GIT Lec 7 - Pancreatic Enzymes

Question 1

What are supplemental pancreatic enzymes?

Answer 1

Pancreatic enzymes like pancrelipase and pancreatin are commercial mixtures of lipases, proteases and amylases; they assist in the digestion of fat, proteins and carbohydrates, respectively.

Question 2

What are the available dosages for Creon-10?

Answer 2

1. 10,000; mainly reserved for pediatrics
2. 25,000; most common. Most adults take 1 or 2 per meal
3. 40,000.

Question 3

How should supplemental pancreatic enzymes be taken?

Answer 3

1. Ideally, these capsules should be taken during eating; preferably with the first mouthful of food. (Foods include snacks, meals, or milky drinks.)
   
   • If the meals are smaller, frequent meals with for example 3 snacks a day, then it may be advised to take a capsule per snack.
2. The capsules must be swallowed with cold water as hot water can make them less effective.
3. The capsules MUST be swallowed whole, if this is difficult, they capsules can be opened up, and the granules inside can be mixed with water or soft food.
   It should be noted that the water or soft food - granules mixture should be taken immediately after preparation and that the granules must not be crushed or chewed.
4. It is important to drink plenty of water/fluids daily
5. The supplements should not be taken on an empty stomach.

Question 4

What are the signs that indicate the use of pancreatic enzymes supplements?

Answer 4

1. Pale stools
2. Loose bowel motion
3. Abdominal pain and bloating after eating
4. Frequent flatulence
5. Good appetite and food intake with continuing weight loss

Question 5

What are the therapeutic uses of supplemental pancreatic enzymes?

Answer 5

1. They are indicated for replacement therapy in symptomatic treatment of malabsorption syndrome caused by pancreatic insufficiency
2. They are indicated for cystic fibrosis

Question 6

what are the side effects of supplemental pancreatic enzymes?

Answer 6

The most common side effect is constipation.
Other less common side effects include:
1. Nausea
2. Abdominal cramps
3. Diarrhea
Hyperuricemia can also occur.
They decrease the absorption of iron salts.

Question 7

What are the precautions that should be taken before prescribing pancreatic enzymes supplements?

Answer 7

1. Before taken pancrealipase; check for allergy to it or to pork proteins: these medications contain inactive components that can cause allergic reactions or other problems.
2. Before using the medication, if the patient has sudden/sever swelling of the pancreas (signs of acute pancreatitis) or sudden worsening of long-term pancreatic disease (flares of chronic pancreatitis); goat formation can occur due to the increased levels of Uric acid in the blood due to the increased blood levels of purine which is converted to uric acid.
3. If the patient is diabetic, pancrealipase may affect blood sugar levels, that’s why it’s important to regularly check blood sugar levels.

Question 8

What are the drug interactions of pancrealipase?

Answer 8

It might interact with some drugs like: acarbose and miglitol (both of which are antidepressants)

Question 9

How do we manage patients with hepatic encephalopathy?

Answer 9

1. Lactulose
2. Metronidazole and neomycin
3. Reduce dietary protein intake
4. Evacuation enema
5. Correct predisposing factors

Question 10

How do we manage patients with ascites?

Answer 10

1. Treatment of underling cause.
2. Bed rest
3. Dietary sodium restriction
4. Diuretics: spironolactone or amiloride.
   Furosemide (40-160mg/day) can also be added to enhance diuresis.
5. Minor weight loss
6. Paracentesis.