><ul...
 
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Stoma stoma patients and their medicines

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

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Stoma stoma patients and their medicines

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

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