Thursday, November 2, 2017

Professional Practice: Discerning Medication Side Effects from Symptoms and Signs


Medication Review and Review of Systems:  Side Effects of Opioid Medications
10.28.2017
Key words:  medication review, documentation standards, professional practice (OPPE), opioids, MEQ, medication side effects, workers’ comp, pain management

Why do you need to know?
It is important and useful for an EAMP to consider the side effects of a patient’s medications.  This helps, when going through the assessment, including the Review of Systems (ROS), to discern what is a side effect from a medication (branch or twig) vs. what is endemic to constitution or specific condition (root and/or earlier branch). 

What is the source of the following information?
The August 2017 CDC online training based on the January 2016 CDC Guidelines on Safe Opioid Prescribing, “Applying CDC’s Guideline for Prescribing Opioids” https://www.cdc.gov/drugoverdose/training/overview/index.html

Common side Effects of Opioid use
Constipation
Dry mouth
Drowsiness
Nausea
Confusion
Vomiting
Tolerance/loss of medication effectiveness
Physical dependence
Decreases ability to safely operate equipment
Sexual dysfunction

Red Flags—Be Wary of Opioid Medication + Nervous System Depressants
Benzodiazepines
Drinking alcohol
Why is this a red flag? 
These combinations [opioid + benzodiazepine or opioid + drinking alcohol] can quickly lead to respiratory depression (slowed and stopped breathing)

Serious Risks Associated with Opioid Use
Death
Opioid use disorder
Respiratory depression
Decreased ability to safely operate a vehicle
Unintentional ingestion by household members/others (children)
Overdose

What Conditions Make People at Extra High Risk for Adverse Events or Death d/t Overdose when taking Opioids, according to the 2016 CDC Guideline?
If they have a history of:
Overdose
Any sleep disorders
Renal or hepatic (liver) problem
Alcohol or substance use problem
Age:  65+
Pregnancy (pregnant women)
If they currently have one of the following:
Depression
Alcohol or substance use
Prescribed over 50 MME/day
Taking benzodiazepines
Treated with methadone

Reference for the above information:
Source:  The 2016 CDC Guidelines on Safe Opioid Prescribing.  For the related CEU training, go to the CDC course, Applying CDC’s Guideline for Prescribing Opioids  

Useful Infographic when Communicating with PCM Colleagues about Non-Pharm Pain Relief Options
Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.

Related Blogposts
Calculating Morphine Equivalent Dose (MEQ)
Metrics and Pain Management, using a Validated Pain Scale

More about sleep disturbance as a side effect of opioid medications, see Sleep disturbance in patients taking opioid medication for chronic back pain, published 2016 in the journal Anaesthesia by Robertson and Purple et al.

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copyright Megan Kingsley Gale
Do not reproduce without the author's written permission

The author can be reached through the Hospital Practice Handbook's Facebook Page.  Just use the "message" feature on that Facebook Page.



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