Abstract:
INTRODUCTION:All health professionals should be aware of the importance of evaluating pain - fifth vital sign- in cancer patients. Peripheral and central acting analgesics are widely used to treat moderate to severe pain, particularly cancer pain. Many guidelines have addressed this issue. However, real life patients' have other problems and comorbidities that may raise doubts when prescribing. MATERIAL AND METHODS:Authors made a literature search, trying to clarify same specific situations: loss of oral route, renal impairment (hemodialysis), hepatic impairment, frequent opiod interactions and the availability of short-acting formulations. RESULTS:The following medicines were included in this analysis: the natural opiates (morphine and codeine), their synthetic and semisynthetic derivatives (hydromorphone, oxycodone, and fentanyl), the partial agonist buprenorphine and finally tramadol and tapentadol. Transdermal systems are only available for buprenorphine and fentanyl. In hepatic impairment, fentanyl is safe, but with the exception of codeine and tramadol; other opioids should be used with caution. In renal failure: fentanyl, hydromorphone, and tapentadol are safe. Morphine should be avoided; other opioids should be used with caution. In hemodialysis, buprenorphine, fentanyl, hydromorphone and tramadol (at doses up to 200 mg/day) may be used. DISCUSSION:Failure to recognize the impact of various situations described throughout this work, including the bioavailability due to loss of oral route, due to pharmacokinetics and pharmacodynamics of the various drugs, either in the context of the impaired metabolism or excretion, or in due to pharmacological interactions, conditions a serious risk of subtreatment of pain and consequent impact in terms of quality of life. CONCLUSION:Opioid prescription is safe and effective, even in moderate to severe comorbidities such as renal and hepatic impairment and in patients with no oral route available. In this case, as when considering pharmacological interactions, an individualized therapeutic plan is the best solution and the patient should be assessed regularly. Unadjusted doses may relate to bad pain control and a higher prevalence of adverse events. :Introdução: A dor é equiparada a quinto sinal vital e deve ser avaliada de forma sistemática em todas as consultas de um paciente com cancro. Os fármacos utilizados na prática oncológica para tratar os doentes com dor crónica moderada a severa incluem analgésicos de ação periférica e central que têm sido abordados em múltiplas diretrizes nacionais e internacionais. No entanto, na prática clínica há que equacionar outros problemas e eventuais comorbilidades, que podem levantar dúvidas no momento da prescrição.Material e Métodos: Fez-se uma revisão da literatura, tentando refletir sobre algumas situações específicas na utilização de opióides, nomeadamente perda da via oral, insuficiência renal (hemodiálise), insuficiência hepática, interações medicamentosas e formulações de ação imediata.Resultados: Os opiáceos naturais (morfina e codeína) e os seus derivados sintéticos e semissintéticos (hidromorfona, oxicodona, fentanilo), o agonista parcial buprenorfina e finalmente o tramadol e tapentadol foram selecionados para esta análise. Os sistemas transdérmicos estão apenas disponíveis para a buprenorfina e o fentanilo. Na insuficiência hepática, o fentanilo foi considerado seguro, mascom exceção da codeína e do tramadol, podem todos ser usados com precaução. Na insuficiência renal, o fentanilo, a hidromorfona e o tapentadol foram considerados seguros. Deve evitar-se a morfina, e os restantes poderão ser usados com precaução. Em pacientes em hemodiálise pode usar-se buprenorfina, fentanilo, hidromorfona e tramadol (em doses até 200 mg/dia).Discussão: O não reconhecimento do impacto das várias situações descritas ao longo deste trabalho, nomeadamente a alteração da biodisponibilidade por perda de via oral, por alteração da farmacocinética e farmacodinâmica dos vários fármacos, quer no contexto da insuficiência de órgão responsável pelo metabolismo ou excreção, quer no contexto das interações farmacológicas, condiciona umnorme risco de subtratamento da dor e consequente impacto em termos de qualidade de vida.Conclusão: A prescrição de opióides é segura e efetiva, mesmo em situações de comorbilidades moderadas a graves como insuficiência renal e hepática e em doentes sem via oral disponível. Neste caso, como quando considerámos as interações farmacológicas, o plano terapêutico deve ser individualizado e o paciente deve ser avaliado regularmente. A seleção inadequada e/ou dose mal ajustada de um fármaco, o não reconhecimento do impacto dos efeitos adversos, frequentemente justificam o mau controlo da dor e a toxicidade excessiva.
journal_name
Acta Med Portjournal_title
Acta medica portuguesaauthors
Vieira C,Brás M,Fragoso Mdoi
10.20344/amp.10500subject
Has Abstractpub_date
2019-05-31 00:00:00pages
388-399issue
5eissn
0870-399Xissn
1646-0758journal_volume
32pub_type
杂志文章,评审abstract::Literature analysis has been controversial about pre-eclampsia. It is known that not pregnant patients should be treated due cardiovascular benefits. However, the real benefits of antihypertensive treatment in pre-eclampsia were not demonstrated. Yet, there are many drugs that can be used for antihypertensive treatmen...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,评审
doi:
更新日期:2008-07-01 00:00:00
abstract::The authors present a clinical case of an intracranial dural arteriovenous malformation with clinical manifestations of a prefrontal syndrome, documented with its respective diagnostic tests, including imaging studies. A number of considerations are being enlarged upon, concerning possible pathophysiological mechanism...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::In order to assess the weight of Rheumatic Diseases, the Authors retrospectively studied 117 patients admitted to the Internal Medicine Service of the Faro District Hospital over a 3 year period (1989-1991). The selection criterion comprised the final rheumatological diagnosis. The diseases were arranged in nosologica...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1993-07-01 00:00:00
abstract::The recent improvement in surgical of therapy of carriers of hepatocellular carcinoma is due to both an early diagnosis of the illness and in the evaluation of set of prognostic and resectability factors. On describing a clinical case of a hepatocellular carcinoma localized on the left lobe of a healthy liver, the imp...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1989-05-01 00:00:00
abstract::Secondary malignancy of the penis is a rare clinical condition, often associated with disseminated genitourinary malignancies. The prognosis is poor and the treatment options include penectomy, local surgical excision, radiation therapy, chemotherapy and supportive therapy. Neither of these therapeutic options lead to...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:10.20344/amp.5775
更新日期:2015-07-01 00:00:00
abstract::From January 1980 until October 1991 we operated 112 patients with Gastric cancer in which Surgery was considered palliative by intra-operative criteria or by pathological analysis of the resected specimen. Locally irresectable tumour was found in 24.1% of the cases, peritoneal metastases (mets.) in 21.4%, liver mets....
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1993-02-01 00:00:00
abstract:INTRODUCTION:Diabetes is a major public health problem and it is related to socioeconomic factors. The aim of this study is to describe socioeconomic inequalities in the distribution of diabetes in the population with 25 years or more, resident in Portugal in 2014. MATERIAL AND METHODS:Data from the Health National Su...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:10.20344/amp.8235
更新日期:2017-08-31 00:00:00
abstract::The authors report a case of seronegative polyarthritis resistant to the anti-inflammatory therapy in a 16-year-old male with intermittent diarrhea. A stool examination showed the presence of cysts of Giardia lamblia and an immunological study detected a partial serum IgA deficiency, including its secretory fraction. ...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract::Before the age of 8 in females and 9 in males, the presence of pubic hair can be the first sign of a gonadal or adrenal disease. In order to identify the late onset type of congenital adrenal hyperplasia in premature pubescence, we did the adrenal short stimulation test with Synacthen, on 30 children. Five girls and o...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1991-07-01 00:00:00
abstract:INTRODUCTION/OBJECTIVES:The authors make the balance of the first five years of teaching Anatomy to the Licensure in Health Sciences, of Lisbon University. MATERIALS AND METHODS:Were studied 408 students, enrolled in the Curricular Unit of Anatomy (mandatory subject of the 1st semester) and 29 in the Curricular Unit o...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2013-05-01 00:00:00
abstract::The Sclerosing Mesenteritis is a rare idiopathic disease. It represents the final stadium of progression of the chronic inflammatory illnesses of the intestinal mesentery, with predominance of fibrosis. The clinical manifestations are varied and unspecific. Diagnosis, that demands high degree of suspicion, can be pres...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2009-11-01 00:00:00
abstract:INTRODUCTION:Progressive multifocal leucoencefalopathy (PML) is a subacute demielinating disease of the Central Nervous System caused by the neurotropic virus John Cunningham (JC), common in immunodeficient patients, namely in HIV infection. PML encephalic lesions have a progressive nature that needs characterization a...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,评审
doi:
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Meningitis is an uncommon clinical manifestation of invasive infection by Streptococcus pyogenes. CASE REPORT:A four years-old female child, previously healthy, started a history of high fever, associated to right otorrhea, prostration and vomiting. On admission she was haemodynamically stable but prostrate...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2011-12-01 00:00:00
abstract:INTRODUCTION:There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:10.20344/amp.10135
更新日期:2018-08-31 00:00:00
abstract::Escherichia coli endocarditis is a rare condition, even though bacteriemia by such agent is common. The infection, normally from a urinary origin, may, in fact, progress without major hemodynamic disturbance and minimal symptoms, regardless its ability of destruction of heart's valvular apparatus. We present a case re...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2010-09-01 00:00:00
abstract:INTRODUCTION:Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:10.20344/amp.13928
更新日期:2020-06-01 00:00:00
abstract::The development of a kidney abscess is extremely rare despite the fact that urinary tract infections are quite common during pregnancy. The pathogenesis of renal abscess has changed over the years. Nowadays, more than 75% of the renal abscess arises from a previous urinary tract infection. The authors report the case ...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Abdominal trauma is a major cause of morbi-mortality all over the world which makes it essential an approach focused on rapid diagnosis and treatment. The main goals of this study are to identify global epidemiologic data of abdominal trauma in our tertiary trauma center and to study traumatic lesions, treat...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2013-11-01 00:00:00
abstract::Over the last 20 years, assisted reproductive technology has been increasingly used. Ever since the first newborn resulting from artificial insemination, over two centuries ago, thousands more children were born resulting from these techniques. In Portugal, assisted reproductive technology began in 1985 at the Hospita...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2005-11-01 00:00:00
abstract::In an attempt to discern the paradigms underlying our medical practice (more specifically paediatrics) over the last 30 years, it was found that these are rather similar to the ones prevailing at the beginning of this period--all wrong-doings were attributed to outside forces which had to be neutralized; the obsession...
journal_title:Acta medica portuguesa
pub_type: 历史文章,杂志文章
doi:
更新日期:2000-07-01 00:00:00
abstract::The authors analyse the appropriateness admissions to the Internal Medicine ward of the Hospital de Santa Luzia (Elvas). A retrospective study was performed during 6 months of 2001, using the Appropriateness Evaluation Protocol (AEP). Non-appropriateness admissions were found in 19% (CI95%: 16-22), and this group of p...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2004-03-01 00:00:00
abstract:INTRODUCTION:Deep brain stimulation (DBS) is effective in advanced Parkinson's disease (PD), improving motor symptoms, fluctuations and quality of life. However, adverse psychiatric outcomes have been reported, albeit variably and in an unstandardized fashion. We aimed to summarize the published evidence on the outcome...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,meta分析,评审
doi:10.20344/amp.4928
更新日期:2014-05-01 00:00:00
abstract::Essencial Thrombocytemia is a rare chronic myeloproliferative disease of unknown etiology, characterized by markedly elevated platelet production (> 600,000/ml). It is more frequent among women above 50 years of age and may be associated with hemorrhagic or thrombotic tendencies. The authors report a case of Essencial...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2003-03-01 00:00:00
abstract::Osteoporosis in men, despite being a less important public health problem than osteoporosis in women, should not be neglected as it has many deleterious effects as well as social and economic costs. Finding the cause of osteoporosis is more complex in men than in women, and prevention should be based on an early evalu...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,评审
doi:
更新日期:1995-05-01 00:00:00
abstract::The availability of scientific information is growing exponentially. Healthcare professionals who wish to keep up-to-date with scientific literature and find the best information should spend their time finding resources that summarize the best available evidence. This manuscript aims to provide bibliographic research...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2013-07-01 00:00:00
abstract::We describe a case report of a 69 year old woman with atrial myxoma, presented as a cerebellar syndrome caused by ischemic infarctions of the posterior circulation. The transthoracic 2D echocardiogram provided the diagnosis of a left atrial myxoma. Seven months after surgical removal of the cardiac tumor, the cerebell...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract::Sepsis is a common pathology during the neonatal period. Low-birth weight is the most important isolated risk factor. With the purpose of determining the prevalence of nosocomial infection in newborns of very low birth weight (VLBW), finding the microbial flora and the mortality of these patients, the authors retrospe...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:1996-10-01 00:00:00
abstract::Testicular microlithiasis is a rare entity, usually asymptomatic and bilateral. There are however reports that until 40% of the cases may be related with testicular tumours. We report an 11-year-old boy, with a four-month history of left testicular mass. Sonography showed increased volume of left testis and bilateral ...
journal_title:Acta medica portuguesa
pub_type: 杂志文章
doi:
更新日期:2005-11-01 00:00:00
abstract::Stevens-Johnson syndrome and toxic epidermal necrolysis are potentially life-threatening adverse cutaneous drug reactions. Clinically, it manifests as a rash, often morbilliform, or atypical target lesions that evolve to epidermal detachment. There is mucosal involvement in almost all patients. The loss of skin's barr...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,评审
doi:
更新日期:2011-12-01 00:00:00
abstract::After the discovery of insulin and during almost an half of a century, physicians and researchers apply their efforts in a better knowledge to reduce the perinatal mortality of the offspring of the diabetic mother. The optimisation of glucose control--the main key of the management of diabetic pregnancy--and the new m...
journal_title:Acta medica portuguesa
pub_type: 杂志文章,评审
doi:
更新日期:2002-05-01 00:00:00