Pharmacologic treatment of Cancer Pain

Question 1

What non-opioid analgesic medication can be used for neuropathic pain and insomnia

Answer 1

amitriptyline (Elavil)

Question 2

NSAID that has the least risk for thrombocytopenia

Answer 2

ketorolac

Question 3

Treatment of refractory pain in WHO analgesic ladder

Answer 3

Interventions such as pumps, blocks, epidurals, RFAs

Question 4

at what point is it reasonable to start parenteral nutrition in a cancer patient with poor nutritional status

Answer 4

when >20% of body weight has been lost

Question 5

What are 3 mixed agonist-antagonist opiods

Answer 5

1. Pentazocine
2. Nalbuphine
3. Butorphanol

Question 6

Treatment of severe pain in WHO analgesic ladder

Answer 6

strong opioids such as Morphine, Oxycodone, Methadone, Levorphanol, Fentanyl

Question 7

patients who receive radiation therapy may benefit from what kind of diet to help with nutritional status

Answer 7

lactose free, low-residue diet

Question 8

How to determine how much of breakthrough pain opioid to take per day

Answer 8

short-acting intermediate release breakthrough medications should make up 10-15%, or 1/6, of total opioid daily dose

Question 9

Treatment of moderate pain in WHO analgesic ladder

Answer 9

Maximized non-opioid dose and add weak opioids such as codeine, hydrocodone, oxycodone, tramadol

Question 10

4 steps of pain recognized in the WHO analgesic ladder

Answer 10

1. Mild
2. Moderate
3. Severe
4. Refractory

Question 11

how gradually should you taper down opioid medication

Answer 11

decrease dose by 25-50% each day

Question 12

Treatment of mild pain in WHO analgesic ladder

Answer 12

non-opioid analgesics

Question 13

Maximum dose/day for tramadol

Answer 13

400mg/day

Question 14

mechanism of action of tramadol

Answer 14

non-opioid centrally acting analgesic with low affinity of mu-receptors. Also inhibits serotonin and norepinephrine reuptake