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Spinal Cord Compression Pharmaceutical Issues

Spinal Cord Compression Pharmaceutical Issues. Rebecca Mills Senior Clinical Pharmacist. Points to Cover. Steroids Dose Adverse effects Counselling Thromboprophylaxis Laxatives. Steroids. Reduce inflammation around the tunour & cord oedema Reduce pain Preserve neurological function

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Spinal Cord Compression Pharmaceutical Issues

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  1. Spinal Cord CompressionPharmaceutical Issues Rebecca Mills Senior Clinical Pharmacist

  2. Points to Cover • Steroids • Dose • Adverse effects • Counselling • Thromboprophylaxis • Laxatives

  3. Steroids • Reduce inflammation around the tunour & cord oedema • Reduce pain • Preserve neurological function • Increase number of patients who remain ambulatory • High dose initially • Reduce rapidly • Where good results possible to stop steroid treatment completely

  4. Choice and dose of steroid • Use dexamethasone • Dose is 16mg per day divided into 2 doses (N.B.= approx 100mg prednisolone) • Trials compared 16mg per day with 96mg per day showed more side-effects with higher dose • Give after Breakfast and Lunch. • Reduce dose over 2 weeks • can cause problems if stopped suddenly. • If symptoms worsen increase dose/reduce more slowly. • Some patients may be on maintenance steroids.

  5. WPH Reducing regimen

  6. Adverse Effects • Gastric irritation • Take after food. • PPI cover • Lansoprazole 15mg OD • Only for the duration of the steroids. • Increased Appetite • Impaired glucose tolerance • Mood disturbances • Fluid retention

  7. Long-term adverse effects • Osteoporosis • Muscle weakness • Reduced healing/ability to fight infection • Care around people with chicken pox/ measles/influenza • Glaucoma • Impaired healing • “Cushing’s Syndrome”……

  8. Points to remember • Take steroids with or after food • Avoid take steroids later than 4pm • Dexamethasone can be dispersed in water & given via PEG/NG (off license) • Dexamethasone liquid is available • If the patient has had other courses of steroids in the last year they may need to reduce the dose more slowly • Avoid contact with anyone with suspected chicken pox or shingles. • Check the patient understands how to reduce their dose.

  9. Thromboprophylaxis • Active Cancer • Reduced Mobility • Inpatient hospital stay = VTE Risk • Prescribe thromboprophylaxis unless contra-indicated. • Consider if thromboprophylaxis is indicated on discharge – immobility?

  10. Laxatives • Constipation often associated with mSCC • Can be one of the presenting symptoms • Maintaining regular bowel action is important for patient comfort • Psychological issues also need to be overcome e.g. patients embarrassment at needing to be assisted with toileting

  11. Laxatives • Oral laxatives may be ineffective or inappropriate • Reflex bowel • Patient has little/no awareness of bowel fulness • Reflex function of the rectum remains • Fast acting rectal measures most appropriate • Bisacodyl suppositories or sodium citrate enemas (15-30mins to effect) • If hard stools, glycerol suppository • Flaccid bowel • May need digital removal • No laxatives recommended

  12. Pain Control • Analgesia • WHO Pain ladder • NICE neuropathic pain guidance • Bone Pain • Zoledronic Acid (IV) • Check Renal function • Denosumab (SC) • Licensed for prevention of skeletal events

  13. Any Questions?

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