Protocols - Hemorio

NAUSEAS AND/OR VOMITS: Less than 50% of the subjects present nauseas and/or vomits. And usually,
in the case of morphine, they present at the onset of the treatment. In the case of methadone, the
presence of nauseas or vomits is a sign of toxicity, i.e., overdose. It indicates that the dose must be
reduced to half or you must increase the interval (if it was every 6 h, turns to every 8h, provided that it is
already been accumulated).
At the subjects who also present constipation, in addition to nauseas and vomits, it is important to
remember to discard intestinal obstruction.
The chosen antiemetic is Haloperidol, in an dose in the morning of 1-2 mg (= 10 - 20 drops) + 5 drops at
night SOS, because it acts right in the vomit center (exactly as the Morphine), it has a great action time
and does not cause hypotension. The methochlopramide has an action for 4 h and may cause
somnolence, agitation and extrapyramidal symptoms. The ondasentrone is too much expensive and its
effect is better when the nausea is caused by chemotherapy.
SOMNOLENCE, SEDATION: Both are more frequent at the onset of the treatment of chronic usage, until
the tolerance is installed (subjects naïve to the treatment may take up to 7-10 days with this effect). For
the treatment of algic, episode crisis, the sedation represents an initial sign of overdose, which anticipates
the breathing depression. However, it may also mean sedation because he had his pain relieved after a
plenty of hours suffering, and even not sleeping. The continuous usage and the experience of the
physician and nurses will help recognizing it.
In relation to Methadone, the somnolence is a sign of overdose, such as the nausea, which usually comes
first.
It is important to note that the usage of other drugs (antidepressant, another opioid, anticonvulsant,
Benzodiazepine, antihistamine, among others) or other changes, such as Hyponatremia, changes of
calcium, intracranial hypertension or anemia.
HYPOTENSION: it may happen using the peridural path, if associated to a local anesthetic or if there is a
concurrent usage with antihypertensive, diuretic, antidepressant, benzodiazepine, phenotiazidic or even if
there is a dehydration setting. In such cases, the hypotension must be corrected in accordance to what
has caused it.
ABUNDANT SWEATING: It is not common to be caused by the usage of opioid. It is also observed at the
abstinence syndrome or in subjects with hepatic failure. Prednisone or prednisolone (5-20 mg) may help.
PHYSICAL DEPENDENCE – PSYCHIC DEPENDENCE AND ADDICTION: Physical dependence occurs
in subjects that use opioid chronically, at a time higher than 15 days, and if discontinued abruptly it
presents a reaction with sweating, midriasis, intense pains, muscle contractions, diarrhea, hyperthermia
and behavioral change, aggressiveness. The physical dependence is due to a neuro-pharmacological
reaction of the drug-receptor.
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