Supportive Care II Flashcards
How do we assess pain within Cancer?
- O: Onset
- P: Provokes
- Q: Quality
- R: Radiate
- S: Severe
- T: Time
- U: Understanding?
What are a few of the principles around pain management in Cancer?
- Cause?
- Around the clock WITH prn
- Lowest dose possible
What is the tiered system for the treatment of Pain in Cancer?
- Pain: non-opioid +/- adjuvant
- More Pain: Opioid +/- non-opioid +/- adjuvant
- MORE PAIN: Opioid +/- non-opioid +/- adjuvant
What are some of the opioids that are used in the treatment of pain in Cancer?
- Morphine, Hydromorphone, Oxycodone, Fentanyl, Methadone
What are some important things about Morphine in Cancer?
- Metabolized in the liver & excreted renally
- Liver dysfunction
What is important to know about Hydromorphone in Cancer?
- Metabolized in the liver & excreted renally
- MORE potent than Morphine
What is important to know about Oxycodone in Cancer?
- Metabolized by 2D6
- Renal Failure can over sedate and CNS toxic
- Liver dysfunction
- NO PCA [no IV]
What is important about Fentanyl in Cancer?
- MOST POTENT PAIN MED
- Metabolized in liver
- SAFE in renal & liver dysfunction
- Patch, IV, buccal, nasal spray, lozenges
What is the dangerous thing about Fentanyl?
- Respiratory Depression
What is important to know about Methadone in Cancer?
- NOT GO TO
- Very unpredictable [t1/2 = 8 to 59h]
- QTc Prologation
What are some of the common toxicities for opioids in Cancer?
- CONSTIPATION: [ADD bowel regimen - NO tolerance]
- Sedation
- N/V
- Pruritis: Mainly with morphine
- Hallucination
- RESPIRATORY DEPRESSION: [give narcan]
What is a Patient Controlled Analgesia?
- PCA: patient demand +/- infusion of opioid [when they want it]
- NOT family controlled
If a patient has Sleep Apnea, should a PCA be used?
- NO
- first 24 hours after surgery is the highest for sedation & respiratory depression
How do you change a PSA?
- Calculate 24hr dose
- Convert
- Reduce by 25%
- Divide into doses
- ADD PRN
In what type of Cancer is a Celiac Plexus Block used in?
- Pancreatic Cancer - Blocks the nevere that supply to the organs in the abdomen
What is important to know to know about VTE and Cancer?
- x9 more risk of VTE with Cancer
What are some of the monotherapy options for VTE in Cancer?
- DOACs [WITHOUT GI lesions]
- LMWH [WITH GI lesions]
- 3 moths duration
What are some fo the Combo therapies for VTE in Cancer?
- LMWH –> Edoxaban
- LMWH/UFH/Fondaparinux –> Warfarin
- 3 month duration
What was the result from Comparion of Low-Molecular-Weight Heparin vs Oral Anticoagulation Therapy [CLOT] in Cancer?
- LMWH > Warfarin??
- Results: Dalteparin was better than Warfarin in decreasing VTE
When screening for breast cancer, what is important to know?
- Mammogram @ 45-55 yearly then >55 every two years
What are some preventions that you can do for Breast Cancer?
- High Risk = surgery [BRAC 1 = Ovarian & Breast]
- Tamoxifen & Raloxifene are approved for prevention [can use both]
What is important to know about Tamoxifen?
- Agonist & Antagonist = Increase Bone and Increase Endometrial cancer
When screening for Prostate Cancer, what is important to know?
- DRE [how does it feel?] & PSA [normal 0-4]
- Men > 50 y –> PSA [>2.5 yearly; <2.5 2 years] +/- DRE
- HIGH RISK: Screen at 45 yo
What are some preventions for Prostate Cancer?
- Finasteride [5a-reductase] BUT only 25% had a decreased risk [those that got prostate cancer had a higher gleason score]
When screening for Colon Cancer, what is important to know?
- Test: Primary Detect Cancer [FIT, FOBT] or Detect Cancer [Colonoscopy]
What are the Primary Detect test of Colon Cancer?
- FIT: detects hemoglobin
- FOBT: blood test?
What is Primary Detect Cancer and Advanced Lesions of Colon Cancer?
how do we detect?
- Colonoscopy: looks at the whole bowel and can remove anything precanerous
When should patient be screened for Colon Cancer?
- >45 years old
- Colonoscopy every 10 years
What are some of the preventions for Colon Cancer?
- COX inhibitors: Celecoxib
- NSAIDS
- Remove colon
When screening for Lung Cancer, what is important to know?
- No real effective way
When screening for Ovarian Cancer, what is important to know?
- No effective screening tool
- LOW RISK: annual physical
- HIGH RISK: Pelic exam, transvaginal ultrasound [looking for hereditary or BRAC]
What are some of the ways that we can prevent Ovarian Cancer?
- Oral contrceptives - your not ovulating as much
- Removing the Ovaries - if BRAC1 & 2
When screening for Melanoma, what is important to know?
- Exam the WHOLE body
- History - clinical examination
What are some ways that we can prevent melanoma?
- SUNSCREEN of SPF > 15
- Avoid tanning beds
- Avoid direct sunlight form 10am to 4pm
