roxanol in neb treatments

[lesrn2005]

I have a pt who takes scheduled neb treatments (COPD diagnosis). She takes scheduled ms contin for gastritis pain- roxanol for breakthru. Has anyone ever put the roxanol in a breathing treatment?

[leslie :-D]

although hepatic first-pass metabolism is avoided, thus potentially escaping some of the gi effects, i've had pts who still get nauseous.

as long as the mso4 solution is for oral consumption (and not injectable) then adding a couple cc's of ns will suffice, as well as directly targeting the pulmonary circulation.

as long as your pt is compliant with the neb treatment, w/sufficient inspirations, then effect can be optimal, even if it is variable.

leslie

[doodlemom]

I have never had good results with morphine nebs - it doesn't seem to work as well as sl for any of my patients.

[leslie :-D]

i don't care for it either, doodlemom.

absorption is too unreliable.

leslie

[AutumnZegel]

Roxanol in nebs is contraindicated because of the sugar and additives. The pharmacy can usually make an additive free version of MSO4 to add to nebulizer that can be really effective d/t limited side effects, when patients are really concerned about sedation this can be effective.

[doodlemom]

We've always used sterile morphine that is meant for injection - still never any good results.

[mc3, ASN, RN]

I called Hospice Pharmacia about this once, because I'd also heard the absorption isn't the same. The Pharmacist told me that, in fact, it is. I have used it in COPD patients with good results. Just have the MD order the sugar-free kind.

mc3

[Midge]

Several years ago in Boston in a palliative care unit we regularly used IV morphine with normal saline in neb treatments. Usually used 2mg morphine from a 4mg syringe with 3 ml of saline. It worked well for lung ca patients as well as end stage COPD. MDs are just not that familiar with this use and hesitate to order it. More research is needed. I have used it in homecare hospice patients in the past couple years and it was like pulling teeth to get both the MDs and the pharmacy on board since they were unfamiliar with it.

[leslie :-D]

I called Hospice Pharmacia about this once, because I'd also heard the absorption isn't the same. The Pharmacist told me that, in fact, it is. I have used it in COPD patients with good results. Just have the MD order the sugar-free kind.

mc3

how can absorption be the same from patient to patient?

one pt can have shallow resp where the next patient will be inspiring deeply.

the one who breathes deeply, will certainly have better absorption and so, better effect.

leslie

[doodlemom]

how can absorption be the same from patient to patient?

one pt can have shallow resp where the next patient will be inspiring deeply.

the one who breathes deeply, will certainly have better absorption and so, better effect.

leslie

Very good point...

[Midge]

I would say that absorption is not the issue. It works well for some patients and for others it is not effective. It is worth trying if only to give patients with severe dyspnea some relief.

[mc3, ASN, RN]

Midge, I had been taught that, as well. Interestingly enough, we had 2 Certified Palliative Care NP's who were from Mass General's Palliative Care program that worked at our hospice. They did our Pain Management Training. Also big advocates for methadone, as was our Palliative Care MD, also from same program (she joined after the NP's) and our Medical Director.

mc3