Symptom Control Flashcards
Compare nociceptive vs neuropathic pain
nociceptive: functioning nervous system. The pain is localised
neuropathic: dysfunctional nervous system. The pain is generally tingling, it travels and it fluctuates
Describe the WHO pain ladder
- paracetamol, NSAIDs
- codeine, tramadol, dihydrocodeine
- morphine, diamorphine, oxycodone, fentanyl
What are some side effects of opioids?
constipation drowsiness dry mouth N&V respiratory depression
What analgesia is best to use in CKD?
Mild renal impairment: oxycodone
Severe renal impairment: fentanyl and buprenorphine
When would you consider up titrating a persons opioid?
> 3 PRN needed a day
How is someone’s new up titrated dose of morphine calculated?
BD dose + PRN doses used = TDD
New BD = TDD/2
New PRN = TDD/6
What is a typical starting regime for someone new to opioids?
15mg BD zomorph (modified release)
5mg PRN oramorph (immediate release)
Compare the side effect profile of oxycodone and morphine
oxycodone is more constipating however leads to less nausea and drowsiness and pruritis
What are the causes of vomiting in a cancer patient?
gastric dysmotility opioid and chemotherapy induced electrolyte disturbances - uraemia - hypercalcaemia - hyponatraemia anxiety induced RICP
How is chemotherapy induced N&V managed?
Ondansetron
How is metabolic derangement induced N&V managed?
haloperidol or levomepromazine
How is N&V due to reduced gastric motility managed?
Metoclopramide
How is N&V due to mechanical bowel obstruction managed?
Cyclizine
How is anxiety induced N&V managed?
Lorazepam
How is RICP in palliative care managed?
Cyclizine + dexamethasone + radiotherapy