Cancer Pain Management Flashcards
What is the conversion ratio of fentanyl to MSO4?
6:1
How long does methadone last with chronic dosing?
6-8 hours
Why can’t we give methadone as PRN?
There is a problem with respiratory depression.
For oral treatment of pain >4, what is the range of the morphine sulfate dose that the NCCN guidelines say to give?
5-10mg
For IV treatment of pain >4, what is the range of the MSO4 dose that the NCCN guidelines say to give?
2-5mg
How long should you expect tolerance for sedation from opioids?
1-3 days
How do you treat persistent sedation?
You optimize the dose and can give Ritalin
How long should you expect tolerance for N/V in patients taking opioids?
3-4 days.
What is the most common cause of nausea in patients taking opioids?
Constipation
What medications can you give to patients to help with N/V due to opioids?
Metoclopramide
Prochlorperazine
What is pruritus?
Several opioids cause histamine release which can cause pruritus as a side effect.
It is severe itching.
What dose should you start at for naloxone when reversing respiratory depression?
0.4mg/10mL
Give 0.5mL every 2 minutes.
You do this to prevent causing severe rebound pain.
Do sleeping patients need naloxone?
No
Why are antidepressants used as an analgesic adjuvant?
TCAs are useful for neuropathic pain.
Why are anticonvulsants used as an analgesic adjuvant?
Useful for neuorpathic pain
Carbamazepine, Gabapentin
Why are corticosteroids used as an analgesic adjuvant?
Useful for pain due to nerve compression or inflammation, lymphedema, bony pain, increased intracranial pressure.
Why are benzodiazepines useful as an adjuvant analgestic?
Useful for muscle spasms
Why are bisphosphonates used as an analgesic adjuvant?
May be useful in bone pain, especially for osteolytic lesions
How do you treat bone pain?
NSAID or NSAID +Opioid
How do you treat muscle spasms?
BZD or baclofen
How do you treat neuropathic pain?
Nortriptyline or Carbamazepine +/- narcotic
If unresponsive use gabapentin, corticosteroid, or mexilitene
How do you treat increased intracranial pressure?
Corticosteroids
