Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Clinical (Winter) > 26 - Cancer Pain > Flashcards

26 - Cancer Pain Flashcards

1
Q

Define opioid addiction

A
  • Primary, chronic disease of brain reward, motivation, memory, and related circuitry
  • No published reports in cancer px w/ no previous substance abuse hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define physical dependence

A
  • Occurrence of abstinence syndrome when the opioid is suddenly stopped
  • Fairly common, need gradual withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define tolerance

A
  • Decrease in one or more effects of the opioid

- Decreased analgesic effect due to tumour progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Briefly describe nociceptive pain

A
  • Direct stimulation of intact nociceptors
  • Transmission along normal nerves
    • Somatic – easy to describe and localize (ex: aching, stabbing, throbbing)
    • Visceral – difficult to describe and localize (ex: squeezing, cramping, sharp or dull)
  • Tissue injury apparent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe neuropathic pain

A
  • Disordered peripheral or central nerves
  • Compression, infiltration, ischemia, metabolic injury
  • Pain may exceed observable injury
  • Less responsive than nociceptive pain
  • Poorly responsive syndromes likely have a neuropathic component
  • Ex: burning, tingling, sharp, electric shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of cancer pain

A
  • Cancer itself (75-80%)
    • Tumour involvement of the bone (30-70%)
    • Tumour involvement of nervous tissue, viscera, blood vessels
  • Tx of cancer (15-19%)
    • Chemotherapy – peripheral neuropathy, mucositis
    • Radiotherapy – plexopathy, pelvic pain
    • Post-surgical – neuropathies
  • Unrelated to cancer (3-5%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tx related neuropathy

A
  • Chemotherapy-induced (cisplatin, oxaliplatin, paclitaxel, thalidomide)
  • Surgical
    • Phantom limb pain
    • Post-mastectomy or post-thoracotomy syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx related immunosuppression

A
  • Post-herpetic neuralgia
    • Topical compounded cream (combination of topical anesthetic, mu receptor blocker, neuropathic pain med, NMDA blocker) if area is small
    • Oral combination of opioid + neuropathic pain med
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Codeine – metabolism and CI

A
  • 10% metabolized by CYP2D6 to morphine which is responsible for analgesia
  • Due to genetics:
    • 5-10% of people will have no analgesic effect
    • 1-29% will have a more pronounced effect
  • Contraindicated w/ paroxetine, fluoxetine, quinidine, haloperidol
  • Contraindicated in renal and liver dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Morphine – metabolism and CI/ caution

A
  • Hepatic metabolism
    • 60% to morphine-3-glucuronide
    • 10% to morphine-6-glucuronide (greater analgesic properties and fewer AE)
    • 4% to normorphine (non-active, non-toxic)
  • Avoid in renal dysfunction and failure
  • Use w/ caution in severe liver dysfunction (increase dosing interval from q6h to q8h)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hydromorphone – metabolism, caution

A
  • Metabolized to hydromorphone 3-glucuronide
  • Use w/ caution in severe liver dysfunction
    • Increase dosing interval from q6h to q8h
  • Dosage conversion from IV to PO is 1:1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is hydromorphone preferred over morphine?

A
  • Renal failure
  • Elderly (> 60 y/o) due to decreased renal function
  • Hx of rashes
  • Nausea and constipation are a problem
  • Sedation is a problem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is fentanyl preferred over morphine and hydromorphone?

A
  • Elderly (> 60 y/o) due to decreased renal function
  • Renal failure and severe liver dysfunction
  • Hx of rashes
  • When nausea and constipation are a problem
  • When sedation is a problem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When should caution be taken w/ fentanyl?

A

Caution w/ CYP 3A4 inhibitors (clarithromycin, voriconazole, grapefruit) and inducers (dilantin, rifampin, steroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Methadone – oral BA, metabolism, MOA, duration of analgesia

A
  • Oral BA > 85%
  • Metabolized in liver = no active metabolites
  • Blocks NMDA receptors
  • Duration of analgesia = 4+ h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Starting doses for IV and PO morphine and hydromorphone for opioid naïve px – moderate pain and frail

A
  • 2.5 mg PO morphine
  • 1 mg IV/SC morphine
  • 0.5 mg PO hydromorphone
  • 0.2 mg IV/SC hydromorphone
17
Q

Starting doses for IV and PO morphine and hydromorphone for opioid naïve px – severe pain and frail

A
  • 5 mg PO morphine
  • 2 mg IV/SC morphine
  • 1 mg PO hydromorphone
  • 0.5 mg IV/SC hydromorphone
18
Q

Starting doses for IV and PO morphine and hydromorphone for opioid naïve px – moderate pain and robust

A
  • 5 mg PO morphine
  • 2 mg IV/SC morphine
  • 1 mg PO hydromorphone
  • 0.5 mg IV/SC hydromorphone
19
Q

Starting doses for IV and PO morphine and hydromorphone for opioid naïve px – severe pain and robust

A
  • 10 mg PO morphine
  • 5 mg IV/SC morphine
  • 2 mg PO hydromorphone
  • 1 mg IV/SC hydromorphone
20
Q

Who should NEVER get a fentanyl patch?

A
  • Opioid naive px
  • < 18 y/o
  • For acute pain
21
Q

Describe bystander apathy

A
  • Belief that others in a group who see the same risks will intervene
  • *No pt should ever walk out the door of your pharmacy w/o a face to face instruction on how to use and dispose of fentanyl patches
22
Q

Titration of opioids for cancer pain

A
  • Correct dose is a compromise between sufficient pain relief, good cognitive function, and acceptable SE profile
  • Start low and titrate slowly, elderly metabolize opioids differently due to decreased renal function and hepatic clearance
23
Q

Guidelines for opioid dose escalation

A
  • Always increase by a percentage of the present dose based upon px pain rating and current assessment
  • Mild pain (1-3/10) -> 25% increase
  • Moderate pain (4-6/10) -> 25-50% increase
  • Severe pain (7-10/10) -> 50-100% increase
24
Q

PO and IV dose of morphine equal to 100 mg PO codeine

A
  • PO = 10 mg

- IV = 5 mg

25
Q

PO and IV dose of oxycodone equal to 100 mg PO codeine

A
  • PO = 5 mg

- IV = n/a

26
Q

PO and IV dose of hydromorphone equal to 100 mg PO codeine

A
  • PO = 2 mg

- IV = 1 mg

27
Q

PO and IV dose of methadone equal to 100 mg PO codeine

A
  • PO = 1 mg

- IV = n/a

28
Q

PO and IV dose of fentanyl equal to 100 mg PO codeine

A
  • PO = n/a

- IV = 50 ug

29
Q

PO and IV dose of sufentanil equal to 100 mg PO codeine

A
  • PO = n/a

- IV = 5 ug

30
Q

Steps to calculate equianalgesic doses

A
  1. Calculate total daily opioid intake (regular and breakthrough doses)
  2. Convert to morphine equivalents
  3. Convert from morphine equivalent to new opioid
  4. Start new product at 50-75% of calculated dosage
  5. Evaluate frequently for uncontrolled pain and re-titrate, if needed
31
Q

What is a typical breakthrough dose?

A

10-15% of daily dose

32
Q

Fentanyl patch conversion process

A
  • Takes 12-16 h to achieve therapeutic fentanyl serum levels
  • Therefore, must provide pt w/ opioid coverage during the conversion period
  • Ex: should be given hydromorphone immediate release at time of patch application (whatever the breakthrough dose is calculated as), 4 h after patch application, and 8 h after patch application
  • Upon system removal, 17 h or more are required for a 50% decrease in serum fentanyl concentrations
33
Q

Opioid side effects

A
  • Common = constipation, N, somnolence, mental clouding

- Less common = urinary retention, pruritus, myoclonus, amenorrhea, sexual dysfunction, headache

34
Q

Opioid induced neurotoxicity (sx and tx)

A
  • Sx = N, twitching/ myoclonus/ seizures, sleeping a lot, change in mental status, delirium, hallucinations, hyperalgesia
  • Tx = hydration, change opioid or reduce dose, treat sx (hallucinations, agitation)
  • Metabolites cause opioid induced neurotoxicity
35
Q

Neuropathic pain – pharm options

A
  • Opioids
  • Anticonvulsants (gabapentin, pregabalin, carbamazepine)
  • Antidepressants (duloxetine, amitriptyline, nortriptyline, venlafaxine, methadone)
  • Cannabinoids
36
Q

Cannabinoid indications (on and off label)

A
  • On-label -> N/V from chemotherapy, chronic pain (neuropathic pain in MS and cancer), anorexia associated w/ HIV/AIDS, drug-resistant epilepsy
  • Off-label -> PTSD, anxiety, insomnia, epilepsy, chronic daily headache, inflammatory conditions, neuropathic/ mixed pain
37
Q

IV dose of codeine equal to 100 mg PO codeine

A

50 mg

Year 3 - Clinical (Winter) (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions