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Pharmacology Made Easy for Ostomies
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WELCOME!
• ANCC Approved for 1.0 Pharmacology Contact Hour. CE credit is individual. Online registration is required for each person who wishes to obtain credit. (No“group” credit is available)
• Attendees will be directed to the evaluation after leaving the webinar. In order to receive contact hours, the evaluation must be completed. An email with theevaluation will be sent to all registered attendees following the presentation.
• The Contact Hour certificate will be emailed within 48 hours of completing the evaluation. Deadline to obtain credit: 11/18/2021 (by 11:59 p.m. CST)
CONTINUING EDUCATION INFORMATION
Pharmacology Made Easy for OSTOMIES
RENEE ANDERSON, MSN, RN, CWON
Associate Director & Special Projects
WEB WOC Nursing Education Program
President, Rainier Clinical Consultants Inc.
Seattle, Washington
DEBRA NETSCH, DNP, APRN, FNP‐BC,
CWOCN‐AP, CFCN
Co‐Director and Virtual Clinical Practicum Faculty
WEB WOC Nursing Education Program
Ridgeview Medical Center, Wound & Hyperbaric Clinic
NP & CWOCN‐AP, Minneapolis, MN.
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Disclosures
The presenters and content developers report no relevant financial relationships with any commercial interests related to this content. They further disclosed that no off‐label/unapproved uses of drugs and/or devices are discussed in this presentation.
Other content developers: JoAnn Ermer‐Seltun MS, RN, ARNP, FNP‐BC, CWOCN, CFCN
WEB WOC PROGRAMS
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Sponsor
This educational offering is sponsored by the Alumni Club of WEB WOC® Nursing Education Program
without other financial support.
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Outcomes
Upon completion of this presentation the learner will:
1. Identify ways to prevent the side effects of common medications for an individual with an ostomy.
2. Describe the pharmacokinetic and pharmacodynamic impact of medications onindividuals with ostomies.
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REVIEW: Terms Simplified
• The study of what a drug does to thebody.
Pharmacodynamics
• The study of what the body does to adrug. 4 phases: ADME!
Pharmacokinetics
• Identify drugs or substances that may affect urinary or fecal diversions!
Clinical Pharmacodynamics Goal
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REVIEW: Pharmacokinetic Process Factors that Affect ABSORPTION & METABOLISM
DRUG RELATED
• Dosage Forms
• Chemical nature
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REVIEW: Pharmacokinetic Process Factors that Affect ABSORPTION & METABOLISM
Body Related
• Absorptive Surface
• GI Motility
• Functional Integrity of absorptivesurface
• Diseases
Other:
• Vascularity
• pH
• Presence of other substances
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Pharmacodynamics: Side Effects of Common Medications on Ostomies
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Antibiotics: diarrhea, gas, dehydration, secondary fungal infections, ↑s INRs
OTC analgesics (NSAIDs): gastric bleeding, irritation, dark ostomy output
Narcotic Pain Medications: constipation
Antacids: constipation or diarrhea depending on the agent used
Diuretics: dehydration and electrolyte abnormalities
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Pharmacodynamics: Preventing the Side
Effects of Medications
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Pharmacodynamics Preventing Side Effects: Antibiotics
• Probiotic supplementation
• Eat yogurt, kefir or buttermilk
Diarrhea
• Closely monitor area around the stoma
• If a rash develops, antifungal powder
Secondary fungal infections
• Should be avoided in urostomy patients
• If used, patient should drink plenty of fluids to dilute the urine
Sulfa antibiotics
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Pharmacodynamics Preventing Side Effects: NSAIDs
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Pharmacodynamics Preventing Side Effects: Opioids
• Slow contraction of the bowel frequentlyleading to constipation
• Reduced flow through the stoma as well asGI discomfort
• Stool softeners may help in preventingconstipation
• Bulk‐forming laxatives and drinking plentyof fluids promote regularity
• Avoid harsh stimulant laxatives
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Pharmacodynamics Preventing Side Effects: Antacids
• Aluminum based antacids cause constipation
• Magnesium based antacids cause diarrhea (avoid with ileostomy)
• Calcium based antacids should be avoidedwith a urostomy
• Proton Pump Inhibitors: not recommendedto be used long‐term. Associated withvitamin malabsorption and C. Difficile
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Pharmacodynamics Preventing Side Effects: Diuretics
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• Common diuretics: hydrochlorothiazide (HCTZ), furosemide, bumetanide,torsemide, spironolactone, triamterene, metolazone
• Can cause dehydration and electrolyte imbalances
• Important to drink enough water or oral hydration solutions
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Colostomy
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Constipation
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TYPES OF LAXATIVES
•works by increasing the water content and bulk of the stool, which helps tomove it through the colon, slow acting
•need adequate fluid intake
•S.E.: bloating, cramping, gas
•e.g. psyllium, calcium polycarbophil, methylcellulose, wheat dextrin
Bulk forming/fiber
•pulls water into the large intestine increasing intraluminal volume andstimulates peristalsis, rapid onset
•S.E.: bloating, gas, cramping, nausea, dehydration
•e.g. magnesium citrate, magnesium hydroxide, sodium phosphate, polyethyleneglycol 3350 (PEG), lactulose
Osmotic and Hyperosmolar Laxatives
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TYPES OF LAXATIVES
• contain a surfactant that helps to "wet" and soften the stool
• retain water within the stool and makes stool easier to pass
• S.E. bloating, cramping, gas, bitter taste
• e.g. docusate, mineral oil
Stool softeners/Emollients
• stimulates the lining of the bowel causing increased peristaltic activity
• S.E. cramping, nausea, urine discoloration, diarrhea
• e.g. senna, phenolphthalein, diphenylmethane, bisacodyl
Stimulant laxatives
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Colostomy Gas and Odor Control
GAS
• Simethicone
• Alpha‐galactosidase
• Take four times a day (with each meal and at bedtime)
ODOR CONTROL
• Bismuth subgallate 1‐2 capsules or chewable tablets up to 4 times daily
• Chlorophyll tablets: 100‐300 mg/day in divided doses (2‐3 times per day)
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Common Medications that may Discolor Feces
• Gray
• Cocoa
• Colchicine
• Some antibiotics
• Black
• Alcohols
• Corticosteroids
• Clindamycin
• Digoxin
• Iron
• NSAIDs
• Pepto‐Bismol
• Potassium
• Red/Pink
• Anticoagulants
• NSAIDs
• Senna
• Tetracycline
• Orange/Red
• Phenazopyridine
• Rifampin
• Green
• Indomethacin (NSAID)
• Medroxyprogesterone
• Pancrelipase
• Senna
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Ileostomy
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Pharmacodynamics:Inactive Ingredients Affecting Ileostomy Output
Polyols: some have osmotic laxative properties
• Sorbitol
• Mannitol
• Maltitol
• Xylitol
Common over the counter medications may contain sorbitol
• e.g., acetaminophen suspension, many cough syrups
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Pharmacokinetic Concern: Absorption
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• Extended Release (ER), Delayed Release (DR), Sustained Release (SR), XR, XL, LA
Controlled‐release medications
•e.g. Aspirin EC, Pantoprazole EC
Enteric Coated tablets
•May need alternative routes
Oral Contraceptives or hormone‐replacement therapy
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Pharmacokinetic Concern: Absorption
• Monitoring for efficacy and toxicity
• What can we measure?• Blood pressure
• Drug levels
Digoxin
Antiepileptic drugs
Levothyroxine
Warfarin
• Pain
• Symptoms
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Concern: High Output
Soluble fiber bulking agents
Antimotility agents
Antisecretory agents
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Soluble Fiber
• Methylcellulose
• Psyllium
• Wheat dextrin
• Banana Flakes
• Guar Gum
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Antimotility Agents
• Loperamide: Initially 4 mg followedby 2 mg after each loose stool(maximum 16 mg/day); takeconsistently
• Diphenoxylate/atropine: 5 mg q6h(maximum 20 mg/day)
• If ostomy output remains>1500ml/day, consider:
• Tincture of opium
• Codeine sulfate
• Morphine sulfate
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Antisecretory Agents
HISTAMINE 2 RECEPTOR BLOCKERS (Antagonists)
• Famotidine, Cimetidine
PROTON PUMP INHIBITORS (PPI)
• Omeprazole, Esomeprazole,Pantoprazole, Lansoprazole
SOMATOSTATIN ANALOGS
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Urostomy
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Common Medications that may Discolor Urine
• Blue/Green• Amitriptylline
• Cimetidine
• Metoclopramide
• Propofol• Triamterene
• Dark brown• Iron• Levodopa• Metronidazole
• Nitrofurantoin
• Red/pink• Aspirin• Doxorubicin• Ibuprofen• Phenytoin
• Orange/Yellow• Heparin• Isoniazid• Niacin• Phenazopyridine• Rifampin
• Riboflavin• Vitamin A
• Warfarin
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Medication Implications for a Urostomy
Urine should be kept acidic
If at risk for calcium stone formation, caution with medications with a calcium carbonate base
Sodium bicarbonate base antacids can alkalinize urine
Ileal conduits that involve a large part of the ileum may need vitamin B12 supplements
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Pharmacodynamics & PharmacokineticsVitamin C (ascorbic acid)
● Acidification of urine (1 ‐ 3 g tid ‐ qid)● Side Effects● Excretion/Metabolism● Drug Interactions● Administration considerations● Monitoring
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Pharmacodynamics & PharmacokineticsCranberry Tablets
● Indications● Side Effects● Excretion/Metabolism● Drug Interactions● Administration considerations● Monitoring
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Summary
Be aware and educate individuals with ostomies about the side effects of common medications.
Individuals with ileostomies need to be aware of the impact of inactive ingredients in medications and issues with medication delivery to ensure proper absorption.
Monitor effluent volume in individuals with high output ostomies and initiate pharmacotherapy as indicated.
Consider an acidification approach for individuals with urostomies.
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ReferencesBridges, M., Nasser, R., & Parrish, C.R. (2019). High output ileostomies: The stakes are higher
than the output. Practical Gastroenterology. pp. 20‐33.
Carmel, J. & Scardillo, J. (2022). Adaptions, rehabilitation, and long‐term care management
issues. In: Carmel, J., Colwell, J., & Goldberg, M. (Eds., 2nd ed.) Wound, Ostomy and
Continence Nurses Society Core Curriculum: Ostomy Management. Wolters Kluwer. pp. 201‐
222.
Nadesalingam, M., (2020, July). Pharmaceutical considerations for patient with stomas. The
Pharmaceutical Journal. https://pharmaceutical‐journal.com/article/ld/pharmaceutical‐
considerations‐for‐patients‐with‐stomas
National Cancer Institute. (2020, September). Drugs approved for colon and rectal cancer.
https://www.cancer.gov/about‐cancer/treatment/drugs/colorectal
Rodrigues‐Bigas, M. (2019, July). Patient education: colon and rectal cancer (beyond the
basics). UpToDate. https://www.uptodate.com/contents/colon‐and‐rectal‐cancer‐beyond‐
the‐basics/print#H11
Saleh, A., (2020, July). Drug therapy and the compromised bowel. Canadian Society of
Intestinal Research. https://badgut.org/information‐centre/a‐z‐digestive‐topics/drug‐
therapy‐and‐the‐compromised‐bowel/
Temiz, Z. & Cavdar, I. (2018). The effects of training and the use of cranberry capsule in
preventing urinary tract infections after urostomy. Complementary Therapies in Clinical
Practice. (31) pp. 111‐117.
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THURSDAYS
12:00 CST
PHARMACOLOGY MADE EASY SERIES
PHARMACOLOGY PRIMER‐available ON DEMAND
DRUGS IMPACTING WOUND CARE‐ available ON DEMAND
WOUNDS: BACTERIAL MANAGEMENT‐available ON DEMAND
OSTOMY‐ NOVEMBER 4TH
FECAL CONTINENCE‐ NOVEMBER 18TH
URINARY CONTINENCE‐ DECEMBER 2ND
Location for ON DEMAND Educational Offerings? Go to WEB WOC website, Continuing Education, Browse Offerings and Pharmacology.
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