Stoma care

Question 1

What is a stoma?

What forms are the most common?

Answer 1

1) A stoma is an artificial opening on the abdomen to divert flow of faeces or urine into an external pouch located outside of the body.
2) Colostomy and ileostomy

Question 2

What formulations are unsuitable to those with a stoma?

Answer 2

EC and M/R are unsuitable especially in ileostomy

Question 3

what type of formulations are suitable to be prescribed in patients with a stoma?

Answer 3

Soluble tablets, liquids, capsules or uncoated tablets due to their quicker dissolution
↳ When a solid-dose forms are given contents of the ostomy bag should be checked for any remnants.

Question 4

What analgesics are suitable for prescribing in those with a stoma and which drugs should be avoided?

Answer 4

1) Paracetamol preferred option
2) Opioids may cause troublesome constipation
3) NSAIDS may cause gastric irritation and bleeding; faecal output should be monitored for traces of blood.

Question 5

What problems can antacids cause in those with a stoma?

Answer 5

diarrhoea from magnesium salts or constipation from aluminium or calcium salts may be increased

Question 6

1) Why should digoxin be prescribed with caution in those with a stoma?
2) How can the risk of digoxin toxicity be reduced?

Answer 6

1) Individuals are susceptible to hypokalaemia due to fluid and sodium depletion
2) Potassium supplements or a potassium-sparing diuretic may be advisable with monitoring for early signs of toxicity.

Question 7

What type of diuretic is recommended in patients with a stoma and why?

Answer 7

1) potassium-sparing diuretic

2) patients may become excessively dehydrated and potassium depletion may easily occur

Question 8

Iron preparations may cause loose stools and sore skin In patients with a stoma. What other options are available to those who are diagnosed with iron deficiency?

Answer 8

1) Intramuscular iron preparation should be used

2) Avoid M/R iron preparations

Question 9

What problems can laxatives cause in those with a stoma and what are the alternative options for patients who are constipated

Answer 9

1) May cause rapid and severe loss of water and electrolytes especially in ileostomy, avoid if possible
2) Constipation common in colostomy: increase fluid and fibre. Bulk-forming drugs can be tried if this fails, lowest dose of stimulant e.g. senna can be used with caution

Question 10

Loperamide and codeine reduce intestinal motility and decrease water and sodium output from an ileostomy. why are higher doses of loperamide needed in patients with a stoma?

Answer 10

1) Loperamide circulates through the enterohepatic circulation, which is disrupted in patients with a short bowel.
( Codeine can be added if response with loperamide hydrochloride alone is inadequate)

Question 11

How should potassium supplements be administered in those with a stoma?

Answer 11

1) Liquid formulations are preferred to modified-release formulations.
2) The daily dose should be split to avoid osmotic diarrhoea.

Question 12

why should preparations containing sorbitol as an excipient should be avoided in those with a stoma?

Answer 12

due to its laxative side effects