Spinal Cord Compression

Pharmaceutical Issues

Rebecca MillsSenior Clinical Pharmacist

Points to Cover Steroids

Dose Adverse effects Counselling

Thromboprophylaxis Laxatives

Steroids Reduce inflammation around the tunour &

cord oedema Reduce pain Preserve neurological function Increase number of patients who remain

ambulatory High dose initially Reduce rapidly Where good results possible to stop

steroid treatment completely

Choice and dose of steroid Use dexamethasone Dose is 16mg per day divided into 2 doses (N.B.=

approx 100mg prednisolone) Trials compared 16mg per day with 96mg per day

showed more side-effects with higher dose Give after Breakfast and Lunch. Reduce dose over 2 weeks

can cause problems if stopped suddenly. If symptoms worsen increase dose/reduce more slowly. Some patients may be on maintenance steroids.

WPH Reducing regimenDay Dexamethasone daily

doseAdministration

1-3 16mg 16mg OM or 8mg BD (8am & 12noon)

4-6 8mg 8mg OM

7-9 4mg 4md OM

10-12 2mg 2mg OM

13 Discontinue

Adverse Effects Gastric irritation

Take after food. PPI cover

Lansoprazole 15mg OD Only for the duration of the steroids.

Increased Appetite Impaired glucose tolerance Mood disturbances Fluid retention

Long-term adverse effects Osteoporosis Muscle weakness Reduced healing/ability to fight infection

Care around people with chicken pox/ measles/influenza

Glaucoma Impaired healing “Cushing’s Syndrome”……

Points to remember Take steroids with or after food Avoid take steroids later than 4pm Dexamethasone can be dispersed in water &

given via PEG/NG (off license) Dexamethasone liquid is available If the patient has had other courses of steroids in

the last year they may need to reduce the dose more slowly

Avoid contact with anyone with suspected chicken pox or shingles.

Check the patient understands how to reduce their dose.

Thromboprophylaxis

Active Cancer Reduced Mobility Inpatient hospital stay

= VTE Risk Prescribe thromboprophylaxis unless

contra-indicated. Consider if thromboprophylaxis is

indicated on discharge – immobility?

Laxatives Constipation often associated with mSCC Can be one of the presenting symptoms Maintaining regular bowel action is

important for patient comfort Psychological issues also need to be

overcome e.g. patients embarrassment at needing to be assisted with toileting

Laxatives Oral laxatives may be ineffective or inappropriate Reflex bowel

Patient has little/no awareness of bowel fulness Reflex function of the rectum remains Fast acting rectal measures most appropriate Bisacodyl suppositories or sodium citrate enemas (15-

30mins to effect) If hard stools, glycerol suppository

Flaccid bowel May need digital removal No laxatives recommended

Pain Control Analgesia

WHO Pain ladder NICE neuropathic pain guidance

Bone Pain Zoledronic Acid (IV)

Check Renal function Denosumab (SC) Licensed for prevention of skeletal events

Any Questions?