Pain ManagementDrug Therapy Workshop课件课件.pptVIP

Yale University School of Medicine Pain ManagementDrug Therapy Workshop The Concept of Total Pain World Health Organization (WHO) Step Ladder Approach Clinical Questions #1 Breakthrough pain dosing should be individualized, but a guide for determining the initial dose of bolus I.V. medication for a patient receiving a long acting oral form of morphine is that the initial breakthrough dose is what percentage of the total daily long-acting morphine dose? a. 10% b. 20% c. 50% d. 100% Answer #1 a. 10% Rationale:10% would be the minimum dose, Titrated to effect. The range is 10-20% Breakthrough Pain Patients on long-acting med always need second, short-acting med, for breakthrough pain to take Q 4 hours or less. Generally, dose of breakthrough opioid should be: 10% of 24 hour dose of analgesics and made available Q 2-4 hours. Example: MS Contin 60mg q12hrs breakthrough dose should be immediate release morphine (MSIR), 10-15 mg Q 2-4 hrs prn. Clinical Question #2 What is the maximum number of tablets of hydrocodone/acetominophen 5 mg/500 mg (e.g., Vicodin ?) you can safely prescribe for a 24 hour period. a. 4 b. 6 c. 8 d. There is no ceiling dose/maximum Answer #2 c. 8 Rationale: 4,000mg of acetominophen in 24 hours is safe for most patients, BUT ceiling dose may need to be modified significantly or the drug not used in patients with: renal or liver disease history of significant alcohol intake consider starting at 50% of standard ceiling dose for elders. Clinical Question #3 A 40 yr. old women with stage IV ovarian cancer reports mild to moderate burning pain in her hands and feet. Ibuprofen has not been effective. You suggest:  a. A COX-2 inhibitor b. Topical capsaicin c. A steroid d. An adjuvant with activity in neuropathic pain  Answer #3 d. An Adjuvant with activity in neuropathic pain Pain characterized by sharp, shooting, electric shocks, parethesias, dysesthesias, cold extremities Neuropathic pain often responds poo