Symptom Control Flashcards

1
Q

Compare nociceptive vs neuropathic pain

A

nociceptive: functioning nervous system. The pain is localised
neuropathic: dysfunctional nervous system. The pain is generally tingling, it travels and it fluctuates

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2
Q

Describe the WHO pain ladder

A
  1. paracetamol, NSAIDs
  2. codeine, tramadol, dihydrocodeine
  3. morphine, diamorphine, oxycodone, fentanyl
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3
Q

What are some side effects of opioids?

A
constipation 
drowsiness
dry mouth 
N&V
respiratory depression
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4
Q

What analgesia is best to use in CKD?

A

Mild renal impairment: oxycodone

Severe renal impairment: fentanyl and buprenorphine

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5
Q

When would you consider up titrating a persons opioid?

A

> 3 PRN needed a day

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6
Q

How is someone’s new up titrated dose of morphine calculated?

A

BD dose + PRN doses used = TDD

New BD = TDD/2
New PRN = TDD/6

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7
Q

What is a typical starting regime for someone new to opioids?

A

15mg BD zomorph (modified release)

5mg PRN oramorph (immediate release)

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8
Q

Compare the side effect profile of oxycodone and morphine

A

oxycodone is more constipating however leads to less nausea and drowsiness and pruritis

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9
Q

What are the causes of vomiting in a cancer patient?

A
gastric dysmotility 
opioid and chemotherapy induced 
electrolyte disturbances
- uraemia 
- hypercalcaemia 
- hyponatraemia 
anxiety induced 
RICP
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10
Q

How is chemotherapy induced N&V managed?

A

Ondansetron

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11
Q

How is metabolic derangement induced N&V managed?

A

haloperidol or levomepromazine

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12
Q

How is N&V due to reduced gastric motility managed?

A

Metoclopramide

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13
Q

How is N&V due to mechanical bowel obstruction managed?

A

Cyclizine

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14
Q

How is anxiety induced N&V managed?

A

Lorazepam

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15
Q

How is RICP in palliative care managed?

A

Cyclizine + dexamethasone + radiotherapy

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16
Q

What are some causes of breathlessness in palliative care?

A
anxiety 
pneumonia 
PE
SVCO
rib metastasis
17
Q

How is breathlessness in palliative care managed?

A
Open windows and increase air flow 
Sit the patient up
Talk about any anxieties they are having
Breathing exercises and physiotherapy 
Morphine 
Benzodiazepines 
Oxygen
18
Q

What causes hiccups in palliative patients?

A

Gastric distention
Phrenic nerve involvement
Uraemia

19
Q

How are intractable hiccups managed?

A

Chlorpromazine

+/- haloperidol, gabapentin and dexamethasone

20
Q

What causes constipation in palliative care?

A
Opioids
Weakness to push 
Dehydration and malnutrition 
Immobility 
Hypercalcaemia 
Spinal cord compression
21
Q

How is constipation in palliative care managed?

A

Co-danthramer (stimulant + softener)
Or
Lactulose + Senna

22
Q

How does end stage lymphoedema present?

A

Non-pitting oedema

Chronic skin changes

23
Q

How is lymphoedema managed?

A

Gradient compression bandaging

24
Q

How should psychological distress associated with cancer/ palliation be managed?

How should it be managed in the terminal phase of illness?

A

Non-pharmacologically: breathing exercises, religious support, CBT
Haloperidol or chlorpromazine

Terminal phase: Midazolam

25
Q

What are the drug options for respiratory secretions? What is the advantage of one vs the other?

A

Hyoscine hydrobromide: sedating
Hyoscine butylbromide: non-sedating

Can also use glycopyrronium

26
Q

What are the advantages and disadvantages of using a patch for analgesia?

A

+ Less constipating

  • Analgesia requirements need to be stable to use
  • Increased N&V
  • Withdrawal symptoms