S. Taniguchi

Initial Palliative Care Drugs' Side Effect

Introduction The initial palliative care includes pharmacological palliative treatment of pain, depression, anxiety, delirium, nausea and dyspnea. Objective: To study the drugs administered to oncologic patients in initial palliative care and its possible side effects. Methods: This retrospective study included 40 oncologic patients with mean age of 69+14.12 under initial palliative care. Results: Opioids, benzodiazepines, neuroleptics, non-steroidal anti-inflammatory drugs (NSAID), corticosteroids had been prescribed in initial palliative care. Opioids such as fentanyl 0.007 mg/kg/day (3.3%), meperidine 0.64 mg/kg/day (3.3%), tramadol 7.4 mg/kg/day (3.3%), methadone 0.2 mg/kg/day (6.70%) and morphine 0.05 mg/kg/day (70.0%) were given for pain control. For anxiolytic and sedative effects, benzodiazepines such as bromazepam 0.092 mg/kg/day (3.3%), diazepam 0.31 mg/kg/day (3.3%), lorazepam 0.012 mg/kg/day (6.7%), alprazolam 0.006 mg/kg/day (6.7%), midazolam 0.014mg/kg/day (13.0%), clonazepam 0.67 mg/kg/day (20.0%), were administered. Levomepromazine 0,65 mg/kg/day (6,70%), quetiapine 0,25mg/kg/day (6,7%), haloperidol 0,06 mg/kg/day (26,7%), chlorpromazine 0,13 mg/kg/day were the neuroleptics prescribed for delirium/hallucination. In pain adjuvant therapy, NSAID such as dipyrone 3.7 mg/kg/day (90.00%), ketoprofen 2.7 mg/kg/day (6.70%) and tenoxicam 0.79mg/kg/day (3.3%) were administered. To treat nausea/vomiting dexamethasone 0.11 mg/kg/day was given to 53.40% patients. Constipation (66,60%), urinary retention (33,30%), nausea/vomiting (33,30% and hypotension (16,60%), motor agitation (33,30%) were described in this study as pharmacological side effects. Conclusions: Drug-related agranulocytosis and hypotension should be observed with the administration of dypirone. Respiratory depression with the association of opiods and benzodiazepines; extrapyramidal side effect (akathisia) due to administration of neuroleptics and dexamethasone immunosuppression should be considered in these patients’ drug prescription.

Neuroleptic Administration to Oncologic Patients Under Palliative Care

Introduction Difficulties in controlling symptoms such as pain, breathlessness or delirium in palliative care patients, may require sedation as therapeutic strategy. Objective To study the drugs administered to patients under Palliative Care Sedation (PCS) and its possible side effects. Methods Our retrospective study included 40 oncological patients with mean age of 69+14.12 years old, under PCS. Results Morphine 0.35mg/kg/day, administered to 22,5% (9) patients, caused reduction of systolic blood pressure in 23.61%, diastolic blood pressure in 27.08%, heart rate in 6.09%, body temperature in 2.59%, respiratory rate in 18.26%. Morphine 0.35mg/kg/day associated with midazolam 0.42mg/kg/day, given to 35%(14) patients, caused reduction of systolic blood pressure in 24.63%, diastolic blood pressure in 27.58%, heart rate in 1.56%, body temperature in 1.58%, respiratory rate in 27.66%. The association of chlorpromazine 0.62mg/kg/day to morphine 0.35mg/kg/day and midazolam 0.42mg/kg/day administered to 42,5% (17) patients, also caused reduction of systolic blood pressure in 22.38%, diastolic blood pressure 20.00%, body temperature 1.79%, respiratory rate 22.00%, but the heart rate increased in 15.88%. The variations of vital signs were obtained by records registered right before the palliative care sedation had initiated and the values recorded in patients’ last day of life. The sedation period was 2,40+0,23days. Conclusion The association of neuroleptics could conduct to extrapyramidal motor agitation, in this case of deeply sedated patients it could be signed by the incresase of the heart rate. Considering the short period of time between the beginning of sedation and the patients’ death; and that palliative sedation should not include the hastening of patients’ death, we suggest a better drug association criteria.

P03-113 - Treatment of extrapyramidal symptoms due to neuroleptic drugs use

Introduction The extra pyramidal effects related to the use of neuroleptics are a limiting factor in schizophrenia treatment. Objective The aim of this study was to identify the neuroleptics prescribed for schizophrenic patients in a public health service, the extra pyramidal symptoms (EPS) incidence and its treatment. Methods Our restrospective study included 40 patients with mean age of 39.13 ± 2.19 in a treatment period of of 134.17 ± 16.83 days. The data were randomly collected from medical records of these patients. Results The patients under study received typical neuroleptics (31.03%),atypical agents (37.93%) or association of both (31.03%). EPS was observed in 65.52% patients of which, 44.83% even though receiving biperiden 2mg, still have EPS. 20.69% were not receiving anticolinergic drug treatment for EPS, but promethazine or anticonvulsants. From the 34.48% who did not showed EPS, 20.69% had biperiden prescription and 13.79 % had been treated with olanzapine, clozapine or risperidone associated or not to clonazepam 2mg. Weigth gain of 5.20 ± 1.14 kg was observed in our total sample. Conclusions We suggest the use of EPS evaluation scale (Sympson - Angus or Barnes). 65.52 % of the patients under study had EPS and 20.69% of them had no prescription of central acting anticholinergic drug. 44.83% even though receiving biperiden 2mg, still have EPS.