cancer pain

Question 1

what is somiatic and visceral pain?

Answer 1

somatic: continious ache, tender to pressure. Worse on movement. Localised, dull pain

visceral:
cramping deep pain
Not related to movement
poorly localised

Question 2

what are the steps of the analgesic ladder?

Answer 2

Stage 1:
non opioid such as aspirin/paracetamol/NSAID

stage 2:
weak opioid:
for mild to moderate pain
codeine 
\+/- non opioid

step 3:
strong opioid
for moderate to severe pain ie morphine
+/- non opioid

Question 3

what is the first line strong opioid for patients with severe pain?

Answer 3

morphine sulphate

Question 4

what are choices of strong opioid?

Answer 4

morphine sulphate
oxycodone
alfentanil
diamorphine

Question 5

what are choices of transdermal strong opioid?

Answer 5

buprenorphine change every 7 days(butran)
fentanyl: change every 72 hours

*both are 100x strong than morphine’

Question 6

what is the potency of morphine vs codeine/tramadol and oxycodone?

Answer 6

Morphine:1
Codeine 1/10
Tramadol 1/10

Oxycodone:2

Question 7

how do you convert oral morphine to S/C morphine?

Answer 7

divide by 2

Oral dose divided by 2 = subcut dose

Question 8

what are legal requirements when prescribing controlled drugs?

Answer 8

legible capital letters
patient details
prescriber details

drug details: formulation, strength, dose, frequency, total quantity in words and figures

cross out left over space

Question 9

how do you calculate how much ‘as required’ opioid to give for breakthrough pain?

Answer 9

1/6th the total 24 hours opioid dose

If voer 3 PRN doses needed background opioid needs reviewing

Question 10

what is the advantage of using a syringe driver?

Answer 10

it enables continious S/C delivery over 24 hours

Question 11

what are adverse effects of opioids?

Answer 11

Common initial:
N+V
drowsiness
unsteady
confusion

common ongoing?
constipation
nausea
vomiting
dry mouth

occasional:
sweating
pruritus
hallucinations
myoclonus
urinary retention

rare:
respiratory depression

Question 12

what should be prescribed with opioids?

Answer 12

regular laxative

PRN antiemetic

Question 13

what opioids should be used in renal impairment?

Answer 13

ones without active metabolites ie alfentanil

Question 14

what are possible choices for ‘adjuvant analgesia’?

Answer 14

anticonvulsants ie gabapentin and pregabalin
anti depressants: amitriptyline
bisphosphonates
steroids

Question 15

what are non pharmacological approaches for pain relief?

Answer 15

• TENS
• massage and other complementary therapy
• counselling
• relaxation techniques
• spiritual support

Question 16

what are possible causes of delirium?

Answer 16

metabolic
opioid toxicity
disease progression
medications
stroke

Question 17

what are features of opioid toxicity?

Answer 17

drowsiness
confusion
myoclonic jerks
vivid dreams
hallucinations
resp depression

Question 18

what are reasons for using S/C route?

Answer 18

nausea
unsafe swallow
unable to take tablets

Question 19

when is oxycodone good to use?

Answer 19

when people are having strong side effects of morphine

Question 20

what is given for opioid toxicity?

Answer 20

naloxone

Question 21

what is good pain relief for metastatic bone pain?

Answer 21

bisphosphonates

Question 22

how do you convert morphine to diamorphine?

Answer 22

divide by 3

Question 23

what are good opioids for people with impaired renal function?

Answer 23

alfentanil
buprenoprhine
fentanyl

Question 24

when are transdermal patches appropriate?

Answer 24

when pain levels are stable and don’t need titrating