Remeber therapeutic heparin
Rescources/Literature
Managment
for patients undergoing urinary diversion with cystectomy, they should receive an opioid antagonist to help quicken GI recovery. I don't think we've been doing this for every cystectomy. Wanted to send a reminder
Entereg is the guideline recommended medication but it is very expensive. Our hospitals do not have the medication. A few studies have come out in the last few year showing non-inferiority using other opioid antagonists. We use Naloxegol (movantik). The dose is either 25mg or 12.5mg daily depending on renal function. They should receive the first dose in pre-op and continued in the hospital until return of bowel function. It can't be given longer than 7 days
At UMC the medication is not available. We have to give the patient a prescription for Naloxegol 25mg or 12.5mg daily for 7 days. They need to bring the medication to hospital and we will need to put a non-formulary medication order
At Tulane, naloxegol is available in the in-patient pharmacy. Can just order this
At VA, a non-formulary request has to be placed. Call the pharmacy as well to see if it's in stock. They need atleast 24 hours notice prior to surgery to get it
If the cream stings - they can apply food grade coconut oil first (using the same applicator) and/or reduce the dose to 1/2 gram. This stinging goes away with use as the tissue improves.
Takes 6-8 weeks to work and they must keep using it