MSNE 5356 Application Paper PP

2.  Opioid Analgesic Narcotic
 opioid (mu) receptor agonist, and an N-methyl-D receptor
(NMDA), dual mechanism
 Reserved for moderate to severe pain
 Pain not relieved by non-narcotics
 Changes how brain and nervous system responds to
pain

3.  Leading disease of adult in Western World
 Studies indicate those with ulcerative colitis over 10
years have 3-fold increase of developing colon
cancer
 Treatment chemotherapy, radiation, pain
management
 Colon Cancer account for 9-10%of all deaths in the
U. S.

4.  Activates opioid receptors on surface of cancer cell
 Increased by grapefruit
 Decreased by Phenobarbital
 MAO inhibitor stopped within 14 days

5.  Prolonged QT interval
 CNS depression
 EKG required 24-72 hours after start or upon
increase of dosing
 Constipation
 Accumulation side effects:
 Sedation
 Nausea
 Respiratory depression

6.  90% Bioavailability
 Vary extremely among individuals
 Caution in elderly cancer patients taking multiple
medications
 Limit medications that inhibit or stimulate the P450
system, in order to avoid interactions and
undesirable side effects

7.  Bound to plasma tissue protein, metabolized by:
 The NMDA receptor is activated when glutamate
and glycine (or D-serine) binds to it when activated
it allows positively charged ions to flow through the
cell membrane.
 Methadone is metabolized by the CYP3A4 and
CYP-450 enzyme system and is a substrate for the
P-Glycoprotein efflux protein in the intestine and
brain

8.  Interdisciplinary environment
 Evidenced-based best practice guidelines
 Methadone prescribing guidelines
 Trusting therapeutic relationship
 Patient education

9.  Goal for elderly cancer patient to have decreased
pain and improved quality of life
 Appropriate assessment tools for elderly
 May require lower dose of methadone
 Monitor comorbidities
 Monitor polypharmacy

10.  Arcangelo, V. P., Wilbur, V. F., (2017). Principles of Pharmacology in Pain Management. In V. P. Arcangelo (Eds.),
Pharmacotherapeutics for advanced practice a practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer.
 Arcangelo V P Peterson A M Wilbur V Reinhold J A 2017 Pharmacotherapeutics for Advanced Practice A Practical
Approach20171025105455713663697Arcangelo V P Peterson A M Wilbur V Reinhold J A 2017 Pharmacotherapeutics for
Advanced Practice A Practical Approach Czosnowski, Q. A., Whitman, C. B., Aykroyd, L., (2017). Principles of
Pharmacology in Pain Management. In V. P. Arcangelo (Eds.), Pharmacotherapeutics for advanced practice a practical
approach (4th ed.). Philadelphia, PA: Wolters Kluwer.
 Division of Unintentional Injury Prevention National Center for Injury Prevention and ControlCenters for Disease Control and
Prevention. (2013). Challenges in the Management of Opioid-Using Patients in Emergency Departments. Retrieved from
http://www.jointcommission.org/assets/1/18/Updated_approved_CDC_slides_to_post_
ED_Opioid_Use_webinar_in_PDF.pdf
 ED_Opioid_Use_webinar_in_PDF.pdf
 Lugo, R. A., Satterfield, K. L., Kern, S.E. (2005). Pharmacokinetics of methadone. PubMed, 19(4), 13-24. Retrieved from
 Peirano, G.,Mammana,G. Bertolino, M., Pastrana, T., Vega, G., Russo, J., & ... Ruggiero, R. (2016). G., Mammana, G., Bertolino,
M., Pastrana, T., Vega, G., Russo, J., & Ruggiero, R. (2016). Methadone as first-line opioid treatment for cancer pain in a
developing country palliative care unit. Supportive Care In Cancer, 24(8), 3551-3556. doi:10.1007/s00520-016-3191-5
 https://www.ncbi.nlm.nih.gov/pubmed/16431829
 Schreiber, J. A. (2013). We've come a long way: A review of cancer pain management. Oncology Nursing Forum, 40(2), 106-108.
 Virshup, D. M., (2010). Biology, Clinical Manifestations, and Treatment of Cancer. In K. H. McCane (Eds.), Pathophysiology: The
Biologic Basis for Disease in Adults and Children, 6th Edition. [Pageburstl]. Retrieved from Afsharimani, B., Kindl, K.,
Good, P., & Hardy, J. (2015). Pharmacological options for the management of refractory cancer pain-what is the evidence?.
Supportive Care In Cancer, 23(5), 1473-1481. doi:10.1007/s00520-015-2678-9