GI Pharmaceutical care Flashcards
Name two GI conditions for which a ‘borderline product’ can be prescribed and explain why the product works
- Crohn’s disease
- lactose intolerance
- coeliac disease
- dermatitis hepetiformis
Explain the pathological basis of coeliac disease
The symptoms of coeliac disease
vary from person to person and can range from very mild to severe.
Symptoms of eating gluten, or being ‘glutened’, include
headaches, diarrhoea, stomach pains and lethargy. The symptoms may last from a few hours to a few days.
The reaction is not the same as an allergic reaction and does not cause anaphylactic shock.
Coeliac disease is known as a ‘multi system’ disorder – symptoms can affect any area of the body. Symptoms differ between individuals in terms of type and severity.
Weight loss with diarrhoea can occur, leading to severe illness resembling malnutrition.
Discuss the major considerations when prescribing for a patient with a stoma
Considerations
Patient has to recover from surgery
Restore lifestyle to as normal as possible
Problems may relate to the stoma or to other conditions
Drug Tariff Part IXC - STOMA APPLIANCES (Colostomy, Ileostomy, Urostomy)
Prescribers and suppliers - note that products not included in the list are not prescribable
Stoma supplies come from mail-order dispensing services
Symptoms when someone with caeliac disease eats gluten
headaches, diarrhoea, stomach pains and lethargy. The symptoms may last from a few hours to a few days
Types of enteral nutrition
Sip Feeds/ Supplements
Nasogastric feeding
PEG/ PEJ Tubes
Distal Feeding
Stroma need prompted by
The commonest causes are cancers of the bladder and colon, and inflammatory bowel disease.
temporary vs permanent stroma
A temporary stoma is usually created to divert faeces away from surgically rejoined intestine or to provide an outlet for faeces if there is an obstruction.
A permanent stoma may be needed when a disease or its treatment results in loss of normal bowel or urinary function.
NB: Stroma patients may suffer from constipation
List some drug related problems for patients with stromas
- enteric coating/SR formulations
- Laxatives
- Constipation in colostomy patients
- Antacids
- Iron preparations
- Compound analgesics
- Oral contraceptives
- Antibiotics
- Diuretics
- Digoxin
- Potassium supplements
Why are enteric coated formulations unsuitable?
unsuitable
May not deliver full dose effectively if transit is rapid
When and why are laxatives a problem?
should not be used in patients with an ileostomy where possible as they may cause rapid and severe loss of water and electrolytes.
How should constipation in colostomy patients be dealt with?
should be treated by increasing fluid intake or dietary fibre. Bulk-forming
drugs can be tried. If they are insufficient, as small a dose as possible of a
stimulant laxative such as senna can be used with caution.
Problems with antacids for stroma patients
The tendency to diarrhoea from magnesium salts or constipation from aluminium or calcium salts may be increased in patients with stoma.
Problems with iron
may cause loose stools and sore skin in these patients. If iron is definitely indicated, an intramuscular iron preparation should be used. Modified-release preparations should be avoided
Problems with iron preparations
may cause loose stools and sore skin in these patients. If iron is definitely indicated, an intramuscular iron preparation should be used. Modified-release preparations should be avoided
compound analgesic problems
(contain codeine)- constipation
problems with oral contraceptives
less reliable
Problems with antibiotics
Can cause diarrhoea
Diuretic issues/problems
cause dehydration and potassium depletion – use potassium sparing diuretic
Digoxin problems
Patients with a stoma are particularly susceptible to hypokalaemia if taking digoxin, due to fluid and sodium depletion. Potassium supplements or a potassium-sparing diuretic may be advisable with monitoring for early signs of toxicity
How to prescribe/administer potassium supplements to stoma patients
Liquid formulations are preferred to modified-release formulations. The daily dose should be split to avoid osmotic diarrhoea.
Appliance issues
Leaking
Stoma size changes with time – refer to Stoma Nurse for measuring
Skin problems - Rash, non-adherence.
May need advice on cleansing agents, protective creams, sealants
On prescription - Skin Fillers and Protectives (Barrier creams, pastes, aerosols, lotions, gels, wipes)
Dexterity – ability to change bag
Odours – deodorants on prescription
Antacid interactions
May impair the absorption of other drugs if taken at the same time (also in feeding tubes)
(e.g. ACE inhibitors, antiepileptics, antibacterials)
May cause dissolution of enteric coatings by raising the pH.
Makes pancreatic enzymes replacement less effective
May affect pH dependent renal excretion
(alkaline urine =↑excretion of aspirin and lithium)
PPIs
Omeprazole, esomeprazole, pantoprazole
Enhance anticoagulant effects
INR increased - warfarin dose may need to be reduced
Enhance effects of phenytoin Plasma concentration of clozapine reduced by omeprazole Omeprazole can block enteral feeding tubes – switch to lansoprazole or esomeprazole
Converting solid dosage forms to other formulations
Check relative (equivalent) bioavailability
Choose licensed product first
Liquid
Melts
orodispersible
Do not crush EC, modified release/slow release preparations
Crushing and opening capsules makes the product unlicensed
Effervescent tablets – some brands contain a significant quantity of sodium
Syrup – some brands contain sorbitol which can cause diarrhoea in large quantities
Oral hypoglycaemic agents – consider switching to insulin if patient cannot swallow
