Adjuvant Analgesics In Palliative And End-Of-Life Care. Mike Harlos MD, CCFP, FCFP Professor and Section Head, Palliative Medicine, University of Manitoba Medical Director, WRHA Palliative Care Medical Director, Pediatric Symptom Management Service. Case Presentation. 55 yo man
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Mike Harlos MD, CCFP, FCFP
Professor and Section Head, Palliative Medicine, University of Manitoba
Medical Director, WRHA Palliative Care
Medical Director, Pediatric Symptom Management Service
¯ tumor mass effects
10 – 20%
dried leaves, flowers
resin from leaves, buds
Isolated pure compounds (>400)
Kalant, Pain Res Manage 2001
Kumar et al, Anaesthesia 2001; 56
Campbell et al, BMJ 323:13-16, 2001
No effect on pupil size, resp. rate, DTRs
Initial euphoria then relaxation
Slowed reaction time, altered perception, impaired coordination
May cause paranoia, delusions, hallucinations, depersonalizationMarijuana - Acute Effects
Carter GT, Weydt P, Kyashna-Tocha M, Abrams DI.
Medicinal cannabis: rational guidelines for dosing.
IDrugs 2004; 7(5):464-470.
“Physicians who recommend, support the use of, or prescribe this substance, must be fully knowledgeable of the risks, benefits, potential complications, and drug interactions associated with its use. Based on the available scientific evidence, the medicinal use of smoked marijuana is at present generally without valid scientific foundation and physicians should not feel obliged to recommend, support, or prescribe this substance”
Available Cannabinoids Control?
Sources: Provincial Drug List; CPS 2002; Marihuana Medical Access Regulations (MMAR), April 2001, Health Canada
Sources: Néron A, Le medecin du Québec 2001; Product monograph NCesamet ICN Canada 2002; Product monograph NMarinol Sanofi-Synthelabo 2002
Ross et al;Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer. BMJ 2003; 327(7413):469
Adjuvants in Control?
Misinterpretedas Disease-Related Pain
Spectrum of Opioid-Induced Neurotoxicity
Mild myoclonus(eg. with sleeping)