Quote from earle58
i'm quite confident the hospice medical director is extremely qualified as to what meds could be absorbed through the intestinal mucosa.
a rather audacious statment, don't you think mr. carpenter, pa-c???
If it was small bowel intestinal mucosa I would agree. However, the large intestine has significantly different mucosa then the small bowel. In particular any medication that is protein bound or lipid bound will probably not be absorbed. You see similar effects in patients with short bowel syndrome or have had gastric bypass. These patients have at least some small bowel unlike patients with a colostomy. I can also show you significantly different absorption profiles between a J-tube and G-tube. Again these patients at least have some small bowel mucosa to absorb.
The other thing that is not stated is where the colostomy is. If it is an ileostomy for example there would be some absorption (but again little or no protein bound absorption). If this is a descending diverting colostomy then this has even less absorption than if it was given rectally. Look at it this way, if you ground up Lithium or Coumadin would you expect these to be absorbed? I would guess that some opiates would be aborbed since these can be given rectally. However I would have no way of knowing how much would be absorbed or how quickly. This is the reason that rectal medication are special preparations. Any other medication would be a complete crapshoot.
As for a hospice medical director knowing which meds could be absorbed through a colostomy, no I would not expect them to know this. Besides the fact that this is hopefully an unusual situation this is outside their area of expertise. I could ask the GI docs here and while they have probably the greatest knowledge about colonic absorption they would still defer to the pharmacist because the pharmacist has more knowledge about the absorption mechanism of a particular drug, whether it can be crushed and how that would affect the absorption. On the other hand I will defer to palliative care on palliative pain issues since that is their area of expertise.
This is the exact reason that all transplant programs are required to have dedicated pharmacists as part of their teams. I know to halve the prograf dose when the patient is on Diflucan. However, when I am trying to figure out Zosyn, Vanco, Micafungin, Acyclovir and Prograf dose and how the kinetics interact, I rely on the pharmacist because that is what they do for a living.
Bottom line is that PO meds are given PO for a reason. Assuming that giving them another route will produce the same effect is unwise in my opinion.
David Carpenter, PA-C