Supportive Care 2

Question 1

Constipation

Answer 1

no tolerance

stimulant laxative +/- stool softener

Question 2

Sedation

Answer 2

tolerance

Hold sedatives and/or anxiolytics

consider dose reduction

Question 3

Nausea/vomiting

Answer 3

tolerance

change opioid or add scheduled anti-emetic

Question 4

Pruritis

Answer 4

change opioid or add anti-histamine

Question 5

Confusion/delirium

Answer 5

change opioid or add neuropletic

Question 6

Myoclonic jerking

Answer 6

change opioid

Question 7

Respiratory depression

Answer 7

Hold opioid AND Nalaoxone–>lose dose if on chronic pain regimen

Dilute 1 mL with 9 mL NS

Give 0.02 mg/0.5 mL naloxone IV push over 2 minutes

Question 8

Conversion of IV PCA to Oral Opioids

Answer 8

1. Calculate 24-hour dose of current drug
2. Convert that to an equi-analgesic 24-hour dose of new agent using conversion chart
3. Reduce dose by 25% to account for cross tolerance
4. Divide total 24-hour dose into appropriate dose
5. Always add breakthrough PRN dosing (10-20% of total 24-hour oral dose every 4 hours)
   a.) Use the same drug (long-acting morphine scheduled + short-acting morphine PRN)