Prescrição combinada de morfina e laxante em pacientes oncológicos adultos

Abstract

Introduction: Pain is one of the most common and graves symptoms by cancer patients and it is traditionally treated with opioid analgesics. In this context, the opioid-induced constipation is a frequent adverse reaction that occurs by agonist action of drugs on μ2 opioid receptors present in the gastrointestinal tract. The action of morphine in these receptors alters the intestinal motility hindering intestinal transit, which is an effect that negatively affects patients quality of life and decreases adherence to drug treatment. Objectives: Given this, the present study aimed to retrospectively analyze the medical records of cancer patients who used morphine, in order to identify the combined prescription of this drug with a laxative agent. Methodology: This study is based on a qualitative and quantitative documentary approach. Data collection took place in Ambulatory 1 and 2 of the Oncology Sector of a highly complex hospital in western Santa Catarina. The data collected are based on the documental basis of the last five prescriptions contained in the medical records of cancer patients, over 18 years of age, who were attended between first of July and September 30th, 2019, excluding those who had no morphine prescription in any of the last five medical visits. The data collected address, gender, age, international classification of diseases, morphine dosage, the absence or presence of a laxative prescription and the dosage and pharmacological class of the laxative, when available. The data were tabulated in the Excel program and analyzed statistically. Discussion: Pain is a prevalent symptom in the oncology population, which is mostly composed of men over 50 years old, and the opioid-induced constipation causes damage in patients functional capacity and well-being. Oncological pain in tumors of the gastrointestinal tract is a very characteristic symptom, both because of the pathophysiology and the anatomical location of the tumor, requiring concomitant and preventive treatment with laxative drugs, especially lactulose. However, a small percentage of these patients use morphine concomitant of laxative, a fact that can further aggravating the health condition of these patients. Conclusion: Opioid-induced constipation is a common adverse effect in cancer patients and unfortunately the data point to an underdiagnosis of this symptom. In this way, it is important that the medical team is trained to carry out an early diagnosis and adequate management of constipation in these patients.