Vol 13, No. 03 March 20, 2008
The March meeting was held at the Meadowview Convention Center in Kingsport, TN. Alexa Wolfe from Cephalon, sponsored the meeting, and our speaker was Cindy Payne-Smith, FNP, who has worked with chronic non-malignant pain patients for over five years, currently in a neurology practice, and previously at Knoxville Anesthesia Pain Clinic. The topic was Fentora, FDA approved for break-through pain (BTP) for narcotic tolerant cancer patients.
PRESENTATION HIGHLIGHTS
- Fentora: on label use for break-through cancer pain.
- Pain patients experience baseline pain, controlled by a long acting opioid, such as Oxycontin, Duragesic, MS Contin, Kadian, Opana, among others. They also experience BTP in spikes throughout the day and night. Previously, Actiq was used for BTP, but it had high visibility, because it was in the form of a sucker. Now Fentora is available, in a faster acting form, as a discreet oravescent buccal tablet.
- Fentora is for use in the narcotic tolerant patient only, such as one who is on an equal or higher dose than 60 mg morphine, 25 mg fentanyl patch, 30 mg oxycodone, or 8 mg oral hydromorphine. (See package insert.)
- Side effects are similar to all opioids, including repiratory depression and constipation. Warnings with Fentora use should include addiction. A predictor of addiction is a patient who had problems with smoking, alcohol, or drugs as a teenager. Fear of tolerance and addiction should not deter the use and dosing of pain medications.
- Fentora is an “oravescent” tablet, designed to be used between the gums and the cheek. It dissolves in less than 15 minutes, lowering the ph of the saliva, which increases bioavailability. There is 48% baseline absorption and 65% absolute availability. Carbonated beverages are contraindicated with use of Fentora due to increased acidity.
- At least 88% of patients on Fentora are on 200 mcg or more. Tablets are available in 100, 200 300, 400, 600, and 800 mcg, and packaged in a box of 28.
- Fentora should be titrated per package insert. Following are suggested dose equivalents:
Actiq Convert to Fentora
200-400 mcg 100 mcg
600-800 mcg 200 mcg
1200-1600 mcg 2 – 200 mcg tablets
- Fentora tablet may be repeated 30 minutes after the previous tablet. If a patient is using more than 4 Fentora tablets daily, the long acting opioid should be increased.
- 57 – 89% of patients with chronic pain experience BTP which may be caused by activity, getting out of bed, something as simple as a cough or sneeze. BTP is often idiopathic, or due to long acting narcotic end of dose failure.
- When BTP is untreated, patients are 2 ½ times more likely to be hospitalized due to decreased function or sleep, and increased anxiety and depression.
- Off Label Questions (sponsor left the room while the speaker answered questions about Fentora and other opioids:
- Overdose of Fentora is responsive to Narcan
- Fentanyl patches do not absorb well without fat
- Gabapenten is often used on top of Lamictal
- Fentora is being used effectively in morning plantar fasciitis and neuropathy pain. It will likely get an indication for polyneuropathy.
The website for monitoring controlled substances use in patients is available through the pharmacy board in Tennessee.
Business Meeting
The regular meeting of the Northeast Tennessee Nurse Practitioners Association was called to order at 7:45 PM on March 20, 2008, in Meadowview Conference Center, Kingsport, by President Vickie Lewis.
Approval of Minutes
- The minutes of the previous meeting were unanimously approved as distributed.
Old business
- The budget proposal for 2008 will be sent via email with the minutes of this meeting. It is a “bare-bones” budget. Members’ suggestions and comments on the budget are welcome (see attached document).
- Some of our members attended last month’s meeting of the TNA, at which Sharon Adkins, Executive Director of TNA, and Laura Beth Brown, TNA President, were present. They presented benefits of TNA membership, and noted the things that TNA has already done to further nursing practice, including advanced nursing. They pointed out the importance of just one person talking to a legislator for positive results for nursing.
New Business
- We are receiving more requests from persons who want to advertise (such as job positions) on the NETNPA website. It was suggested we consider charging for this, since there are other websites that charge over $200.00 for postings. Members are asked to consider this, and we can vote when we have a quorum.
- Membership: There are multiple expired memberships. We will be sending a blanket e-mail to ask for membership dues and will post email address for responses.
- The drawing for CEU money winner (based on meeting attendance) will be held at the next meeting.
Job availability:
- ETSU is looking for a temporary NP for the college clinic.
- Washington County Health Department in Johnson City.
- Part-time or full-time NP needed for Centerpointe Medical Clinic in Kingsport. Contact April Barrett at 423-247-7030.
Education opportunities:
- Diabetes workshop 4/4/08 at BRMC. Free, with CEU’s available.
- APN Conference in Nashville 4/25/08 (Note: this conference has now been canceled.)
- April 17 & 18: Managing Alzheimer's Disease and other Dementias: Meeting the Ever-changing Needs of the Person with Dementia at Millennium Centre in Johnson City. Approved for 12 ACCME/AMA CME credits*.
- April 26 & 27: New Horizons in Cardiovascular Health for Primary Care Providers at the Grove Park Inn in Asheville, NC. Approved for 7.5 ACCME/AMA CME credits*. (If you would like to attend this conference and stay at the Grove Park-please contact us so that we may secure you a room at the conference rate.)
- For more information or to register please visit our website: http://com.etsu.edu/cme and click on special conferences or call the ETSU Office of CME 423-439-8027. The conference brochures with agendas are available on the website
Next Meeting:
- The next meeting will be held at Guiseppe’s in Kingsport, Thursday, April 17, at 6:30 PM.
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