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    Home > Active Ingredient News > Anesthesia Topics > Expert consensus on adverse reactions of analgesic drugs, get the main points in one article!

    Expert consensus on adverse reactions of analgesic drugs, get the main points in one article!

    • Last Update: 2021-08-03
    • Source: Internet
    • Author: User
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    The International Association for the Study of Pain (IASP ) defines pain as anunpleasant feeling and emotional experience related
    to actual or potential tissue damage .
    According to the pathophysiological mechanism, cancer pain is mostly mixed pain, with both nociceptive pain and neuropathic pain


    .


    The International Association for the Study of Pain (IASP ) defines pain as an unpleasant feeling and emotional experience related


    pixabay

    pixabay

    Pain is the result of the mutual influence of a person's physical, psychological, social, cultural and spiritual environment


    .


    Pain is the result of the mutual influence of a person's physical, psychological, social, cultural and spiritual environment


    The first stage selection non-steroidal anti-inflammatory drugs ( nonste- roidal Anti-inflammatory Drug , NSAID is ); a first phase of selecting a non-steroidal anti-inflammatory drugs ( nonste- roidal Anti-inflammatory Drug , NSAID is );

    The second stageif the NSAID can not relieve the pain, opioids can use weak or strong opioids are low dose combination and NSAID ;

    The second stageif the NSAID can not relieve the pain, opioids can use weak or strong opioids are low doses, and the combination of NSAID ; second stage as if the NSAID can not relieve the pain, can use weak opioid or by Low-dose strong opioids, and can be combined with NSAID ;

    The third stage: If the pain is still uncontrollable, strong opioids can be used, and NSAID can be combined


    .


    The third stage: If the pain is still uncontrollable, strong opioids can be used, and NSAID can be used in combination


    In addition, three ladder drugs simultaneously , to follow condition selected tricyclic antidepressants or anticonvulsants drugs such adjuvant


    1 , non-steroidal anti-inflammatory drugs 1 , non-steroidal anti-inflammatory drugs

    NSAID mainly through the inhibition of cyclooxygenase ( cyclooxygen- ASE , COX-.
    1 ) to generate a catalytic COX produce adverse reactions of gastrointestinalshould, while suppressing COX function, can inhibit platelet aggregation,thereby increasing the likelihood of gastrointestinal bleeding , Aggravate digestive ulcers
    .
    For a history of peptic ulcer, history of alcohol abuse or organ dysfunction (such as liver dysfunction) in terms of elderly patients, NSAID can lead to eliminateadverse effects of the system, such as peptic ulcer worse, long-term usewill cause gastric mucosal injury


    .


    NSAID mainly through the inhibition of cyclooxygenase ( cyclooxygen- ASE , COX-.


    Recommended: ① combination with proton pump inhibitors or misoprostol prophylaxisof peptic ulcer or switch selective COX-2 inhibitors; ② have cardiovascularpatients with vascular disease and avoid Aspirin


    2 , acetaminophen 2 , acetaminophen

    Acetaminophen analgesic is mainly used for a first step, solution containingheat-inflammatory and analgesic effects have not function
    .
    Acetaminophen bygenerating toxic liver microsomes metabolized to acetyl-p-benzoquinone imine, needto glutathione detoxification


    .


    Acetaminophen analgesic is mainly used for a first step, solution containing heat-inflammatory and analgesic effects have not function
    .
    Acetaminophen by generating toxic liver microsomes metabolized to acetyl-p-benzoquinone imine, need to glutathione detoxification
    .
    After long-term medication, glutathione is depleted , the acetyl benzoquinone imine form a covalent bond with the liver, kidney protein molecule irreversible binding, cause liver cells, renal tubular cells bad die
    .
    Therefore, the adverse reactions of acetaminophen are mainly reflected in two aspects of
    liver damage and kidney damage .
    Excessive use of acetaminophen can cause liver failure and even death in patients.
    Patients with low renal function are prone to adverse reactions such as renal colic
    .

    Recommendation: ①Try not to use it in combination with opioids
    .
    ② limiting system of acetaminophen daily intake of phenol no more than 4 G , suffering from long-term use of those daily intake of no more than 3 G
    .
    Recommended grade: A
    .

    Recommendation: ①Try not to use it in combination with opioids
    .
    ② limiting system of acetaminophen daily intake of phenol no more than 4 G , suffering from long-term use of those daily intake of no more than 3 G
    .
    Recommended grade: A
    .
    Recommendation: ①Try not to use it in combination with opioids
    .
    ② limiting system of acetaminophen daily intake of phenol no more than 4 G , suffering from long-term use of those daily intake of no more than 3 G
    .
    Recommended grade: A
    .

    3.
    Opioids

    3 , opioids 3 , opioids

    Constipation is opioid analgesics intolerable adverse reactions should generally be continued during the treatment of pain in opioid now
    .
    Recommendations: ①In the course of opioid use, combined use of laxatives (osmotic laxatives or stimulant laxatives) to prevent constipation , pay attention to the increase in the dose of opioids, but also increase the dose of laxatives appropriately .
    ② When emphasis constipation patients, the exclusion of constipation as a result of other causes of obstruction, the patient needs to drop a given laxatives, patients 1 ~ 2 d unforced defecation 1 times or in combination with secondary co-medication reduced opioid dose .
    ③If laxatives are not sufficient to treat opioid-induced constipation, they can be combined with peripherally acting opioid receptor antagonists, such as methylnaltrexone .
    Recommended grade : A .





    Constipation is opioid analgesics intolerable adverse reactions should generally be continued during the treatment of pain in opioid now
    .
    Recommendation: ①In the process of opioid use, joint use recommendation: ①In the process of opioid use, combined use of laxatives (osmotic laxative or stimulant laxative) to prevent the occurrence of constipation , pay attention to the increase in the dose of opioids Also moderately increase the dose of laxatives .
    ② When emphasis constipation patients, the exclusion of constipation as a result of other causes of obstruction, the patient needs to drop a given laxatives, patients 1 ~ 2 d unforced defecation 1 times or in combination with secondary co-medication reduced opioid dose .
    ③If laxatives are not enough to treat opioid-induced constipation, they can be combined with peripherally acting opioid receptor antagonists, such as methylnaltrexone .
    Recommended grade : A .
    Laxatives (osmotic laxatives or stimulant laxatives) to prevent the occurrence of constipation , pay attention to the increase in the dose of opioids should also moderately increase the dose of laxatives .
    ② When emphasis constipation patients, the exclusion of constipation as a result of other causes of obstruction, the patient needs to drop a given laxatives, patients 1 ~ 2 d unforced defecation 1 times or in combination with secondary co-medication dose decreased opioid


    .
    ③If laxatives are not sufficient to treat opioid-induced constipation, they can be combined with peripherally acting opioid receptor antagonists, such as methylnaltrexone
    .
    Recommended grade :
    A .

    Nausea and vomiting Approximately 40% of patients may experience nausea after using opioids, and 15% to 25% of patients may experience vomiting
    .
    Recommendations: ① When dealing with persistent nausea caused by opioids , increase therapies for different mechanisms of action, such as adding 5-HT receptor antagonists, scopolamine and other drugs to treat nausea .
    ② intestinal obstruction blocking the patient is recommended olanzapine .
    ③ Glucocorticoids are used in combination with metoclopramide and ondansetron .
    Recommended grade : A .




    Nausea and vomiting Approximately 40% of patients may experience nausea after using opioids, and 15% to 25% of patients may experience vomiting
    .
    Recommendations: ①Recommendation for dealing with persistent nausea caused by opioids: ①When dealing with persistent nausea caused by opioids , increase therapies for different mechanisms of action, such as adding 5 ‑HT receptor antagonists, scopolamine and other drugs.
    Treat nausea .
    ② intestinal obstruction blocking the patient is recommended olanzapine .
    ③ Glucocorticoids are used in combination with metoclopramide and ondansetron .
    Recommended grade : A .
    At the same time, increase therapies for different mechanisms of action, such as adding 5-HT receptor antagonists, scopolamine and other drugs to treat nausea .
    ② intestinal obstruction blocking the patient is recommended olanzapine .
    ③ Glucocorticoids are used in combination with metoclopramide and ondansetron .
    Recommended grade : A .



    Opioids on the central sedative effect, may be suppressed made Brain Stem of preBötzinger complex bonded body producing green of respiratory suction section rhythm , easily cause respiratory depression in patients, as well as opioids major cause of death
    .
    Recommendations: ①The overall symptoms of the patient are stable, non-invasive respiratory support should be given, and the patient's symptoms should be closely monitored .
    ②If the patient is in poor condition, naloxone is used to relieve symptoms .
    Naloxone was diluted with saline 10% ( 10 ml liquid in an amount of naloxone .
    1 ml ), each 30 to 60 to the second .
    1 ~ 2 ml , until the patient 's symptoms improved .
    ③ to accept the need for long-term opioid patients were treated, while taking naloxone considered to reduce the risk if necessary .
    Recommended grade : A .





    Opioids on the central sedative effect, may be suppressed made Brain Stem of preBötzinger complex bonded body producing green of respiratory suction section rhythm , easily cause respiratory depression in patients, as well as opioids major cause of death
    .
    Recommendations: ①The patient's overall symptoms are stable, and noninvasive respiratory support is given.
    Recommendation: ①The patient's overall symptoms are stable, and noninvasive respiratory support is given, and the patient's symptoms are closely monitored .
    ②If the patient is in poor condition, naloxone is used to relieve symptoms .
    Naloxone was diluted with saline 10% ( 10 ml liquid in an amount of naloxone .
    1 ml ), each 30 to 60 to the second .
    1 ~ 2 ml , until the patient 's symptoms improved .
    ③ to accept the need for long-term opioid patients were treated, while taking naloxone considered to reduce the risk if necessary .
    Recommended grade : A .
    Monitor patient's symptoms closely



    .
    ②If the patient is in poor condition, naloxone is used to relieve symptoms
    .
    Naloxone was diluted with saline 10% ( 10 ml liquid in an amount of naloxone .
    1 ml ), each 30 to 60 to the second .
    1 ~ 2 ml , until the patient 's symptoms improved
    .
    ③ to accept the need for long-term opioid patients were treated, while taking naloxone considered to reduce the risk if necessary
    .
    Recommended grade :
    A .

    Neurotoxicity ( opioid-induced neurotoxici- TY , OIN ) ranging from excessive sleepiness (sedation) to hallucinations, delirium, muscle array twin, seizures and hyperalgesia
    .
    Recommendation: ①For patients with OIN , it is recommended to change opioids or reduce the dose
    .
    ②For patients with delirium who require medical intervention , consider risperidone 0.
    25 to 0.
    5 mg , 1 to 2 times a
    day .
    For Parkinson's patients, consider using quetiapine
    .
    ③ according to need other opioids haloperidol, olanzapine, or risperidone or use drugs
    .
    Recommended grade :
    B .

    Neurotoxicity ( opioid-induced neurotoxici- TY , OIN ) ranging from excessive sleepiness (sedation) to hallucinations, delirium, muscle array twin, seizures and hyperalgesia
    .
    Recommendation: ①Recommendation : ①For patients with OIN , it is recommended to change opioids or reduce the dose
    .
    ②For patients with delirium who require medical intervention , consider risperidone 0.
    25 to 0.
    5 mg , 1 to 2 times a
    day .
    For Parkinson's patients, consider using quetiapine
    .
    ③ according to need other opioids haloperidol, olanzapine, or risperidone or use drugs
    .
    Recommended grade :
    B .
    For patients with OIN , it is recommended to change opioids or reduce the dose
    .
    ②For patients with delirium who require medical intervention , consider risperidone 0.
    25 to 0.
    5 mg , 1 to 2 times a
    day .
    For Parkinson's patients, consider using quetiapine
    .
    ③ according to need other opioids haloperidol, olanzapine, or risperidone or use drugs
    .
    Recommended level : B
    .

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    。②
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    Hyperalgesia Increased doses of long-term opioid therapy may cause opioid-induced hyperalgesia, leading to increased pain rather than relief
    .
    Recommended: ① plus adjuvant to the pharmaceutical art nerve block or reduce small amounts of opioid .
    ②Combine palmitoylethanolamide ( PEA ) and opioids to develop an individualized plan .
    Recommended grade : B .



    Hyperalgesia Increased doses of long-term opioid therapy may cause opioid-induced hyperalgesia, leading to increased pain rather than relief
    .
    Recommended: ① plus adjuvant drugs or nerve block technique Save Recommended: ① plus adjuvant to the pharmaceutical art nerve block or reduce small amounts of opioid .
    ②Combine palmitoylethanolamide ( PEA ) and opioids to develop an individualized plan .
    Recommended grade : B .
    Reduce the amount of opioids .
    ②Combine palmitoylethanolamide ( PEA ) and opioids to develop an individualized plan .
    Recommended grade : B .


    Immunosuppression receiving chronic opioid analgesic therapy patient's immune system is often suppressed, and further the outer circumference depletion of endogenous opioid analgesic acting substance mediated decrease opioid analgesic reactive energy
    .
    Recommendations: ①Choose non-opioid-dependent treatment options such as nerve block technology .
    ② with various opioid properties, the choice of free immune system suppression is not strong opioids such as buprenorphine, fentanyl Nigeria skinning agents and the like .
    Recommended grade : C .



    Immunosuppression receiving chronic opioid analgesic therapy patient's immune system is often suppressed, and further the outer circumference depletion of endogenous opioid analgesic acting substance mediated decrease opioid analgesic reactive energy
    .
    Recommendations: ①Recommendations for choosing non-opioid dependence such as nerve block technique : ①Choose non-opioid dependence treatment such as nerve block technique .
    ② with various opioid properties, the choice of free immune system suppression is not strong opioids such as buprenorphine, fentanyl Nigeria skinning agents and the like .
    Recommended grade : C .
    Treatment plan .
    ② with various opioid properties, the choice of free immune system suppression is not strong opioids such as buprenorphine, fentanyl Nigeria skinning agents and the like .
    Recommended grade : C .


    Endocrine disorders opioid primarily by HPA inner shaft secretion system impact which hypogonadism is now recognized as one of the adverse effects, while opioids may result in hyperprolactinemia, resulting in disorder of bone metabolism
    .
    Recommendation: If the patient has hypofunction of the adrenal cortex and hypogonadism, it is recommended to stop or reduce the dose of opioids and take appropriate hormone therapy
    .
    Recommended grade :
    A .

    Endocrine disorders opioid primarily by HPA inner shaft secretion system impact which hypogonadism is now recognized as one of the adverse effects, while opioids may result in hyperprolactinemia, resulting in disorder of bone metabolism
    .
    Recommendation: If the patient has hypofunction of the adrenal cortex and hypogonadism, it is recommended to stop or reduce the dose of opioids and take appropriate hormone therapy
    .
    Recommended grade :
    A .
    Recommendation: If the patient has hypofunction of the adrenal cortex and hypogonadism, it is recommended to stop or reduce the dose of opioids and take appropriate hormone therapy
    .
    Recommended grade :
    A .

    Drug addiction in a review of the data found that opioids an existing abuse with the available energy of of 32% , as addiction to be capable of to 23%
    .
    Opioid drug dependence because of their characteristics has been strictly regulated for patients, drug dependence is likely to cause withdrawal symptoms are likely to cause an opioid drug abuse and even poisoning, overdose were triad
    .
    Recommended: ① opioid follow strict regulations tubes controlled, regular administration, stratification and assessment of patients with drug-related behavior assessment, regular follow-up, focus on abnormal behavior of the drug in patients .
    ② in drug withdrawal symptoms when reducing the dose was administered naloxone rescue .
    Recommended grade : A .



    Drug addiction in a review of the data found that opioids an existing abuse with the available energy of of 32% , as addiction to be capable of to 23%
    .
    Opioid drug dependence because of their characteristics has been strictly regulated for patients, drug dependence is likely to cause withdrawal symptoms are likely to cause an opioid drug abuse and even poisoning, overdose were triad
    .
    Recommended: ① opioid follow strict regulations tubes controlled, regular administration, stratification and assessment of patients with drug-related behavior assessment, regular follow-up, focus on abnormal behavior of the drug in patients .
    ② in drug withdrawal symptoms when reducing the dose was administered naloxone rescue .
    Recommended grade : A .
    Recommended: ① opioid follow strict regulations tubes controlled, regular administration, stratification and assessment of patients with drug-related behavior assessment, regular follow-up, focus on abnormal behavior of the drug in patients .
    ② in drug withdrawal symptoms when reducing the dose was administered naloxone rescue .
    Recommended grade : A .


    Original source

    Original source

    Chinese Anti-Cancer Association Professional Committee tumor nutrition .
    Adverse drug reactions analgesic expert consensus .
    Tumor metabolism and electronic Journal of Nutrition 2021 Nian 4 Yue 9 Ri on 8 Volume 2 Qi

    Chinese Anti-Cancer Association Professional Committee tumor nutrition .
    Adverse drug reactions analgesic expert consensus .
    Tumor metabolism and electronic Journal of Nutrition 2021 Nian 4 Yue 9 on May 8 , Volume 2 Qi in this message
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