Page 50 - CPG - Clinical Practice Guidelines - Management of Cancer Pain
P. 50

Management of Cancer Pain (Second Edition)
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                   Side Effects                 Management
                   Constipation  Faecal softeners
                                 •  lactulose
                                 •  macrogol
                                 Stimulant laxatives
                                 •  bisacodyl
                                 •  senna
                   Nausea and    Anti-emetics
                   Vomiting      •  Metoclopramide
                                 •  Haloperidol
                                 •  Prochlorperazine
                   Dry Mouth     Non-pharmacological treatment:
                                 •  Good oral hygiene
                                 •  Sugar-free chewing gum and candies/sweets
                                 •  Saliva stimulants (e.g. mouth spray/gel)
                   Sedation and   •  Opioid dose reduction, titrate to the lowest effective
                   drowsiness      dose, and consider opioid switching
                                 •  Methylphenidate and other psychostimulant drugs can
                                   be considered if necessary
                   Delirium and   •  Can be managed by dose reduction and opioid switching
                   neurotoxicity  •  Can consider using clonazepam, sodium valproate and
                   (e.g. confusion     baclofen for myoclonus
                   and myoclonus)  •  Can consider antipsychotics for delirium
                   Pruritus      •  May consider antihistamines
                                 •  Opioid switching may be necessary if the symptoms
                                   are severe

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                  that may occur during rapid titration.  It is uncommon during chronic
                                                9
                  administration.   When appropriately titrated against the patient’s pain,
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                  strong opioids do not cause clinically important respiratory depression. 34
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                  sedation assessment is a good early clinical indicator of opioid-induced
                  respiratory depression. 9

                  If  severe respiratory depression occurs (respiratory rate <8/minute),
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                  titrated every 1 - 3 minutes against the patient’s respiratory rate.
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                  analgesic effects  and  causes  major physical withdrawal syndromes.
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                  FDUGLDF DUUHVW KDYH EHHQ UHSRUWHG ZLWK QDOR[RQH XVH  34


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