cord compression pharmaceutical issues脊髓压迫症的药物问题课件

Spinal Cord Compression Pharmaceutical Issues Rebecca Mills Senior Clinical Pharmacist Points to Cover pSteroids nDose nAdverse effects nCounselling pThromboprophylaxis pLaxatives Steroids pReduce inflammation around the tunour & cord oedema nReduce pain nPreserve neurological function nIncrease number of patients who remain ambulatory pHigh dose initially pReduce rapidly pWhere good results possible to stop steroid treatment completely Choice and dose of steroid pUse dexamethasone pDose is 16mg per day divided into 2 doses (N.B.= approx 100mg prednisolone) pTrials compared 16mg per day with 96mg per day showed more side-effects with higher dose pGive after Breakfast and Lunch. pReduce dose over 2 weeks ncan cause problems if stopped suddenly. nIf symptoms worsen increase dose/reduce more slowly. nSome patients may be on maintenance steroids. WPH Reducing regimen DayDexamethasone daily doseAdministration 1-316mg16mg OM or 8mg BD (8am & 12noon) 4-68mg8mg OM 7-94mg4md OM 10-122mg2mg OM 13Discontinue Adverse Effects pGastric irritation nTake after food. nPPI cover Lansoprazole 15mg OD Only for the duration of the steroids. pIncreased Appetite pImpaired glucose tolerance pMood disturbances pFluid retention Long-term adverse effects pOsteoporosis pMuscle weakness pReduced healing/ability to fight infection nCare around people with chicken pox/ measles/influenza pGlaucoma pImpaired healing p“Cushings Syndrome” Points to remember pTake steroids with or after food pAvoid take steroids later than 4pm pDexamethasone can be dispersed in water & given via PEG/NG (off license) pDexamethasone liquid is available pIf the patient has had other courses of steroids in the last year they may need to reduce the dose more slowly pAvoid contact with anyone with suspected chicken pox or shingles. pCheck the patient understands how to reduce their dose. Thromboprophylaxis pActive Cancer pReduced Mobility pInpatient hospital stay = VTE Risk pPrescribe thromboprophylaxis unless contra-indicated. pConsider if thromboprophylaxis is indicated on discharge immobility? Laxatives pConstipation often associated with mSCC pCan be one of the presenting symptoms pMaintaining regular bowel action is important for patient comfort pPsychological issues also need to be overcome e.g. patients embarrassment at needing to be assisted with toileting Laxatives pOral laxatives may be ineffective or inappropriate pReflex bowel nPatient has little/no awareness of bowel fulness nReflex function of the rectum remains nFast acting rectal measures most appropriate nBisacodyl suppositories or sodium citrate enemas (15- 30mins to effect) nIf hard stools, glycerol suppository pFlaccid bowel nMay need digital removal nNo laxatives recommended Pain Control pAnalgesia nWHO Pain ladder nNICE neuropath