Palliative/Symptoms

Question 1

Opioid S/E and management

Answer 1

constipation - PEG, senna
N/V: D2 antagonist
urinary retention: nalbuphine
myoclonnus: benzo, opioid rotation
Pruritus: nalbuphine, naloxone, antihistamine

Question 2

Opioid rotation when to do equi-analgesic or dose reduction

Answer 2

Bad pain control, bad S/E: equi-analgesic

Good pain control, bad S/E: 25% dose reduction

Question 3

Common opioid conversion

PO to IV morphine
IV to PO morphine

PO morphine to PO HM
PO HM to PO morphine

Answer 3

PO to IV morphine x0.3
IV to PO morphine x3

PO morphine to PO HM x0.2
PO HM to PO morphine x5

Question 4

Neuropathic pain management classes and examples

Answer 4

Gabapentin
TCA: amitriptyline
SNRI: venlafaxine, duloxetine
anti-epileptic: carbamazepine, topiramate
local: lidocane, ketamine
Opioid: methadone

Question 5

Palliative management
- dyspnea
- secretions
- delirium

Answer 5

• dyspnea: tx if distressing; opioid 25-50% analgesic dosing, fan to face, benzo
• secretions: tx if distressing; atropine 1% eyedrops SL/bucal, scopolamine SC
• delirium: conservative, haldol; avoid benzo/anticholinergic

Question 6

Antiemetic Classes
5HT3 antag
GC
NK-1 antag
Dopamine antag
CBD1 agonist
H1 antag
ACh antag

Answer 6

5HT3 antag: ondans etc
GC: dex
NK-1 antag: Aprepitant (>12yo, avoid w cyclo/ifos)
Dopamine antag: metoclopramide, olanz
CBD1 agonist: nabilone
H1 antag: gravol
ACh antag: scopolamine

Question 7

Antiemetic
LR:
MR:
HR:

Answer 7

LR: 5HT3
MR: 5HT3 + dex
HR: 5HT3 + dex (half dose) if permitted + aprepitant

Question 8

When to use/void Aprepitant for CINV

Answer 8

only >12yo

use if high ematogenicity (carbo, cisplat, cyclo, cytarabine, MTX > 12)

avoid for cyclo, ifos