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  #1  
Old 06-13-2011
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Drug What to take with Fentanyl!

A 57 year old patient, living at home, has severe pain due to metastatic carcinoma that is being managed whit fentanyl delivered transdermally from a patch. He should also be taking, or at least have on hand:

a) apomorphine
b) loperamide
c) docusate
d) morphine
e) naloxone

(this is from Kaplan)
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Old 06-13-2011
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E) Noloxone

Fentanyl is an opiate
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Old 06-13-2011
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I would say C) Docusate

There is no reason to "be taking" noloxone concurrently with an opiate - it is used in the emergent treatment of overdoses of opiates, which are almost always in the setting of an abusive heroin abuser (not in a patient taking prescription medication for pain - I'll address this below). You wouldn't give noloxone to a patient taking therapeutic opiates any sooner than you'd give cyproheptadine to a patient taking an SSRI, or dantrolene to a patient taking a neuroleptic. These drugs are used in the hospital to treat emergency situations - they're not treatments we can expect patients to self-administer.

It's a common misconception that the levels of opiate administration needed for adequate analgesia are close to the levels needed for addiction and overdose - in fact, opiates like fentanyl are quite safe for patients to use as-needed, as long as they are properly instructed on how to do so.


Docusate is a stool softener, that would be given to a patient on opiates to help prevent or relieve some of the constipation that is likely to be encountered as a side effect. Constipation and miosis are the two side effects of opiates that patients do not develop any form of tolerance to.

Last edited by Tig2575; 06-13-2011 at 11:41 AM. Reason: (typo)
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The right answer here is docusate.

kaplan: naloxone is used IV in overdose situations, but would not be provided to the patient for use PRN.
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Old 06-13-2011
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Clearly I have no clinical experience yet

Thanks for the explanation Tig!
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Old 06-13-2011
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This is a clever question,
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Old 06-13-2011
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Yes clever question indeed!

Yes I do orthogeriatrics and we prescribe docusate with opiates as prophylatic laxative.
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Old 06-13-2011
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docusate:
side effects like miosis and constipation show no tolerance.
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Default What to take with fentanyl

I am a pharmacist and docusate is the right answer as fentanyl is constipating.
I also fill a lot of prescriptions from oncologists and hospice patients and sometimes we do see prescriptions for short acting morphine with it for break through pain.
Could morphine be a correct answer too?
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Tricky Question... Thanks for the explanation ..
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