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Pain Control in Cancer Patients

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

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Pain Control in Cancer Patients

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  1. Pain Control in Cancer Patients

  2. MScontin 10mg MScontin 30mg Oxycontin 10mg Oxycontin 40mg

  3. IR codon 5mg Myprodol Codein 10mg Ibuprofen 200mg Paracetamol 250mg

  4. Visual Analogue Scale

  5. WHO 3단계 Guideline 1단계: 경도에서 중등도 통증 non-opioid±adjuvant 2단계: weak opoid±non-opioid±adjuvant 3단계: strong opoid±non-opioid±adjuvan

  6. Non-opioid • Aspirin • Acetaminophen • NSAID Ibuprofen(Carol-FR) ¶good for inflammation, bone mets

  7. 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

  8. 가슴, 등, 혹은 팔 상부의 염증이 없고, 털이 없는 부위에 경피제를 부착하십시오. 보통 72시간마다 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 3일 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 patch사용법

  9. Strong Opioid • Morphine IV, SQ MS-contin • Oxycontin • Durogesic patch(fentanyl)

  10. 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

  11. Dose Planning of Morphine • 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

  12. Dose Planning of Morphine • 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

  13. Dose Planning of Morphine • 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

  14. Dose Planning of Morphine • KISS- Keep It Same and Simple • Manage opioids side effects • Constipation must be treated prophylactically Opioids decrease- less than 25%

  15. 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

  16. 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

  17. Side Effects of Morphine • Constipation: tolerance 없음 • Nausea/vomit: tolerance 있음. 1주후정도 자연 소실 대책: oral->iv, sc->->oral • Sleepy: 치료시작초기나 증량시->3~5일후 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->2~3분 간격으로 반복(반감기 1시간) (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

  18. Opioid에 잘 듣지 않는 pain =>opioid plus Adjuvant 1)neuropathic pain: etravil, neurontin 2)bone mets: bisphosphonate,RTx (pamidronate 60mg+NS 500ml ivf for 6hrs )

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