Ostomies

Question 1

where to look for advice on if a med an be given via enteral feeding tube

Answer 1

enteral feeding tubes section in meds complete

Question 2

what is the main focus of pharmacy advice with peg feeding tubes

Answer 2

ensure px continue to get their meds and nutrition

Question 3

give an appropriate volume of water that can be used to flush a PEG tube before, after and in between administration of medicines

Answer 3

10ml

Question 4

what type of syringe should be used for enteral feeding

Answer 4

enteral syringes

Question 5

should drugs be mixed together for peg feeding yes or no

Answer 5

no

Question 6

although switching to solution/ suspension ideal, tablets can be crushed and given via enteral tube when

Answer 6

if they are the only licensed product

Question 7

what class of drugs is 5fu

Answer 7

antimetabolite

Question 8

give a brief explanation of why chemotherapy is given alongside radiotherapy

Answer 8

sensitises tumour cells to radiotherapy
shrinks large tumours
helps stop spread of metastases
can be used after to kill residual cancer cells

Question 9

why might patients have to wait a period of 6 weeks between completion of chemo radiotherapy and surgery

Answer 9

weakens immune system -> reduced wcc
would be at risk of thrombocytopenia and neutropenic sepsis
allows immune system to recover before surgery

Question 10

what dietary advice can you give someone with a stoma that is experiencing constipation

Answer 10

increase fluid intake
eat wholemeal grains
brown bread and pasta
increase fruit and vegetable intake

Question 11

who should you signpost patients with stomas to if their constipation does not resolve

Answer 11

stoma care nurse

Question 12

is constipation more common for colostomy or ileostomy

Answer 12

colostomy

Question 13

what classes of medications can cause constipation

Answer 13

calcium containing antacids or opioids

Question 14

constipation can cause stoma prolapse and overflow diarrhoea, if identified who do patients need to be referred back to

Answer 14

surgical nursing support team

Question 15

name one condition that you might wish to check in patients that have recently had a stoma relating to their mental health

Answer 15

depression

Question 16

to deal with constipation you can increase faecal mass to distend the lower bowel and promote x

Answer 16

peristalsis

Question 17

list some different bulking agents that could be used to manage constipation

Answer 17

methylcellulose
isphagula husk
sterculia

Question 18

list some different osmotic laxatives that could be used to manage constipation

Answer 18

lactulose
macrogol
- retain water to inc stool volume

Question 19

which type of laxative is a last resort

Answer 19

stimulant

Question 20

name 2 stimulant laxatives that could be used as a last resort for constipation in stoma patients

Answer 20

Bisacodyl
docusate

Question 21

what consideration should be made to the dose of stimulant laxatives

Answer 21

smallest dose to give a soft formed stool

Question 22

why should stimulant laxatives not routinely be given to stoma patients

Answer 22

adaptation of stoma

Question 23

what advice can you give to stoma patients about air travel for the first time

Answer 23

hydration
loperamide
rehydration salts
drainable and non drainable appliances
pre cut pouches
impregnanted wipes
adhesive removers
disposal bags
ensure pouch filter is working before flight

Question 24

patients should work out how many pouches are needed for holiday and then x the number and pack some extras

Answer 24

double

Question 25

if patients wear a closed stoma pouch why might they want to opt for a drainable one on holiday

Answer 25

in case of tummy bugs or looser stools

Question 26

why might patients want to take a travel certificate or letter explaining their condition with them

Answer 26

get through security easier

Question 27

what can be done to stoma bags if they cause ballooning due to pressure change

Answer 27

release gas or change pouch

Question 28

drug class of mesalazine

Answer 28

aminosalicylate

Question 29

how does mesalazine work to treat IBS etc

Answer 29

modulation of prostaglandin and leukotrines which are chemical mediators of inflammatory response, act locally, reduce inflammation in intestine lining

Question 30

what is the drug class of azathioprine

Answer 30

immunosuppressant

Question 31

moa of immunosuppressanst such as azathioprine

Answer 31

suppress IS, reduce inflamation, preventing rejection in organ transplantation

Question 32

azathioprine is usually titrated from what drug class

Answer 32

corticosteroids

Question 33

corticosteroids suppress leukotrines etc for crohns/UC and usually work in the first instance but eventually become

Answer 33

steroid resistant

Question 34

what monitoring is required azathioprine

Answer 34

toxicity throughout fbc weekly first 4 weeks then every 3 months

Question 35

what are you looking for in blood tests when monitoring azathioprine

Answer 35

neutrophil and platelet depletion

Question 36

what toxicity/ warning signs are you checking for in the entirety of azathioprine therapy

Answer 36

myelosuppression

Question 37

for mesalazine renal function should be monitored how often

Answer 37

before treatment, at 3 months and then annually

Question 38

a rare issue that can occur with mesalzine use is agranulocytosis, what warning signs should you look out for

Answer 38

unexplained bruising bleeding tiredness malaise

Question 39

what enzyme metabolises azathioprine

Answer 39

tpmt

Question 40

why might patients with low levels of tpmt on azathioprine need low levels of the drug compared to patients with normal enzyme levels

Answer 40

myelosuppression

Question 41

what screening can give an indication to azathioprine response but may not necessarily change treatment options and outcomes

Answer 41

tpmt

Question 42

infliximab, adalimumab and golimumab are all examples of monoclonal antibodies, how do they work

Answer 42

binds to tnf alpha to reduce inflammation and prevent damage to cells lining the gut

Question 43

what JAK inhibitor may be used to treat these conditions

Answer 43

tofacitinib

Question 44

what integrin binding drug may be used in these conditions

Answer 44

vedolizumab

Question 45

what interleukin binding drug may be used in these conditions

Answer 45

ustekinumab

Question 46

ustekinumab

Answer 46

Ulcerative colitis

Question 47

many patients dont need any pharmacological therapy after subtotal colectomy, but for those that do for rectal inflammation what may be given

Answer 47

steroid enemas or suppositories

Question 48

what food factors can aggravate stomas and cause them to become sore with more liquid output

Answer 48

beans chocolate spicy food raw fruit spinach sweeteners

Question 49

true or false excessive consumption of beer or lager can irritate stomas

Answer 49

true

Question 50

2 drugs or classes of drugs that can cause liquid outputs and irritate stomas

Answer 50

magnesium containing antacids and methyldopa

Question 51

blockage can give symptoms of diarrhoea as solids are bypassed by liquids in the bowel, what would make you rule this out

Answer 51

extreme pain, sometimes watery output and px wont be able to stand

Question 52

what drugs should NEVER be used in the event of blockages

Answer 52

laxatives

Question 53

what drug can be used to manage diarrhoea in stomas even in high doses outside of its licence

Answer 53

loperamide

Question 54

codeine use has been associated with x in the case of ostomies

Answer 54

intestinal obstruction so avoid long term use

Question 55

X in pouch can be used to reduce number of leaks

Answer 55

gelling agents

Question 56

what advice can you give patients to deal with pouch leakage

Answer 56

change regularly make sure secured when exercising gently peel barrier from skin take time be gentle ensure stoma stays clean no perfume or cream on it

Question 57

what can be used to protect broken peristomal skin

Answer 57

stoma powder

Question 58

what leakage prevention products exist

Answer 58

skin barrier rings paste strips

Question 59

what alternative methods of contraception may be suitable for patients aside from barrier methods

Answer 59

progesterone injections or birth control patch

Question 60

how may oral contraceptive efficacy be altered in large bowel disease

Answer 60

unlikely reduced

Question 61

how may oral contraceptive efficacy be altered in small bowel disease

Answer 61

possibly reduced and malabsorption (crohns)

Question 62

people with autoimmune disease are more/ less at risk of VTE

Answer 62

more