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oncology and pain management with an occupational therapy focus

Objectives. Describe and apply the basic principles of pharmacology to the drugs discussedIdentify the implications for occupational therapy evaluation and treatmentDescribe the disease process of osteosarcoma, its treatment, and their impact on occupational therapy evaluation and treatment.. CHEMOTHERAPY: BACKGROUND.

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oncology and pain management with an occupational therapy focus

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    1. ONCOLOGY AND PAIN MANAGEMENT WITH AN OCCUPATIONAL THERAPY FOCUS Jennifer Beall, Pharm.D. Assistant Professor, McWhorter School of Pharmacy Samford University

    3. CHEMOTHERAPY: BACKGROUND Most chemotherapy agents work by stopping growth of or killing cancer cells. Biological process involved include cell cycle, RNA and DNA synthesis. Newer cancer treatments attack cells from different ways: cutting off blood supply, identifying cancer cell as foreign, etc.

    4. CHEMOTHERAPY: CELL CYCLE G0: resting phase G1: pre-DNA synthesis S: DNA synthesis G2: post-DNA synthesis M: mitosis (actual cell division) Some chemotherapy drugs are cell-cycle-specific

    5. CHEMOTHERAPY: CONCEPTS Growth fraction: percent of dividing cells related to total population of cancer cells Total cell kill: every tumor cell that is able to divide must be killed to eliminate the cancer Other factors also affect a cell’s response to chemo: tumor-cell heterogeneity, drug resistance, dose intensity and patient-specific factors.

    6. CHEMOTHERAPY: SIDE EFFECTS Most common: bone marrow toxicity, GI upset, alopecia Some adverse effects are due to attack of rapidly-dividing cells Neurotoxicity possible with several drugs (see appendix)

    7. CHEMOTHERAPY: CATEGORIES Alkylating Agents Antimetabolites Antibiotics Plant Alkaloids Hormones Heavy Metal Compounds Miscellaneous Agents

    8. OSTEOSARCOMA Osteosarcoma is cancer of bone that occurs mainly in adolescents and young adults Surgery alone is not enough; patients will likely need chemotherapy The site of the tumor can determine prognosis Source:http://www.cancer.gov/cancerinfo/pdq/treatment/osteosarcoma/healthprofessional/#Section_1

    9. OSTEOSARCOMA (Cont’d) Chemotherapy regimens use methotrexate, doxorubicin, cyclophosphamide, cisplatin, ifosfamide, etoposide and carboplatin Surgery and radiation therapy can also be used

    10. ANALGESIA: BACKGROUND Physiology of pain: Stimulus activates nociceptors, which translates stimulus into an electrical signal Electrical signal is sent along the nerves to the spinal cord Pain is regulated in the CNS by opioid receptors

    11. ANALGESIA: TREATMENT WHO Analgesic ladder Non-opioids include acetaminophen (Tylenol®), NSAIDs, COX-2 inhibitors Combination products include Darvocet, Lortab, Vioden, Vicoprofen, Percocet Opioids include morphine, meperidine, codeine, oxycodone, hydrocodone

    12. ANALGESICS: NSAIDs Mechanism of action: inhibits cyclooxygenase, which stops prostaglandin and thromboxane synthesis Role of prostaglandins: ranges from vasodilation or –constriction, involved in inflammatory response, help produce fever, involved in dysmenorrhea Role of thromboxane: blood clotting

    13. ANALGESICS: NSAIDs COX-1 vs. COX-2: COX-1 is found in stomach mucosa, kidneys Role of COX-1: helps protect stomach lining from gastric acid; helps maintain renal function; helps regulate normal platelet activity COX-2 is produced by cells when they are injured Role of COX-2: helps produce prostaglandins to respond to pain and inflammation

    14. ANALGESICS: USES OF NSAIDs Treatment of pain / inflammation: these drugs are used for mild-moderate pain (i.e. muscle aches, arthritis, dysmenorrhea, post-surgical pain) Treatment of fever: ibuprofen is most common; aspirin should NOT be used in children with fever

    15. ANALGESICS: USES OF NSAIDs Treatment of vascular disorders: aspirin is commonly used for its inhibition of platelet aggregation to prevent MI or stroke Prevention of cancer: aspirin use may decrease risk of colon cancer; COX-2 inhibitors are being studied in preventing various types of cancer (skin, breast, colon)

    16. ANALGESICS: NSAID SIDE EFFECTS GI problems: Ranges from discomfort to ulceration May be prevented by using buffered or enteric-coated formulations Kidney problems Especially in those with renal dysfunction or the elderly

    17. ANALGESICS: NSAID SIDE EFFECTS Allergic-type reactions Rare; produces bronchospasm, urticaria Overdose Aspirin: symptoms range from tinnitus to metabolic acidosis Acetaminophen: can result in liver failure

    18. ANALGESICS: COX-2 INHIBITORS Products on market: celecoxib (Celebrex®), rofecoxib (Vioxx®), meloxicam (Mobic®), valdecoxib (Bextra®) Selective for COX-2 enzyme to reduce effects to GI tract, kidneys May still cause GI side effects (diarrhea, heartburn); may increase risk of upper respiratory tract infections

    19. ANALGESICS: ACETAMINOPHEN Mechanism of action unknown; possibly via prostaglandin inhibition Is analgesic and antipyretic; is not anti-inflammatory or anticoagulant May be toxic to liver, especially when used with alcohol

    20. ANALGESICS: OPIOIDS “Opioid” vs. “narcotic” Endogenous opioid receptors: Mu: causes sedation, respiratory depression, constipation Kappa: causes sedation, psychotic effects, constipation Delta: inhibits dopamine release

    21. ANALGESICS: OPIOIDS Agonists: acts primarily at mu receptors Agonist-antagonists: act as agonists at one type of receptor yet acts as antagonist at other types Antagonists: block opioid receptors

    22. ANALGESICS: OPIOIDS Mechanism of action: inhibition of transmission of the electrical signal across the synapse. Opioid receptors are located on pre-and post-synaptic neurons Decreases neurotransmitter release from presynaptic neuron; decreases excitability of postsynaptic neuron

    23. ANALGESICS: OPIOIDS Clinical applications: Used mostly for severe and chronic pain Strengths: no maximum dose, effective, available in several dosage forms (including PCA) Weaknesses: side effects (sedation, constipation, respiratory depression), potential for abuse and addiction

    24. ANALGESICS: OPIOIDS Addiction: psychological dependence, seen as continued need for drug for effects other than pain relief Tolerance: a larger dose is required to maintain the original effect Physical dependence: patient experience withdrawal symptoms if drug is suddenly discontinued

    25. CONCLUSION: SPECIAL CONCERNS FOR REHABILITATION PATIENTS Chemotherapy: Drugs that can cause neurotoxic effects Cancers that affect bone, or nervous system Analgesia: Drugs used to treat disorders requiring rehabilitation Side effects of opioids (i.e. sedation, dizziness) that require special handling of patients

    26. QUESTIONS?

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