Question

Mr. Santiago is a 70 y/o male with dx of Prostate CA with bone metastasis admitted to Palliative Care unit to receive end-of-life care. He has also hx of DM, HT and GERD. His pain is currently managed with Oxycontin 80 mg q 12 hrs plus Morphine 10 mg/5ml 10ml q 4hrs prn for breakthrough pain. He is still able to verbalize, although he is showing signs of deterioration, with decreased appetite and dysphagia. He rates his pain intensity as 8/10 during the last days, but has not asked for his breakthrough pain medication because he does not want to "bother the staff." He also complains of constipation, in spite of being treated with Senokot-S 2 tabs at bedtime as laxative agent.

1. The team’s physician suggests switching Oxycontin to Fentanyl patch and asks you about the recommended conversion dose.

2. What other recommendations would you have for this patient?

Answer 1

Fentanyl transdermal patch is effective to treat chronic pain especially in opioid tolerance.

action -this drug can change the way body feel and responds to pain .However ,nausea ,vomiting,constipation ,headache,loss of appetite,severely low blood pressure ,stomach cramps  are its common sideeffects

this patient has constipation and decreased appetite therefore the effect of fentanyl has to be better double checked

constipation is very common side effect of fentanyl -dietary changes ,laxatives and stool softners are necessary to treat constipation due to fentanyl

drop in blood pressure is common with dosage changes - after the first dose docter may increase dose of fentanyl during this time frequent blood pressure monitoring is needed to prevent complications

clinical monitoring

1 monitor breath rate - because ther is a chance of slowed breathing or changes in normal pattern

2 check liver and kidney function before starting fentanyl

3 maintain blood pressure

OTHER TREATMENT METHODS

PALLIATIVE RADIATION provides pain relief in case of localized bone pain

BISPHOSPHONATES - CAN IMPROVE BONE PAIN AND DELAY OR PREVENT BONE METASTASIS