pain control in cancer patients. mscontin 10mg mscontin 30mg oxycontin 10mg oxycontin 40mg
TRANSCRIPT
![Page 1: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/1.jpg)
Pain Control in Cancer Patients
![Page 2: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/2.jpg)
![Page 3: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/3.jpg)
MScontin
10mgMScontin
30mg
Oxycontin
10mgOxycontin
40mg
![Page 4: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/4.jpg)
IR codon
5mg
Myprodol
Codein 10mg
Ibuprofen 200mg
Paracetamol 250mg
![Page 5: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/5.jpg)
Visual Analogue Scale
![Page 6: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/6.jpg)
WHO 3 단계 Guideline
1 단계 : 경도에서 중등도 통증 non-opioid±adjuvant2 단계 : weak opoid±non-opioid±adjuvant3 단계 : strong opoid±non-opioid±adjuvan
![Page 7: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/7.jpg)
Non-opioid Aspirin Acetaminophen NSAID Ibuprofen(Carol-FR) ¶good for inflammation, bone mets
![Page 8: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/8.jpg)
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
![Page 9: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/9.jpg)
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
![Page 10: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/10.jpg)
Morphine IV, SQ MS-contin Oxycontin Durogesic patch(fentanyl)
Strong Opioid
![Page 11: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/11.jpg)
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
![Page 12: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/12.jpg)
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
![Page 13: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/13.jpg)
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
![Page 14: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/14.jpg)
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
![Page 15: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/15.jpg)
KISS- Keep It Same and Simple Manage opioids side effects- Constipation must be treated prophyla
cticallyOpioids decrease- less than 25%
Dose Planning of Morphine
![Page 16: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/16.jpg)
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
![Page 17: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/17.jpg)
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
![Page 18: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/18.jpg)
![Page 19: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/19.jpg)
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
![Page 20: Pain Control in Cancer Patients. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg](https://reader036.vdocuments.pub/reader036/viewer/2022062314/56649ed15503460f94be077d/html5/thumbnails/20.jpg)
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 )