Palliative Care and Pain Management

Question 1

Converting from one opioid to another, change in dosage

Answer 1

decrease by 25% if well tolerated

Question 2

dosing of prn opioid

Answer 2

10-20% of 24 hour dose

Question 3

3:2:1 rule of opioid conversion

Answer 3

1mg IV morphine, 2mg PO oxycodone, 3 mg PO morphine

Question 4

SPIKES- S

Answer 4

setting up

Question 5

SPIKES - P

Answer 5

obtaining patient’s perspective

-

Question 6

SPIKES - I

Answer 6

obtain the patient’s invitation

Question 7

SKIPES - K

Answer 7

giving knowledge and information to the patient

Question 8

SPIKES - E

Answer 8

address EMOTIONS with EMPATHETIC responses

Question 9

SPIKES - S (final)

Answer 9

Strategy and Summary

Question 10

VOMIT - V

Answer 10

Vestibular
Cholinergic and Histamine Receptors
Scopalmine patch, promethazine

Question 11

VOMIT - O

Answer 11

Obstruction of Bowel By Constipation

stimulate mesenteric plexus - senna

Question 12

VOMIT - M

Answer 12

Dysmotility of upper Gut
Cholinergic, Histamine 5HT3/4

Prokinetics- metoclopramide

Question 13

VOMIT- I

Answer 13

Infection, Inflammation
cholinergic, histaminic, 5ht3, neurokinin 1
Promethazine, prochloperazine

Question 14

VOMIT - T

Answer 14

Toxins stimulating chemoreceptor trigger zone in the brain (including opioids)Dopamine 2, 5HT3
prochloperazine, haloperidol, ondasteron

Question 15

opioid receptors

Answer 15

mu, delta, kappa

also sigma, epsilon

Question 16

Somatic Pain

Answer 16

well localized
aching, squeezing, throbbing, stabbing
ex bone pain

Question 17

Visceral Pain

Answer 17

diffuse, poorly localized

dull, crampy, achy

Question 18

codeine

Answer 18

weak opioid, metabolized in liver to morphine

many people are slow metabolizers

Question 19

Methadone- MOA

Answer 19

mu opioid receptor

N-methyl-D-asparate (NMDA) receptor antagonist

Question 20

Hyperalgesia

Answer 20

increased sensitivity to pain

Question 21

Allodynia

Answer 21

pain w/ non-painful stimuli

Question 22

Bone Pain treatment, consider

Answer 22

bisphosphonate
calcitonin
steroids
radiotherapy

Question 23

Bowel spasm treatment, consider

Answer 23

octreotide, anticholinergic

Question 24

Tramadol MOA

Answer 24

weak opioid (mu receptor)
NERI
alpha-2 agonist

Question 25

Ketamine MOA

Answer 25

NMDA receptor antagonist
mu, delta, kappa
serotonergic, noradrenergic, cholinergic