11. Stoma

Question 1

Stoma

Answer 1

An opening that diverts the flow or urine or faeces into an external bag

Question 2

What are the types of stoma

Answer 2

Colostomy - where one end of the colon is diverted through a stoma

Ileostomy - where one end of the small intestine is diverted through a stoma

Question 3

What preparations must be avoided in patients with a stoma

Answer 3

AVOID enteric coated preparations and modified release preparations as not enough of the drug will be released

INSTEAD offer soluble/uncoated tablets, liquids and capsules

Patients with stomas are more susceptible to gastro-intestinal effects, so should use with caution: GI bleeding with NSAIDs, opioids, iron, magnesium and aluminium antacids

Question 4

Stomas and electrolytes

Answer 4

Patients with stoma can lose a lot of water and electrolytes

Question 5

Electrolyte management

Answer 5

Hypokalaemia can predispose to digoxin toxicity

Diuretics can also cause hypokalaemia and dehydration as side effects

Consider adding a potassium-sparing diuretic or potassium supplement to counteract this

Question 6

Stoma and laxatives

Answer 6

Laxatives should be avoided in ileostomy as such patients already suffer from diarrhoea

However, bulk-forming laxatives can be used to treat patients with a colostomy