About Initiative
Point of Care
Webcast on Demand

Live webcast
Jointly sponsored by
University of Kentucky
College of Pharmacy
and Vemco MedEd

This activity is supported
by an educational grant from
Janssen Pharmaceuticals, Inc.,
administered by
Janssen Scientific Affairs, LLC

The online tutorial series with a case reinforces practical application of tools and competencies acquired during the live activity. Each tool is a combination of essentials in clinical practice, links to relevant scientific publications, and printable handout material for reference. Clinical Case following the online tutorials gives the learners an opportunity to earn extra CE credit upon completion.

  1. Differentiating Types of Pain
  3. Assessment of Pain
  5. Know Your Drugs: Non-Opioids
  7. Know Your Drugs: Opioids
  9. Minimizing Adverse Effects
  11. Clinical Case

Minimizing Adverse Effects

The long-term use of opioids is associated with several adverse effects and clinicians should be prepared to anticipate, identify, and treat these occurrences. The most common opioid associated adverse effects include:
  • Constipation
  • Nausea and vomiting
  • Sedation
  • Sexual dysfunction
  • Pruritus
  • Myoclonus

Opioid-Induced Hyperalgesia
Opioid-induced hyperalgesia (OIH) can also severely impact the effectiveness of opioid treatment and can result in either increased sensitivity to pain, aggravation of pre-existing pain, or expression of novel pain symptoms. Some strategies to prevent OIH from occurring include:
  • Use of adjuvant therapies for "opioid sparing" effect (e.g., use of anticonvulsants or antidepressants)
  • Opioid rotation to take advantage of "incomplete cross tolerance"
  • Use a combination of an opioid and low-dose mu receptor antagonist (e.g., buprenorphine and naltrexone)
  • Blockade of the NMDA receptor (e.g., use of ketamine)

Methadone Monitoring
The use of methadone may prolong the rate-corrected QT interval and result in torsades de pointes. Therefore, clinicians should take precautions prior to initiating methadone treatment for their patients.
  • Disclosure: Clinicians should inform patients of arrhythmia risk when they prescribe methadone
  • Clinical History: Clinicians should ask patients about any history of structural heart disease, arrhythmia, and syncope
  • Screening: Obtain a pretreatment electrocardiogram for all patients to measure the QTc interval and a follow-up EKG within 30 days and annually.
    • Additional EKG is recommended if the methadone dose exceeds 100 mg/day or patients have unexplained syncope or seizures.
  • Drug Interactions: Clinicians should be aware of interactions between methadone and other drugs that possess QT interval prolongation properties or slow the elimination of methadone

Suggested Reading:

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