NCCN成人癌痛更新解读.pptVIP

2016NCCN成人癌痛更新解读;目录;疼痛定义被修正;癌痛管理原则之总论;患者与家属宣教;疼痛管理的目的更具体、可测量、以患者为中心 ;使用PADTTM评价4A’s;优化镇痛;优化日常活动;最小副作用;避免异常的药物相关行为;目录;全面筛查;阿片类药物处方的一般原则;阿片类药物处方的一般原则;“维持患者安全和减少长期阿片类药物使用中阿片误用和滥用的风险策略”;;;;;芬太尼贴剂剂量转换;芬太尼贴剂;supplemental medicinal fiber such as psyllium (eg, Metamucil) is unlikely to control opioid-induced constipation and is not recommended. (see NO.3 in Preventive Measures of Constipation) supplemental medicinal fiber such as psyllium (eg, Metamucil) is unlikely to control opioid-induced constipation and may worsen constipation. “便秘—预防措施”第3点将：复合物如美达施似乎不能控制阿片类药物诱发的便秘，不推荐使用修正为可能加重便秘的情况。 ;When response to laxative therapy has not been sufficient for opioid-induced constipation in patients with advanced illness, consider methylnaltrexone, 0.15 mg/kg subcutaneously, maximum one dose per day. (see NO.9 in If constipation persists of Constipation) When response to laxative therapy has not been sufficient for opioid-induced constipation in patients with advanced illness, consider methylnaltrexone, 0.15 mg/kg subcutaneously, maximum one dose per day. Other second-line agents include lubiprostone and naloxegol (FDA approved for opioid-induced constipation), and linaclotide (FDA approved for idiopathic constipation). “便秘—如果便秘持续存在”第9点增加了：其他二线药物包括鲁比前列酮和纳洛西酮（FDA批准用于阿片诱发性便秘），以及利那洛肽（FDA批准用于特发性便秘）。 ;在“Nausea—If nausea develops”这一节，下属6条目的顺序发生了变化，16版将15版的条目3放在了条目4的位置，将15版条目4放在了条目5的位置，将15版条目5提前到了条目3的位置，而且为15版的条目3和条目5增加了一些内容，具体如下：;Consider olanzapine, 2.5–5 mg, for patients with bowel obstruction. (see NO.3 in If nausea develops of Nausea，2015 V2) Consider orally disintegrating olanzapine, 2.5–5 mg PO daily, for patients with bowel obstruction. Olanzapine has lower risk of extrapyramidal reactions than typical antipsychotics such as haloperidol. (see NO.4 in If nausea develops of Nausea，2016 V1) 将：对于肠梗阻患者考虑使用奥氮平，2.5-5mg修正为对于肠梗阻患者考虑使用奥氮平口腔崩解片，每日2.5-5mg口服；奥氮平引发锥体外系反应的风险比像氟哌啶醇之类的典型抗精神疾病药物要低。 ;Consider adding a serotonin antagonist (eg, ondansetron, 8 mg PO 3 times a day; granisetron, 2 mg PO