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Oncology and Palliative Care > Pain Management > Flashcards

Pain Management Flashcards

1
Q

What is Step 1 in the WHO pain ladder?

A

Non-opioid analgesia ± adjuvants

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2
Q

What is Step 2 in the WHO pain ladder?

A

Weak opioid analgesia + non-opioid analgesia ± adjuvants

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3
Q

What is Step 3 in the WHO pain ladder?

A

Strong opioid analgesia + non-opioid analgesia ± adjuvants

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4
Q

Give an example of a non-opioid analgesic agent and an appropriate dose

A

Paracetamol 1g QDS po

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5
Q

Give 3 examples of weak opioid analgesic agents used for the management of pain

A

Co-codamol 30/500
Co-dydramol
Tramadol

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6
Q

What are the components of co-codamol 30/500?

A

Codeine 30mg

Paracetamol 500mg

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7
Q

What are the components of co-dydramol?

A

Dihydrocodeine

Paracetamol

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8
Q

Give examples of strong opioid analgesic agents

A 
Morphine
Oxycodone
Fentanyl
Diamorphine
Buprenorphine
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9
Q

List some adjuvant analgesics which can be used alongside the steps of the WHO pain ladder

A 
NSAIDs e.g. ibuprofen
Tricyclics e.g. amitriptyline
Gabapentin
Bisphosphonates
Steroids
Radiotherapy
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10
Q

What are the names (drug name and trade name) of the short-acting and the long-acting preparations for morphine?

A 
Short-acting = Oral morphine sulphate solution (Oramorph)
Long-acting = Morphine sulphate slow release tablets (MST Continus)
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11
Q

True / False: It is acceptable to use the trade name for morphine when prescribing

A

True - You can write ‘Oramorph’ on the prescription

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12
Q

How long does Oramorph last for?

A

4 hours

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13
Q

How many doses of long-acting morphine (morphine sulphate slow release tablets) are given daily?

A

2 doses - one in the morning and one in the evening

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14
Q

What is the trade name for the short-acting morphine TABLETS which are available?

A

Sevredol

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15
Q

What dose of Oramorph would you start someone on?

A

Usually 10mg - If they have been on regular Step 2 analgesia they have already shown they can cope with opioids so this is appropriate. Consider lower dose in people with risk factors.

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16
Q

How frequently would you prescribe Oramorph?

A

Every 4 hours

17
Q

How do you work out the dose of long-acting morphine (MST Continus) to give?

A

Add up the total dose of short-acting Oramorph the patient is taking in one day and divide this into 2 equal doses. For example, if patient is on 10mg of Oramorph 4hrly (6 times per day) they take 60mg of morphine. 60/2 = 30 so the dose of MST Continus is 30mg twice a day (one in the morning and one in the evening)

18
Q

What might you consider prescribing alongside morphine to reduce the effects of a particular side effect?

A

Anti-emetic - Morphine commonly causes nausea and vomiting

Metoclopromide 10mg TDS po or s/c

19
Q

Can you give ‘breakthrough’ morphine to a patient already on long-acting MST Continus?

A

Yes

20
Q

What would be your choice of breakthrough analgesia for a patient who is already on long-acting MST Continus?

A

Oramorph (a short-acting morphine preparation)

21
Q

How would you work out the dose of breakthrough morphine required for a patient who is daily long-acting MST Continus if they needed extra analgesia for acute pain?

A

Total daily dose of morphine divided by 6 e.g. if patient is on 60mg of MST Continus daily (split into 2x 30mg doses), then you can prescribe 60/6 = 10mg of Oramorph as breakthrough medication

22
Q

What is the dosing instruction for PRN ‘breakthrough’ morphine?

A

Max. 2 doses every 4 hours or 6 doses per 24 hours

23
Q

What does of codeine is in the standard dose of co-codamol which is prescribed?

A

30mg (Co-codamol is usually 30/500)

24
Q

How long does it take for the effects of a morphine patch to wear off?

A

12-18 hours

25
Q

If switching from MST Continus BD to Fentanyl patches, how much overlap should there be between the 2 medications?

A

Take the final tablet of MST Continus at the same time as applying the Fentanyl patch

26
Q

Tramadol 100mg is equivalent to what dose of oral morphine sulphate?

A

20mg (conversion is 5:1)

27
Q

What must be included on a prescription for a controlled drug?

A
  • Prescriber details: Signature, date, prescriber address
  • Patient full name, DOB and address
  • The name and form of the drug e.g. morphine sulphate tablets
  • The dose (e.g. 40mg) or strength (e.g. 10mg/5mL) of the drug
  • The total quantity or total number of units written in words and figures
28
Q

How would you write an outpatient prescription of Morphine Sulphate Tablets (MST) 40mg PO BD?

A 
Morphine sulphate tablets (MST) 40mg PO BD
Supply 20 (twenty) 10mg tablets and 20 (twenty) 30mg tablets
29
Q

What dose of MST Continus is NOT available?

A

Tablets don’t come in 20mg

30
Q

List some side effects of NSAIDs

A 
Fluid retention, hypertension
Heart failure
Bleeding
GI disturbance - Ulcers, dyspepsia, nausea and vomiting
Nephrotoxocity and renal failure
Bronchospasm

Oncology and Palliative Care (4 decks)

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