Sample Answer for NUR-635 Topic 14 DQ 2 Included After Question
Review your patient from Topic 14 DQ1 and answer the following questions, taking into consideration the patient’s pain. Include your references in APA format.
Select a medication and discuss the ethnic, cultural, or genetic differences in the use and consideration for cancer pain.
Share the mechanism of action of this medication and hints for monitoring side effects and drug interactions, including interactions with CAM.
Discuss evidence and treatment guidelines to determine appropriate therapeutic options for a patient with cancer pain.
Elaborate on a pain management strategy for adequate pain management.
American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2
A Sample Answer For the Assignment: NUR-635 Topic 14 DQ 2
Title: NUR-635 Topic 14 DQ 2
Medication
Oxycodone is appropriate for treating cancer pain.
Mechanism of Action
Oxycodone is a semisynthetic opioid with agonistic properties on mu, kappa, and delta-type opioid receptors, with the strongest affinity being for mu-type receptors. Upon binding to these G-protein coupled receptors, oxycodone stimulates the exchange of GDP on the G-alpha subunit for GTP, resulting in the inhibition of adenylate cyclase and a decrease in intracellular cAMP. This signal cascade leads to a consequent inhibition of the nociceptive neurotransmitters acetylcholine, dopamine, GABA, noradrenaline, and substance P and the hormones glucagon, insulin, somatostatin, and vasopressin. As with other opioids, oxycodone causes hyperpolarization and reduced excitability of neurons in the central nervous system (CNS). This generalized CNS depression results from the agonistic effect on kappa-type receptors, leading to N-type voltage-gated calcium channel closure. In contrast, stimulation of the mu and delta-type receptors opens calcium-dependent inward-rectifying potassium channels (Sadiq et al., 2022).
Side Effects
Oxycodone has the potential for addiction, and it is classified as a control substance. The side effect profile of oxycodone is similar to that of other opioid medications. Constipation is the most common overall side effect. The intensity of these side effects tends to decrease over time. Most common side effects are, asthenia, dizziness, dry mouth, headache, nausea, pruritus, somnolence, sweating and vomiting. Other side effects are bradycardia , hypotension, confusion, drowsiness and hallucinations (Sadiq et al., 2022).
Monitoring
Patients taking oxycodone require monitoring for the presence of constipation, pain relief, other side effects, and appropriate usage. Their blood pressure, heart rate, and respiratory rate should also be monitored, especially for the first 24 to 72 hours after initiating therapy or increasing dosage. If pain continues to increase after stabilizing dosage, the clinician should investigate alternative causes of pain before increasing medication dosage or frequency. If adverse effects develop, consider decreasing the dosage to find an appropriate therapeutic level without unacceptable adverse effects. Due to the high misuse potential and possibly fatal results of an oxycodone overdose, prescriptions should be written for the lowest therapeutic dose and only for the period the patient is expected to be in pain. Close follow-up should be arranged (Sadiq et al., 2022).
Drug-Drug interactions Including CAM
Using this medicine with any of the following medicines, levoketoconazole, nalmefene, naltrexone, safinamide and samidorphan is not recommended. Your provider may decide not to treat you with oxycodone or may change some of the other medicines you take. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Using this medicine with ethanol or grapefruit juice is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco (May Clinic, 2023).
References:
Mayo Foundation for Medical Education and Research. (2023, November 1). Oxycodone (oral route) before using. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/oxycodone-oral-route/before-using/drg-20074193
Sadiq NM, Dice TJ, Mead T. Oxycodone. [Updated 2022 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482226/
Select a medication and discuss the ethnic, cultural, or genetic differences in the use and consideration for cancer pain.
Ketamine is FDA approved for use in anesthesia and procedural sedation with off-label use of pain and depression management. Ketamine infiltrated into the surgical wound at the time of mastectomy may improve short and long-term pain management quality in patients with breast cancer (López, et al., 2021).
Share the mechanism of action of this medication and hints for monitoring side effects and drug interactions, including interactions with CAM.
Ketamine is a nonbarbiturate dissociative anesthetic and noncompetitive NMDA and glutamate receptor antagonist. As an antidepressant, effects far outlast the actual drug levels and are probably mediated by a secondary increase in structural synaptic connectivity (Rosenbaum et al., 2023). Ketamine may interact with the sigma receptors and reverses tolerance to opioids. It maintains normal skeletal muscle tone, permits spontaneous respiration, and is associated with cardiovascular and respiratory stimulation (Rosenbaum et al., 2023). As a result, hypertension and tachycardia are common side effects. The drug should not be given if the patient is profoundly hypertensive. Rapid infusion can lead to respiratory depression. In settings where ketamine is used, there must be preparation for emergency intubation.
Elaborate on a pain management strategy for adequate pain management.
Intravenous dosing is 1 to 2 mg/kg bolus and subsequent infusion at a rate of 0.5 mg/kg/min. An IV benzo aids in calming the body of tension, tachycardia, and anxiety that may occur on induction of ketamine. IM dosages range from 6.5 to 13 mg/kg (3 to 6 mg/lb) (Rosenbaum et al., 2023). For patients with opioid tolerance and in pain crisis, low dose ketamine is infused at 0.1 to 0.4 mg/kg IV to treat pain and reverse opioid tolerance.
References
López, M., Padilla, M. L., García, B., Orozco, J., & Rodilla, A. M. (2021). Prevention of Acute
Postoperative Pain in Breast Cancer: A Comparison between Opioids versus Ketamine in the Intraoperatory Analgesia. Pain Research & Management, 1–8. https://doi-org.lopes.idm.oclc.org/10.1155/2021/3290289
Rosenbaum SB, Gupta V, Patel P, et al. Ketamine. [Updated 2023 May 26]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470357/
