Spinal Cord Compression Pharmaceutical Issues
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Transcript Spinal Cord Compression Pharmaceutical Issues
Spinal Cord Compression
Pharmaceutical 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
Day
Dexamethasone daily
dose
Administration
1-3
16mg
16mg OM or
8mg BD
(8am & 12noon)
4-6
8mg
8mg OM
7-9
4mg
4md OM
10-12
2mg
2mg OM
13
Discontinue
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
Maintaining regular bowel action is
important for patient comfort
Psychological issues also need to be
overcome e.g. patients embarrassment at
needing to be assisted with toileting
Laxatives
Oral laxatives may be ineffective or inappropriate
Reflex bowel
Patient has little/no awareness of bowel fulness
Reflex function of the rectum remains
Fast acting rectal measures most appropriate
Bisacodyl suppositories or sodium citrate enemas (1530mins to effect)
If hard stools, glycerol suppository
Flaccid bowel
May need digital removal
No laxatives recommended
Pain Control
Analgesia
WHO Pain ladder
NICE neuropathic pain guidance
Bone Pain
Zoledronic Acid (IV)
Check Renal function
Denosumab (SC)
Licensed for prevention of skeletal events
Any Questions?