Pancreatic enzyme replacements: Nursing pharmacology

Pancreatic enzyme replacement therapy is the administration of digestive enzymes that are normally produced by the pancreas to digest food.

Pancreatic enzyme replacement is primarily used in conditions that result in pancreatic enzyme deficiency, such as cystic fibrosis, chronic pancreatitis, pancreatic duct obstruction like by tumors, and surgeries like pancreatectomy.

Additionally, it can be used in conditions that cause insufficient secretion of pancreatic enzymes, such as gastric and intestinal resection surgeries.

The main pancreatic enzyme replacement available is pancrelipase, which can be administered orally, immediately before or with a meal or snack.

Now, the medication is covered with an enteric coat that protects them from gastric acid, so they can safely reach the duodenum.

Once there, the tablet coat dissolves in the alkaline environment and releases the replacement enzymes, which perform the function normally accomplished by the pancreatic enzymes.

These include amylase, proteases, and lipase. Amylase digest carbohydrates into smaller units of glucose molecules.

On the other hand, proteases include trypsin and chromatrypsin, which break down proteins into amino acids. Finally, lipase digests lipids like triglycerides into glycerol and fatty acids.

These smaller molecules are then absorbed across the intestinal cells into the bloodstream. Now, pancreatic enzyme replacement therapy is generally safe and well-tolerated.

However, some clients may experience gastrointestinal side effects like abdominal pain, nausea and vomiting, flatulence, constipation, or diarrhea.

Pancreatic enzyme replacement can also affect blood glucose level, so these clients should undergo frequent blood glucose monitoring.

Other side effects include headaches, ear pain, nasal congestion, and a cough. Less common side effects include dizziness, epistaxis, gallstones, and pruritis, such as pruritis ani due to irritation of the skin around the anus.

Pancreatic enzyme replacement is extracted from pig pancreas, so it is contraindicated in clients with hypersensitivity to porcelain products.

In addition, as a precaution, it should not be used during pregnancy and breastfeeding. Finally, pancreatic enzyme replacement therapy should be used with caution in clients with Crohn's disease, pancreatitis, or diabetes mellitus.

Now, if your client with chronic pancreatitis is prescribed pancreatic enzyme replacement, first obtain a focused health history and assessment.

Ask about past and current gastrointestinal symptoms such as abdominal pain and cramping after meals, indigestion, vomiting, and steadarrhea or fatty stools.

Also ask about their nutritional intake, food preferences, and typical daily diet, as well as recent weight loss. Then, assess your client's weight and vital signs, observing for signs of hypotension or dehydration.

Lastly, note recent laboratory test results, including albumin, calcium, magnesium, phosphate, glucose, uric acid, as well as Vitamin D E, and B12 levels.

And note the results of tests for fecal fat and elastase. Next, be sure to explain how the prescribed medication works to improve digestion and decrease symptoms like abdominal pain and steadarrhea.

Emphasize the importance of taking the medication as prescribed with every meal or snack, and to swallow their medication whole without crushing or chewing.

If they need to take an antacid, teach them to separate their antacid and pancreatic enzyme by 2 hours. Be sure to teach your client about dietary modifications they can make to help decrease their symptoms.

Explain how pancreatic stimulation can be decreased by eating small, frequent meals that are nutrient-dense, high in protein, and low in fat.

Advise them to choose whole grain products, fruits and vegetables, as well as to avoid refined sugar and fatty foods, and to abstain from alcohol and smoking.

In addition, teach your client to recognize symptoms of steadorrhea, which are pale, loose, malodorous stools. And let them know these stools should decrease with adherence to pancreatic enzyme replacement therapy and the recommended dietary modifications.

Lastly, teach your client to report persistence of side effects such as headache and flatulence, and to report symptoms of elevated uric acid levels, such as painful, swollen joints, as well as symptoms of hyperglycemia like frequent urination and increased thirst and appetite.

Finally, monitor your client for resolution of symptoms and for problems such as elevated uric acid and blood glucose, as well as manifestations of malabsorption like decreasing weight, steadorrhea, and osteoporosis.

Alright, as a quick recap, pancreatic enzyme replacement is used to replace deficient pancreatic enzymes such as lipase, protease, and amylase.

A common side effect is constipation, but the client may also experience abdominal pain, flatulence, and diarrhea. Nursing considerations involve obtaining a complete dietary history and monitoring for pancreatic insufficiency, including steadorrhea, malabsorption, and weight loss.

Clients should be counseled about taking their medication as prescribed, adhering to recommended dietary modifications, and abstaining from alcohol and smoking.

Finally, nursing considerations are also focused on teaching about self-monitoring for potential side effects.