Cord Compression Pharmaceutical Issues脊髓压迫症的药物问题课件.pptVIP

Spinal Cord CompressionPharmaceutical Issues Rebecca Mills Senior Clinical Pharmacist Points to Cover Steroids Dose Adverse effects Counselling Thromboprophylaxis Laxatives Steroids Reduce inflammation around the tunour cord oedema Reduce pain Preserve neurological function Increase number of patients who remain ambulatory High dose initially Reduce rapidly Where good results possible to stop steroid treatment completely Choice and dose of steroid Use dexamethasone Dose is 16mg per day divided into 2 doses (N.B.= approx 100mg prednisolone) Trials compared 16mg per day with 96mg per day showed more side-effects with higher dose Give after Breakfast and Lunch. Reduce dose over 2 weeks can cause problems if stopped suddenly. If symptoms worsen increase dose/reduce more slowly. Some patients may be on maintenance steroids. WPH Reducing regimen Adverse Effects Gastric irritation Take after food. PPI cover Lansoprazole 15mg OD Only for the duration of the steroids. Increased Appetite Impaired glucose tolerance Mood disturbances Fluid retention Long-term adverse effects Osteoporosis Muscle weakness Reduced healing/ability to fight infection Care around people with chicken pox/ measles/influenza Glaucoma Impaired healing “Cushing’s Syndrome”…… Points to remember Take steroids with or after food Avoid take steroids later than 4pm Dexamethasone can be dispersed in water given via PEG/NG (off license) Dexamethasone liquid is available If the patient has had other courses of steroids in the last year they may need to reduce the dose more slowly Avoid contact with anyone with suspected chicken pox or shingles. Check the patient understands how to reduce their dose. Thromboprophylaxis Active Cancer Reduced Mobility Inpatient hospital stay = VTE Risk Prescribe thromboprophylaxis unless contra-indicated. Consider if thromboprophylaxis is indicated on discharge – immobility? Laxatives Constipation often associated with mSCC Can be one of the presenting symptoms Maintainin