Stoma Patients and their Medicines

Alan Timmins MSc MRPharmSPrincipal Pharmacist – Clinical ServicesQueen Margaret Hospital, Dunfermline

•How do medicines affect stomas?

•How do stomas affect medicines?

Ileum → Ileostomy

Colon → Colostomy

Ileum → Ileostomy

Dehydration

Colon → ColostomyConstipation

Maintaining the Balance

• Reduce gut motility

• Dry up secretions

• Provide more bulk

• Provide supplements of electrolytes etc

Other Scenarios

•Urostomy

•Short Bowel

How Drugs Affect Gut Function

• Autonomic nervous system Cholinergic Adrenergic

• Direct effect Laxatives Analgesics

• Indirect Effect Diuretics

Parasympathetic stimulation

• ↑ Peristalsis

• ↑ Secretions

• Relaxation of sphincters

Parasympathetic blockade

• ↓ Peristalsis• ↓Secretions• Contraction of sphincters

• ANTICHOLINERGICS

Anticholinergics

• Tricyclics• Antipsychotics• Antiarrhythmics• Sedating antihistamines• Oxybutynin/ tolterodine• Dicyclomine/ Hyoscine/

propantheline/ atropine

Laxatives

• Bulk – Fibre

– lactulose

• Stimulants – Senna/ bisacodyl

–Glycerin

Analgesics

• Opioids- receptors in gut

LoperamideCodeine

Antibiotics

• Upset gut flora

• Most cause diarrhoea

• Macrolides - prokinetic

Antacids

• Aluminium – constipation

• Magnesium - diarrhoea

Choice of Formulation

• Should all medicines for stoma patients be given as liquids?

Formulations

• Solutions• Suspensions• Plain tablets/ capsules• E/C tablets/ capsules• S/R tablets/ capsules

S/R Preps

• Mechanism of S/R action

• Release profile

• Absorption profile

Remember…

• There could be a problem with efficacy

• There may be an impact on stoma function

• MONITOR

May need to…

• Increase dose• Increase frequency• Change formulation• Change treatment