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Year 4 Oncology > Pain > Flashcards

Pain Flashcards

1
Q

History of pain

A

SQITARS
Associated symptoms - breathlessness, bowels
Treatments already tried - frequency and dose
ICE

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2
Q

Features of pain in advanced disease

A

Persistent
Multiple aetiologies
Impairs function
Fear of cancer worsening

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3
Q

Causes of chest pain in cancer pateints

A

Cancer related - bone mets, invasion, malignant spinal cord compression

Treatment related - reaction to radiotherapy, oesophagitis, pneumonitis

Other medical conditions - Pneumonia, pneumothorax (biopsy), PE, MI, anxiety, MSK

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4
Q

Pathophysiology nociceptive pain

A

Caused by an identifiable lesion causing tissue damage which stimulates pain receptors in the normal nervous system

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5
Q

Features of somatic nociceptive pain

A

Sharp
Throbbing
Well localised

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6
Q

Pathophysiology of neuropathic pain

A

Caused by damage to the nervous system e.g. spinal cord compression

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7
Q

Pathophysiology of neuropathic pain

A

Caused by damage to the nervous system e.g. spinal cord compression

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8
Q

Features of visceral nociceptive pain

A

Diffuse ache

Difficult to localise

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9
Q

Features of neuropathic pain

A 
Stabbing or shooting 
Burning 
Numbness or pins and needles 
Electric shock 
Hypersensitivity
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10
Q

Types of analgesics

A

Non- opiods
Adjuvants
Opiods

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11
Q

Examples of non-opiods

A

Paracetamol

Ibuprofen and other NSAIDs - diclofenac, naproxen

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12
Q

Examples of adjuvants

A

Anti - convulsant - Gabapentin, pregabalin
Antidepressants - Amitriptyline (TCA), duloxetine (SNRI)
Benzodiazepines - Diazepam, clonazepam
Bisphosphonates - for bone pain

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13
Q

Examples of opioids

A 
Morphine 
Fentanyl 
Tramadol 
Oxycodone 
Dihydrocodeine
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14
Q

WHO analgesic ladder

A
  1. Non-opioid
    +/- adjuvant
  2. Opioid for mild/moderate pain
    +/- non-opioid
    +/- adjuvant
  3. Opioid for moderate/ severe pain
    +/- non-opioid
    +/- adjuvant
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15
Q

COX2 NSAIDs and interactions

A

If there is no CV or GI risk - ibuprofen, diclofenac, naproxen

If there is a GI risk - COX 2 - celecoxib

If there is a CV risk - naproxen, ibuprofen

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16
Q

What is also prescribed with NSAIDs

A

PPI

17
Q

When to give analgesics

A

Consider with pain that is only partially responsive to opioid analgesia

Opioid sparing effect

18
Q

Drugs for neuropathic pain

A

Amitriptyline - prescribe at night
Gabapentin
Pregabalin

19
Q

Advice for neuropathic pain medication

A

Takes at least 5 days for full benefit

May need further titration

20
Q

Side effects of amitriptyline

A

Confusion
Sedation
Hypotension
Care with CVS disease

21
Q

Side effects of pregabalin and gabapentin

A 
Confusion 
Sedation 
Tremor 
Dizziness 
Care with renal impairment
22
Q

WHO principles for analgesics

A 
By mouth where possible 
By the clock rather than by pain 
By the ladder 
If adjusting SR, adjust PRN 
Use adjuvants at any step
23
Q

Examples of 1st, 2nd and 3rd line analgesics

A

Step 1: Paracetamol and NSAIDs

Step 2: Dihydrocodeine, codeine phosphate, tramadol, co-codamol

Step 3: Oxycodone, morphine, fentanyl, diamorphine

24
Q

Liver pain

A

Give dexamethasone to decrease inflammation

NSAIDs

25
Q

Converting between codeine and morphine

A

10: 1 codeine: morphine

e. g. 240mg codeine = TDD 24mg morphine

26
Q

Slow-release and PRN immediate-release morphine calculation

A

Slow release = TDD/ 2

PRN = TDD/ 6

27
Q

Max number of PRN morphine doses in 24hrs

A

6

28
Q

Immediate-release morphine

A

Oramorph liquid - 10mg/5ml

29
Q

Slow-release morphine

A

Zomorph capsules BD
MST tablets BD - used for small doses

Take 12 hourly

30
Q

Common side effects for opioids

A

Constipation - give laxative
Dry mouth
Nausea and vomiting - give anti-emetic
Drowsiness/ sedation - normally gets better and can drive if they feel fine

31
Q

Opioids and respiratory distress

A

Check renal function as occurs with renal failure

32
Q

Opioids and addiction

A

If used appropriately and at the right dose, it shouldn’t be a problem

33
Q

Opioids and approaching the end of life

A

Often this slows the progression of deconditioning so there is a better quality of life

34
Q

Fentanyl features

A

Transdermal patch
Non renally excreted
Takes 12 - 24 hrs to reach steady state

35
Q

Fentanyl and morphine

A

12mcg/hour patch = 45mg TDD morphine

45/6 = 7.5mg - prescribe 8mg oramorph PRN

36
Q

Syringe driver morphine

A

Delivered subcut - 1/2 24 hour oral dose

e.g. if 50mg zomorph BD = morphine 50mg/24hr via SCSD

37
Q

Opioid toxicity presentation

A 
Pinpoint pupils 
Hallucinations 
Drowsiness 
Vomiting 
Confusion 
Myoclonic jerks 
Respiratory depression
38
Q

When does opioid toxicity present

A

If dose is escalated too quickly

Renal impairment - withhold zomorph and check renal function

Poor opioid responsive pain but escalated

Intervention to reduce pain such as nerve block and given opioid

39
Q

Controlled drug prescription

A
  • Name and ID of the patient
  • Write prescription as normal
  • Write supply and give pharmacist exact instructions
  • Drug name and the formulation and strength
  • Total no. of tablets in words and figures

Year 4 Oncology (21 decks)

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