Question

KR is a 64-year-old woman who presents with increasing abdominal cramping and nausea for several days. She says her last bowel movement was 6 days ago and her symptoms started when she began an opioid analgesic 2 weeks ago for postprocedural pain in association with a knee replacement surgery. KR has tried to quit taking the opioid analgesics altogether, but she only makes it about halfway through the morning before the pain becomes unbearable. What is the best course of action for KR?

A) Decrease the dose of her current opioid therapy
B) Increase the dose of her current opioid therapy
C) Start a stimulant laxative
D) Start a peripherally acting μ-opioid receptor antagonist (PAMORA)

Answer 1

The best course of action for KR, a 64-year-old woman experiencing abdominal cramping and nausea after starting an opioid analgesic, would be to start a peripherally acting μ-opioid receptor antagonist (PAMORA).

Step-by-step explanation:

The best course of action for KR, a 64-year-old woman experiencing abdominal cramping and nausea after starting an opioid analgesic, would be to start a peripherally acting μ-opioid receptor antagonist (PAMORA). PAMORAs are medications that can help alleviate opioid-induced constipation without affecting the analgesic effects of opioids. They work by blocking the opioid receptors in the gut, which reduces the constipating effects of opioids.

One example of a PAMORA is methylnaltrexone, which is administered as a subcutaneous injection. It has been shown to be effective in relieving constipation caused by opioid use without interfering with pain relief. KR should consult with her healthcare provider to discuss the possibility of starting a PAMORA and to determine the appropriate dosage and frequency of administration.