Supportive Care II (Weddle) Flashcards
Describe nociceptive pain.
tissue injury that activates specific pain receptors (nociceptors) that are sensitive to stimuli
What are the two subtypes of nociceptive pain?
somatic and visceral pain
Describe somatic pain.
associated with receptors on surface tissues/deep tissues such as bones, joints, muscle, or connective tissue
Describe visceral pain.
associated with receptors located in the viscera (internal organs)
A patient presents to your pharmacy complaining of a burning feeling in his right leg. Is this pain most likely nociceptive or neuropathic?
neuropathic
A patient presents to your pharmacy complaining of stabbing abdominal pain. Is this pain most likely nociceptive or neuropathic?
nociceptive
Many cancer patients will have a combination of ________ and ________ pain.
acute; chronic
What does OPQRSTU stand for?
- What is the onset of the pain?
- What provokes it?
- What is the quality of the pain?
- Does the pain radiate?
- How severe is the pain?
- Time of the pain
- Understanding and impact
Can morphine be used in renal insufficiency? Hepatic insufficiency?
no; use caution
Can hydromorphone be used in renal insufficiency? Hepatic insufficiency?
yes but use lower doses/longer intervals; use caution
Which opioid product is not available in an IV formulation?
oxycodone
What adverse effects are associated with the use of oxycodone in renal failure patients?
oversedation and CNS toxicity
What is the only opioid that is safe for renal and liver dysfunction?
fentanyl
What is (arguably) the #1 benefit of methadone?
low cost
Can methadone be used in patients with renal failure? Liver dysfunction?
yes; not advised
What potential adverse event can occur with methadone?
QT prolongation
True or false: each opioid has a maximum dose.
false
Why should you reduce the dose by 25% when switching between two opioids?
cross-tolerance
How can you combat opioid-associated constipation?
mild stimulant laxative +/- a stool softener
With which opioid is pruritis most often seen?
morphine
What drug should be administered for opioid-induced respiratory depression?
naloxone
PCAs should be used in with caution in patients with ____________.
sleep apnea
Cardiac plexus block is used commonly in patients with _________ cancer.
pancreatic
When would a patient warrant intrathecal pain medication?
if they are refractory to other opioid therapy or increased toxicities
On-Q pumps deliver medication ___________.
locally
Cancer patients are considered to be in a ____________ state.
hypercoagulable
What VTE treatment option is best for patients without gastric/gastroesophageal lesions?
DOACs (apixaban, rivaroxaban)
What VTE treatment option is preferred in patients with gastric/gastroesophageal lesions?
LMWH (dalteparin, enoxaparin)
What were the results of the CLOT trial?
dalteparin was more effective than warfarin in reducing risk of recurrent VTE without increasing bleeding risk
What was the conclusion reached in the SELECT-D trial?
rivaroxaban was associated with relatively low VTE recurrence but higher CRNMB compared with dalteparin
What conclusions were reached with the Hokusai VTE cancer trial?
PO edoxaban was noninferior SQ dalteparin in regards to recurrent VTE/major bleeding
edoxaban had higher rate of major bleeding, but lower rate of recurrent VTE
What are some absolute contraindications for DOAC use?
- stage IV/V CKD
- active/significant liver disease
- strong dual inhibitors/inducers of CYP3A4 + PGP
- PGP inducers/inhibitors
What is a vesicant?
drug/agent capable of producing blistering and/or serious tissue damage when infiltration into the tissue occurs
Give four examples of injection site necrosis antidotes.
- DMSO
- Dexrazoxane
- Hyaluronidase
- Sodium thiosulfate
