Oncology Flashcards
Opiods are toxic to kidneys why?
many incl morphine renally excreted; increases risk of accumulation and toxicity
if eGFR is less than 90 what opiod?
why
oxycodone
metabolised by liver
step 1 for pain?
dose?
paracetamol
0.5g-1g every4-6 hours ; maximum 4g daily
examples of nsaids?
use
ibiprofen, naproxen, diclofenac
pain
inflammation
pyrexia
dosing of nsaid?
300-400mg 3/4 x a day
600mg 4x if needed
maintenance dose is 200-400mg per day
weak opiods?
codein
co-codamol (+paracetamol)
di-hydrocodeine
di-hydrocodeine dose
30mg every 4/6 hours
what is an alternative to codeine / co-codamol
dose?
tramadol
initially 100mg, then 50-100mg every 4-6 hours; usual maximum 400mg/24 hours
strong opiate ABC
antiemetic
breakthrough pain
laxatives for Constipation
top dose of tramadol?
400mg
management of pain in intial 24 hours
what strong opiod?
oromorph 5-10mg 4 hourly
renal failure which strong opioid?
alfentanil - hepatic metabolism
why are NSAIDs avoided in renal failure?
they work by inhibiting cyclo-oxygenase (COX) 1 and 2, preventing prostaglandin formation
bone mets causing pain - treatment
palliative radiotherapy
A single 8 Gray (dose) in one fraction (treatment) has been shown to reduce pain caused by bone metastases
zoledronic acid - bisphosphonate ; inhibits osteoclast driven resorption
which is the best antiemetic for opioid caused nausea ?
metoclopramide 10mg / 3x a day
pro-kinetic
untreated metastatic bone disease runs the risk of?
Hypercalcaemia
signs of hypercalcaemia ?
N+V
muscle twitch / weakness
fatigue, confused,
bone pain / fragile bones
polyuria/ polydipsia
syringe pump - what four main symptoms?
agitation / pain/ nausea/vomiting
midazolam for agitation,
morphine sulphate for pain,
metoclopramide for nausea/vomiting
glycopyrronium for respiratory secretions
