LOL in end stages COPD/CHF not taking oral well and was previously on 40mg oxycontin po bid. I spoke to NP who then gave order for buccal oxycodone (oxyfast) 10-20mg qh prn because of concerns with pain coverage.
Now somebody on days (who were also crushing the oxycontin) has added an FYI to med sheets which says give oxycontin rectally if unable to swallow. I've seen this once before and I disagree.
It just seems to me that if the tablet moves away from the mucosa there will be an unpredictable and untitratable absorption pattern, a BM could dislodge the tablet thereby losing all pain control and there are question as to whether or not the tablet will properly dissolve given the differences in the environments. And it's got to be there for 12 hours.
I think that pain relief at the end of life is extremely important. No one should experience pain at the end. I think starting fentanyl trans-dermal now would be a swell idea combined with the oxyfast and would be easily titratable. We might not have much time to be experimenting to see if pr would work and then arguing over whether it worked.
Keep in mind that the resident has severe pain when moved and fairly severe dementia and is not able to communicate much verbally.
So I guess my question (after venting) is does this work? Any takers?
Apr 8, '04
i've given meds rectally if not contraindicated, and it's not a predictable method because of all the variables. oxyfast comes in 20mg/cc. intrabuccal and/or sublingual is much more realisitic and reliable. i agree with the fentanyl patch and oxyfast either scheduled or prn. and by all means, call your pharmacy and see what they say.