Brainscape's Knowledge GenomeTM

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


See full index

Pain > Chronic Malignant and Non-Malignant Pain > Flashcards

Chronic Malignant and Non-Malignant Pain Flashcards

1
Q

What is the definition of chronic malignant pain?

A

Pain associated with potentially life-threatening conditions

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

What are the causes of cancer pain?

A

Pain associated with tumor or metastasis
Pain associated with treatment
Pain unrelated to either

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

What are the types of cancer pain?

A

Nociceptive (surgical procedures, tumor, bone metastasis)
Neuropathic (chemotherapy, radiation therapy, surgical injury to nerves, tumor/metastasis-related
Mixed

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

What are complications from chronic malignant pain?

A 
Anxiety
Depression
Wt loss
Sleep disturbance
Decreased QoL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are medication options for chronic malignant pain?

A 
Morphine
Fentanyl
Hydrocodone
Oxycodone
Hydromorphone
Oxymorphone
Methadone
Tramadol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What types of medications are most commonly used in cancer pain?

A

Pure agonists (morphine, oxycodone, hydromorphone, and fentanyl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which opioid is considered the standard starting drug of choice in opioid naive patients?

A

Morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is morphine eliminated?

A

Renally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is fentanyl used in cancer pain?

A

Transdermal patches when opioid tolerant patients are in need of around the clock pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which routes of fentanyl are used for breakthrough pain in opioid tolerant patients?

A

Transmucosal
Buccal
Intranasal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is hydrocodone used in cancer pain?

A

Limited to mild, initial use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which medication can be used for cancer pain in morphine intolerant patients?

A

Oxycodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can methadone be initiated?

A

By physicians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does tramadol compare to morphine?

A

1/10 potency of morphine

Higher doses lead to increased AEs

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

What do adjuvant analgesics treat?

A

Bone pain
Neuropathic pain
Bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the cause of bone pain?

A

Tumor metastasis to bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are tx options for bone pain?

A 
Radiation/surgery
NSAIDs/APAP
Corticosteroids
Bisphosphonates
Denosumab
Calcitonin
Radioisotopes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

For what conditions are corticosteroids used?

A 
Bone pain
Compression of neural structures
HA d/t increased intracranial pressure
Arthralgia
Metastatic spinal cord compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are positive SE of corticosteroid use?

A

Improve appetite, nausea and malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which corticosteroid is commonly used and why?

A

Dexamethasone, low mineralcorticoid effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the MOa of bisphosphonates?

A

Inhibit osteoclast activity
Reduce bone resorption
Reduce tumor associated osteolysis
Delayed skeletal events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which bisphosphonates are administered IV?

A

Zoledronic acid

Pamidronate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are AEs associated with bisphosphonates?

A

Flu like reaction (treated with APAP)
Impaired renal function
Hypocalcemia
Osteonecrosis of the jaw (IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When should bisphosphonates be avoided?

A

CrCl < 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the MOA of denosumab?

A

Monoclonal antibody that binds to and inhibits RANKL leading to prevention of osteoclast formation and decreased bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the AEs of denosumab?

A

Hypocalcemia
Osteonecrosis of the jaw
Fatigue
HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What agent can be used for bone pain if all others fail?

A

Calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Where are radioisotopes absorbed?

A

Areas of high bone turnover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the causes of neuropathic pain?

A

Tumor
Surgery
Chrmotherapy
Radiation

30
Q

What are the pharmacologic options for neuropathic pain?

A 
TCAs
Gabapentin
Pregabalin
SNRIs
Corticosteroids***
31
Q

What is the first line option of bowel obstruction?

A

Surgery

32
Q

What are tx options if bowel obstruction surgery is not an option?

A

Octreotide and anticholinergics decrease intraluminal secretions and peristaltic movements
Corticosteroids decrease edema in the area

33
Q

When is a patient considered opioid tolerant?

A

Those who have taken opioids for at least one week

34
Q

What is the treatment recommendation for opioid-naive patients with moderate to severe pain (4+)?

A

For acute, severe pain or pain crisis, consider hospital or inpatient hospice admission
Start and rapidly titrate short-acting opioid

35
Q

What is the treatment recommendation for opioid-naive patients with mild pain (1-3)?

A

Consider non-opioids and adjuvant analgesics first, then short-acting opioids

36
Q

What is the first step for uncontrolled pain 4+ in opioid naive patients?

A

Give morphine IR 5-15 mg PO or 2-5 mg IV (or PCA)

37
Q

What is the second step for uncontrolled pain 4+ in opioid naive patients?

A

Reassess efficacy and AE in 60 minutes (PO) or 15 minutes (IV)

38
Q

What do we do if the pain is unchanged or increased in opioid naive patients?

A

Increase dose by 50-100%

39
Q

What do we do if the pain is decreased but inadequately controlled in an opioid naive patient?

A

Repeat same dose

40
Q

What do we do if the pain is decreased but adequately controlled in an opioid naive patient?

A

Continue at current effective dose as needed over initial 24 hours

41
Q

What is the first step for uncontrolled pain 4+ in opioid tolerant patients?

A

Administer a “rescue” dose (PO or IV) equivalent to 10-20% of total opioid taken in previous 24 hours

42
Q

What is the subsequent pain management for mild pain?

A

Reassess and modify regimen to minimize AEs

Taper opioids and other treatments when no longer needed

43
Q

What is the subsequent pain management for moderate-severe pain?

A

Re-evaluate opioid titrate and diagnosis if needed
Consider pain specialty consultation
Consider opioid rotation if dose limiting AE occur
Consider adding/adjusting adjuvant analgesics

44
Q

When should a long acting opioid be started?

A

After stabilized on short-acting opioids

45
Q

How are long-acting opioids dosed?

A

q12h (some q8h)

46
Q

If a patient has adequate analgesia and intolerable AEs, how do we adjust the medication?

A

Reduce dose by 10-25%

47
Q

If a patient is well controlled with stable disease and never needs breakthrough medications, completion of acute pain event, or improvement of pain control with non-opioids, how do we adjust the dose?

A

Reduce dose by 10-20%

48
Q

What is the dose of breakthrough pain?

A

10% TDD

49
Q

What is Breakthrough pain?

A

Pain that fails to be controlled by regularly scheduled opioids

50
Q

How frequently can short-acting pain medications be dosed?

A

Combination - 4-6 hours

Pure opioids - as short as every 1 hour, but usually every 4-6 hours

51
Q

If a patient is opioid-tolerant, how do we increase dosages?

A

Increase both scheduled and PRN opioids

52
Q

How do we prophylax for constipation?

A

Stimulant laxative +/- stool softener (senna-s)
Propylene glycol twice daily
Adequate fluid intake if possible

53
Q

How do we treat constipation if it develops?

A

Titrate bowel regimen to produce 1 non-forced BM every 1-2 days
Consider adding Mg-based products, bisacodyl, lactulose, sorbitol

54
Q

If there is no adequate response to constipation treatment, what is the next therapy option?

A

Methylnaltrexone

Naloxegol

55
Q

Why do methylnaltrexone and naloxegol not affected opioid analgesic effects?

A

Do not cross BBB

56
Q

What are other second line agents for constipation?

A

Injectable methylnaltrexone (Relistor)
Lubiprostone
Linaclotide

57
Q

What are the options for pain relief that is inadequate but sedation is interfering with dose titration?

A

Decrease opioid dose if possible
Add non-opioid analgesic to reduce opioid dose
Use a lower dose of opioid more frequently to reduce peak concentration

58
Q

What are options to tx sedation?

A

Methylphenidate
Dextroamphetamine
Modafinil
Caffeine

59
Q

How do we adjust opioid doses in delirium?

A

Lowering dose or changing to a different opioid

60
Q

How do we treat delirium d/t opioids?

A

Haloperidol
Olanzapine
Risperidone

61
Q

What do we do if the patient has nausea?

A

Ensure patient is having bowel movements

Should resolve with continued opioid exposure

62
Q

What are prophylaxis/treatments for nausea?

A 
Metoclopramide
Prochlopramide
Haloperidol
Olanzapine
Serotonin antagonists are options but may cause constipation
Opioid rotations
63
Q

How do we treat respiratory depression?

A

Cautiously administer naloxone

64
Q

How do we treat pruritus?

A

Antihistamines

Change to another opioid

65
Q

What is the last line for pruritus?

A

Small doses of a mixed agonist-antagonist (nalbuphine) as needed or continuous infusion of naloxone

66
Q

When does palliative care begin?

A

At diagnosis

67
Q

When are patients placed in hospice?

A

Less than 6 months prognosis

68
Q

How do we determine d/cing medications?

A

Determine utility of medication

  • How would the patient benefit from this medication
  • Remaining life expectancy vs time until benefit of drug is seen
  • Consider goals of care when analyzing medication utility
69
Q

Can morphine be used to treat dyspnea?

A

Yes

70
Q

How do we treat increased secretions?

A

Atropine eye drops administered SL
Scopolamine patch
Glycopyrrolate

71
Q

What is chronic non-malignant pain?

A

Pain lasting longer than 3 months or beyond the expected period of healing of tissue pathology

72
Q

What is the pathophysiology of chronic non-malignant pain?

A

Damage to the peripheral or CNS

Pain (5 decks)

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