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Finals > Ostomies > Flashcards

Ostomies Flashcards

1
Q

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

A

enteral feeding tubes section in meds complete

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2
Q

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

A

ensure px continue to get their meds and nutrition

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3
Q

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

A

10ml

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4
Q

what type of syringe should be used for enteral feeding

A

enteral syringes

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5
Q

should drugs be mixed together for peg feeding yes or no

A

no

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6
Q

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

A

if they are the only licensed product

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7
Q

what class of drugs is 5fu

A

antimetabolite

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8
Q

give a brief explanation of why chemotherapy is given alongside radiotherapy

A

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

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9
Q

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

A

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

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10
Q

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

A

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

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11
Q

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

A

stoma care nurse

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12
Q

is constipation more common for colostomy or ileostomy

A

colostomy

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13
Q

what classes of medications can cause constipation

A

calcium containing antacids or opioids

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14
Q

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

A

surgical nursing support team

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15
Q

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

A

depression

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16
Q

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

A

peristalsis

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17
Q

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

A

methylcellulose
isphagula husk
sterculia

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18
Q

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

A

lactulose
macrogol
- retain water to inc stool volume

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19
Q

which type of laxative is a last resort

A

stimulant

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20
Q

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

A

Bisacodyl
docusate

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21
Q

what consideration should be made to the dose of stimulant laxatives

A

smallest dose to give a soft formed stool

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22
Q

why should stimulant laxatives not routinely be given to stoma patients

A

adaptation of stoma

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23
Q

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

A

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

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24
Q

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

A

double

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25
Q

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

A

in case of tummy bugs or looser stools

26
Q

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

A

get through security easier

27
Q

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

A

release gas or change pouch

28
Q

drug class of mesalazine

A

aminosalicylate

29
Q

how does mesalazine work to treat IBS etc

A

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

30
Q

what is the drug class of azathioprine

A

immunosuppressant

31
Q

moa of immunosuppressanst such as azathioprine

A

suppress IS, reduce inflamation, preventing rejection in organ transplantation

32
Q

azathioprine is usually titrated from what drug class

A

corticosteroids

33
Q

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

A

steroid resistant

34
Q

what monitoring is required azathioprine

A

toxicity throughout
fbc weekly first 4 weeks then every 3 months

35
Q

what are you looking for in blood tests when monitoring azathioprine

A

neutrophil and platelet depletion

36
Q

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

A

myelosuppression

37
Q

for mesalazine renal function should be monitored how often

A

before treatment, at 3 months and then annually

38
Q

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

A

unexplained bruising
bleeding
tiredness
malaise

39
Q

what enzyme metabolises azathioprine

A

tpmt

40
Q

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

A

myelosuppression

41
Q

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

A

tpmt

42
Q

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

A

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

43
Q

what JAK inhibitor may be used to treat these conditions

A

tofacitinib

44
Q

what integrin binding drug may be used in these conditions

A

vedolizumab

45
Q

what interleukin binding drug may be used in these conditions

A

ustekinumab

46
Q

ustekinumab

A

Ulcerative colitis

47
Q

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

A

steroid enemas or suppositories

48
Q

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

A

beans
chocolate
spicy food
raw fruit
spinach
sweeteners

49
Q

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

A

true

50
Q

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

A

magnesium containing antacids and methyldopa

51
Q

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

A

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

52
Q

what drugs should NEVER be used in the event of blockages

A

laxatives

53
Q

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

A

loperamide

54
Q

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

A

intestinal obstruction
so avoid long term use

55
Q

X in pouch can be used to reduce number of leaks

A

gelling agents

56
Q

what advice can you give patients to deal with pouch leakage

A

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

57
Q

what can be used to protect broken peristomal skin

A

stoma powder

58
Q

what leakage prevention products exist

A

skin barrier rings
paste
strips

59
Q

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

A

progesterone injections or birth control patch

60
Q

how may oral contraceptive efficacy be altered in large bowel disease

A

unlikely reduced

61
Q

how may oral contraceptive efficacy be altered in small bowel disease

A

possibly reduced
and malabsorption (crohns)

62
Q

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

A

more

Finals (30 decks)

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