Exocrine Pancreatic Insufficiency

Question 1

What symptoms and conditions are associated with exocrine pancreatic insufficiency?

Answer 1

Reduced secretion of pancreatic enzymes into duodenum which can cause malnutrition, maldigestion, GI symptoms such as diarrhoea, ab cramps, steatorrhoea (lots of fat in faeces)

Question 2

Aims of tx?

Answer 2

Relieve gi symptoms and achieve normal nutrition.

Question 3

Drug tx requires the use of pancreatin, what main groups does pancreatin not contain?
Lipase
Amylase
Peptin
Protease

Answer 3

Peptin

Question 4

High doses of pancreatin can cause fibrosing colonopathy in patients with CF, manufacturers recommend if a patient taking pacreatin develops new abdominal symptoms the pt should be reviewed to exclude colonic damage. At what dose should pancreatin be limited to in CF pts?

Answer 4

Not to 10000 units/kg/day exceed

Question 5

What classes of drug can be trialled in conjunction with pancreatin to improve effectiveness?

Answer 5

Acid suppressants (PPI H2 re

Question 6

What non drug advice can you give?

Answer 6

Distribute food intake with 3 meals per day, and two or three snacks.. foods difficult to digest (legufibre foods) should bemes, high avoided. Avoid alcohol.

Question 7

What 2 environmental factors can effect pancreatin and how can this be resolved?

Answer 7

Inactivated by gastric acid- best taken with, before or just after food.
Inactivated by heat- excessive heat should be avoided if mixing with food or drink, mixture should not be kept for more than an hour, any leftovers should be disposed.

Question 8

What are the recommended methods of administration for pancreatin GR granules and capsules.

Answer 8

GR/EC resistant granules should be mixed with slightly acidic foods or liquids (apple juice) and swallowed whole to enhance absorption. Creon micra for kids can be mixed with small amount of milk on a spoon and administered immediately, not to be added to baby’s bottle.. advise adequate hydration.