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CA > Pain Management unit 1 > Flashcards

Pain Management unit 1 Flashcards

1
Q

Pharmacotherapeutic Intervention

A

By mouth

*By clock

*By ladder

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2
Q

By the
mouth

A

the least invasive and safest method.

  • reserved for those not able to take orally
  • unable to absorb drugs via the gastrointestinal tract.
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3
Q

By the
clock

A

most oral analgesics act only for 4 hours or less,

should be prescribed 4 hourly to achieve therapeutic effects.

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4
Q

By the
ladder

A

WHO’s pain ladder

  • dose must be titrated until:
  1. the maximum recommended dose is reached
  2. the pain is relieved
  3. or the patients experience serious side effects.
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5
Q

WHO’s Pain Ladder

step 1

A

STEP 1

Non-opioids
Paracetamol, NSAID,
COX-2 inhibitors
± adjuvant analgesic

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6
Q

WHO’s Pain Ladder

step 2

A

STEP 2

Weak opioids
Tramadol, Codeine
± adjuvant analgesic

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7
Q

WHO’s Pain Ladder

step 3

A

Strong opioids

Immediate release:
Morphine solution
Oxycodone
Methadone

Controlled release:
Morphine Sulphate Tab
Oxycontin
Transdermal Fentanyl

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8
Q

Adjuvant
Analgesics

A

Helpful in neuropathic pain, can be added in any
steps in WHO Pain Ladder

Tricyclic antidepressants

Anticonvulsants

-Gabapentin
-Pregabalin

Topical

-Lignocaine

Steroid

-Dexamethasone

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9
Q

Morphine

A

Commonest strong opioid used for palliative patients.

Used for moderate to severe pain; and dyspnea.

  • Liquid:
  • Mist Morphine Solution (1mg/ml)
  • Oramorph Morphine syrup (2mg/ml)
  • RA-Morph(Rapid Acting) Morphine solution (1mg/ml)
  • Tablet: Morphine Sulphate (Sustained-Released) Tablet, also known as MST (10mg /30mg tablets). Cannot be cut/crushed.
  • Injectable: Per ampoule Morphine (10mg/ml) given subcutaneously or
    intravenously
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10
Q

Liquid morphine

A

Mist Morphine Solution (1mg/ml)
* Oramorph Morphine syrup (2mg/ml)
* RA-Morph(Rapid Acting) Morphine solution (1mg/ml)

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11
Q

Tablet morphine

A

Morphine Sulphate (Sustained-Released) Tablet, also known as MST (10mg /30mg tablets).

Cannot be cut/crushed.

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12
Q

Injectable morphine

A

Injectable: Per ampoule Morphine (10mg/ml) given subcutaneously or
intravenously

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13
Q

Common side effects of Morphine

A

constipation, nausea, vomiting, sedation and confusion.

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14
Q

_______________ are needed for ALL patients on Morphine.

A

Laxatives

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15
Q

Morphine Toxicity

A

Myoclonic jerks, pinpoint pupils and respiratory depression

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16
Q

Fentanyl

A

Is a safe strong opioid in moderate to severe renal failure

  • More potent than Morphine Ratio is 1:100
  • Doses are the same for transdermal, subcutaneous and
    intravenous routes.
  • Transdermal Fentanyl patch:
  • 12mcg/hr
  • 25mcg/hr
  • 50mcg/hr
17
Q

Transdermal Fentanyl takes about _______ hrs to have its maximal
effects and has similar residual effect ________ after it is removed.

Last for about ____________ hrs.

A

about 8-12hrs to have its maximal

8-12 hrs

72

18
Q

Fentanyl indications (7)

A

When orally intake is not possible (nausea and vomiting).

  • Difficult compliance to Oral Morphine.
  • Patient develops side effects or toxicity of Morphine and the need to
    opioid rotate.
  • Severe constipation with Morphine.
  • Renal impairment
  • Liver impairment
  • Patient is averse to Morphine but agreeable to use another strong opioid.
19
Q

Fentanyl side effect

A

Similar to Morphine but less constipation

20
Q

Fentanyl Usual dose (Start)

A

Transdermal: 6mcg/hr q72H (use half of a 12mcg/hr patch)

Infusion (SC): 10mcg/hr (0.2 ml/hr)

21
Q

Opioids in Renal
Failure

A

Caution is required when
estimated creatinine clearance
falls below 30ml/min, whether
or not a patient is on dialysis

Fentanyl is recommended in
moderate to severe renal
impairment

22
Q

Opioids in
Liver Failure

A

Fentanyl is the opioid of choice
in patients with moderate to
severe liver failure or cirrhosis

Other opioids may be used with
caution (by decreasing dose and
frequency) and careful
monitoring for side effect

23
Q

Guide to the use of opioids

A
  1. Educate patient/caregiver
    in the use of opioid
  2. Advise about the
    common side- effects
  3. Empower
    caregiver to
    manage side
    effects.
  4. Address concerns
    about opioid use.
24
Q

Non-pharmacotherapeutic
Intervention

A

Address the concept of “Total
Pain” in holistic dimensions.

  • Appreciate the role of
    multidisciplinary team in
    managing “Total Pain”
25
Q

Non-pharmacotherapeutic
Intervention

A

Examples:

  • Radiotherapy
  • Palliative
    surgery
  • Physiotherapy/
    Occupational
    therapy
  • Transcutaneous
    Electrical Nerve
    Stimulators
    (TENS)

Examples:
* Massage
therapy
* Acupuncture
* Music therapy
* Art therapy
* Namaste

26
Q

Namaste care

A

“Honour the spirit within”

  • Structured programme for
    person living with Advanced
    Dementia
  • Incorporates sensory
    intervention, social contact
    and environmental
    modification
27
Q
A

CA (19 decks)

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