1. Section III: Pharmacological Therapies
Nonopioids
Opioids
Adjuvants
Routes of administration
APS, 2008; Pasero & McCaffery, 2011

2. Nonopioids Acetaminophen Analgesic and antipyretic
High doses can cause liver dysfunction
Use cautiously with older adults
Paice., 2015;
Pasero & McCaffery, 2011

3. Nonopioids: Role of NSAIDs
Antipyretic, anti-inflammatory, and analgesic
Toxicity
Adverse effects
Paice, 2015

4. Opioids: Most Commonly Used in Palliative Care
Buprenorphine
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Methadone
Morphine
Oxycodone
Oxymorphone
Tapentadol
Tramadol
Mechanism of action: Opioids block the release of neurotransmitters that are involved in the processing of pain

5. Opioids: Adverse Effects
Respiratory depression
Constipation
Sedation
Urinary retention
Nausea/vomiting
Pruritus
Myoclonus

6. Opioids: Definitions Addiction Tolerance Physiologic dependance
Paice, 2015

7. Adjuvant Analgesics: Antidepressants
Tricyclic antidepressants (TCAs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)

8. Adjuvant Analgesics: Anticonvulsants
Used for neuropathic pain
Gabapentin
Dose: 100 mg po TID and titrate gradually
Pregabalin
Dose: 50 mg TID x 1 wk then 100 mg BID or TID

9. Adjuvant Analgesics: Local Anesthetics
Topical: Lidocaine gel, lidocaine/prilocaine cream and lidocaine 5% patch
Intravenous
Spinal

10. Adjuvant Analgesics: Corticosteroids
Indications
Activates/increase appetite
Proximal muscle wasting
Administer - q am

11. Routes of Administration
Oral
Transmucosal
Buccal
Sublingual
Nasal
Rectal
Transdermal
Topical

12. Routes of Administration (cont.)
Parenteral
Intravenous
Subcutaneous
Intramuscular
Spinal
Epidural
Intrathecal

13. Lets Practice: A Case Study
Ms. T is 86-years-old
Two days ago, she fell and broke her hip and had surgery yesterday
Many co-morbidities (e.g. diabetes, CHF, renal failure), and diagnosed with stage III colon cancer 10 months ago
Morphine 1 mg/hr continuous rate with no breakthrough dosage
Assessment: Multiple sites of pain with pain score of “8” for incisional pain
Surgeon “I'm afraid of overdosing her”
Your response?