pain control in cancer patients
DESCRIPTION
Pain Control in Cancer Patients. MScontin 10mg. MScontin 30mg. Oxycontin 10mg. Oxycontin 40mg. IR codon 5mg. Myprodol. Codein 10mg Ibuprofen 200mg Paracetamol 250mg. Visual Analogue Scale. WHO 3 단계 Guideline. 1 단계 : 경도에서 중등도 통증 non-opioid±adjuvant - PowerPoint PPT PresentationTRANSCRIPT
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Pain Control in Cancer Patients
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MScontin
10mgMScontin
30mg
Oxycontin
10mgOxycontin
40mg
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IR codon
5mg
Myprodol
Codein 10mg
Ibuprofen 200mg
Paracetamol 250mg
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Visual Analogue Scale
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WHO 3 단계 Guideline
1 단계 : 경도에서 중등도 통증 non-opioid±adjuvant2 단계 : weak opoid±non-opioid±adjuvant3 단계 : strong opoid±non-opioid±adjuvan
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Non-opioid Aspirin Acetaminophen NSAID Ibuprofen(Carol-FR) ¶good for inflammation, bone mets
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Weak Opioid Codeine phosphate initial dose: 20mg x 4~6/day effect: 30min->max. 2hr->duration:4~6hr max dose:200~300mg/day eqi dose of morphine: 1/6 of MS-contin¶dose-up: same NSAID plus codeine 20->30->40->50mg every 1~3d
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가슴 , 등 , 혹은 팔 상부의 염증이 없고 , 털이 없는 부위에 경피제를 부착하십시오 . 보통 72 시간마다 한번씩이나 의사의 지시대로 경피제를 교환하십시오 . 화상 , 베임 , 염증 부위에 경피제를 부착하지 마십시오 . 필요하다면 , 부착할 부위의 털을 자르십시오 ( 면도하지 마십시오 ). 염증을 피하기 위해 , 매번 다른 부위에 부착하고 같은 부위에 부착하게 될 때에는 적어도 3 일 간격을 두고 사용하십시오 . 경피제를 새로 부착하기 전에 , 먼저 붙였던 경피제를 떼어내는 걸 기억하십시오 . 사용하던 경피제는 반드시 접착력이 있는 면을 마주보게 반으로 접어서 붙이고 즉시 변기에 버린 후 물을 내리십시오 .
Fentanyl patch 사용법
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Morphine IV, SQ MS-contin Oxycontin Durogesic patch(fentanyl)
Strong Opioid
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Dose Planning of Morphine
3~5mg SQ, no pain for 4hr Start with MS-contin: x 3 of SQ dose
¶IV infusion is possible For rapid pain control or In poor GI intake * Morphine 20mg+NS 500ml->IVF at 20 μgtt/min
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Short-acting drug is given when needed every 2~3 hours
After 5~6 half-lives(1 day for morphine) basal daily requirment is determined.
Never use long acting opioids to control acute pain
Dose Planning of Morphine
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Titrate dose at least every 24hrs when pain is moderate, every 2hrs when pain is severe
Increase dose by 25-50% for moderate pain, 50-100% for severe pain
Rectal=oral, SQ=IM=IV
Dose Planning of Morphine
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Manage breakthrough pain with short acting opioids using 1/3 of single dose amount or 5-15% of total daily dose
Use Around The Clock pain medicine for ongoing pain not prn
Short-acting opioid is needed more than 3/day->long-acitng is increased
Dose Planning of Morphine
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KISS- Keep It Same and Simple Manage opioids side effects- Constipation must be treated prophyla
cticallyOpioids decrease- less than 25%
Dose Planning of Morphine
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PK Data of Strong Opioid
SQ morphine: 15min->max 30~60min MS-contin: max 2~3hr->duration 12hr Durogesic patch: release 25μg~50 μg/hr ex)50 μg x 24hr=1.2mg/day
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Equianalgesic Dose
Codeine=1/6 of MS-contin MS-contin=1/3~1/2 of IV,SQ morphine IV,SQ morphine=1/50 of fentanyl patch
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Side Effects of Morphine Constipation: tolerance 없음 Nausea/vomit: tolerance 있음 . 1 주후정도 자연 소실 대책 : oral->iv, sc->->oral Sleepy: 치료시작초기나 증량시 ->3~5 일후 tolerance 생김 통증이 없는 상태에서 졸음이 있으면 과량투여 가능성 Halucination/confusion: 과량 , 고령자 , 뇌종양 감량 필요 Respiratory depression 대책 : RR≤11:stop opioid RR≤8: naloxone 0.2mg IV->2~3 분 간격으로 반복 ( 반감기 1 시간 ) (seizure 유의 ) Dry mouth: 50% 에서 발생 대책 : 얼음물 , 비타민 C 음료 , 인공타약 Diaphoresis Iching: 경막외 투여시 발생이 많음 Urinary difficulty: 경막외 투여시 발생이 많음 Dizziness: 고령자에 많음 . 미리 보호자에게 설명
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Opioid 에 잘 듣지 않는 pain
=>opioid plus Adjuvant 1)neuropathic pain: etravil, neurontin 2)bone mets: bisphosphonate,RTx (pamidronate 60mg+NS 500ml ivf for 6hrs )