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How can you ease Opioid SEs?
Dose related = Start low and go slow
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What is the most common Opioid SE?
Constipation
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Do patients become tolerant to Opioid induced constipation?
No
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What type of laxative is preferred for Opioid induced constipation?
Stimulant
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What type of laxative should be cautioned for Opioid induced constipation and why?
- Fiber laxatives may worsen problem if taken with inadequate fluid
- Docusate does nothing for peristalsis
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What is the max time period a patient should go without a Bowel movement?
3 days
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When you increase opioids, what other medication should you potentially also increase?
Laxatives
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If constipation develops and a patient is already on a laxative, what suggestions can you make?
- Titrate to max laxative dose
- Consider co-analgesic to reduce opioid dose
- Add another agent adjunctively
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Do Opioid antagonists provide analgesia, anti-inflammatory effects or fever reduction?
No
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What class of drug is Alvimopan (Entereg)?
Opioid antagonist
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What is the brand name for Alvimopan?
Entereg
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What situation is CI for Alvimopan (Entereg)?
Having taken opioids more than 7 days
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How long can you use Alvimopan (Entereg)?
15 days max
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What risks are there to taking Alvimopan (Entereg)?
Increaseed MI risk
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What is the brand name for Methylnaltrexone?
Relistor
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What is Methylnaltrexone (Relistor) used for?
- Opioid induced constipation
- (Opioid antagonist)
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Do patients become tolerant to opioid induced nausea?
Yes, most patients
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Ho can you treat Opioid induced nausea?
- Antiemetics: Phenothiazines:
- Prochlorperazine 10 mg
- Promethazine 25 mg
- NOT ZOFRAN
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How can you prevent opioid induced nausea?
- Send patients with medication when starting opiods
- Antiemetics: Phenothiazines:
- Prochlorperazine 10 mg
- Promethazine 25 mg
- NOT ZOFRAN
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When would you expect patients to develop opioid induced sedation?
With initiation of therapy
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Do patients develop tolerance to opioid induced sedation?
Yes, usually
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How can you treat opioid induced sedation?
Stimulants like Modafenil or methylfenidate
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How can you prevent opioid induced sedation?
Start low and go slow
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What constitutes respiratory depression?
< 8 breaths/minute
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When should you give opioid antagonistswith respiratory depression?
When unarousable
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What are the opiod antagonists used to treat respiratory depression?
- Naloxone (Narcan)
- Naltrexone
- Nalmefene
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How can you treat Opioid allergies?
- Switch classes
- Reduce dose
- Give an antihistamine
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How can caffeine be used in the treatment of pain?
Reduce total dose of NSAIDs or opioids
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Cn you cut lidocaine patches?
Yes
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Can you cut Fntanyl patches?
No
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Bupivicaine comes in what dosage form?
ER liposomal
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What classes of drugs serve as Pan adjuvants?
- TCAs
- SSNRIs
- Anticonvulsants
- Corticosteroids
- Anesthetics
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Under what situation would you use antidepressants as an adjunct to pain medication?
Chronic and neuropathic pain
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What situation warrants the use of adjunctive SNRIs, Duloxetine and Venlafaxine for pain treatment?
- Fibromyalgia
- Diabetic neuropathy
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What are the precautions and CIs for TCA adjunctive therapy in pain treatment?
CI: coronary disease/ventricular arrhythmias, get an EKG before starting
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Would you use a higher or lower dose to treat pain with a TCA than you would use to treat depression?
Lower
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What type of pain are TCAs good at treating?
Neuropathic pain
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What anticonvulsants can be used for pain?
- Gabapentin
- Pregabalin
- Carbemazepine
- Divalpoate
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What is the MOA of anticonvulsants in treating pain?
Reduce membrane excitability, but not completely understood
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What type of pain would you treat with anticonvulsants?
- Neuropathic and Chronic
- Trigeminal neuralgia
- Postherpetic neuropathy
- Diabetic and peripheral neuropathy
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What types of pain can be treated by local anesthetics?
acute and chronic localized pain
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