Symptom management + palliative care Flashcards
What are the different types of pain?
Nociceptive - normal nervous system, identifiable lesion causing tissue damage
eg. somatic - skin, muscle, bone
visceral - solid organ
Neuropathic - prob w nervous system, nerve structure damaged
Can be mixed
What is the WHO analgesic ladder and what drugs fit into each bit?
- Simple analgesics/non opioids - paracetamol, NSAIDs, COX-2
- Weak opioids - tramadol, co codamol, codeine, dihydrocodeine
- Strong opioids - diamorphine, morphine, fentanyl, oxycodone
When should you use an NSAID and when should you use a COX-2?
No CVS or GI risk = NSAID eg. naproxen, ibuprofen, diclofenac
GI risk = Cox-2 eg. celecoxib
CV risk = NSAID
Prescribe PPI for all in cancer
What are adjuvants?
Drugs whose primary indication isn’t for pain
Used for pain that doesn’t respond to opioid analgesia
What are some examples of adjuvants?
Amitryptilline and duloxetine = tricyclic antidepressant
Pregabalin and gabapentin = antiepileptics
Diazepam and clonazepam = benzos
Dex
Bisphosphonate for bone pain
What is the dose equivilate of morphine to codeine?
Codeine : morphine = 10:1
eg. 240mg codeine = 24mg morphine
What are some SEs of opioids when used for persistant pain?
Constipation
Dry mouth
N+V
Drowsiness/sedation
What are some opioid prescribing principles?
- If prescribing slow release reg morphine, always prescribe PRN immediate release
- Always prescribe w laxative and anti emetic
What is are the principles for up titration of opioid dose?
If using lots and lots of PRN intermediate release = indicator that not given enough slow release
Add up total daily dose = how much they are taking in 24 hours
TDD divide by 2 = new morphine slow release dose (BD)
TDD divide by 6 = new morphine immediate release PRN dose
What is the ratio of SC to oral morphine?
Oral to SC = 2:1 ???? pretty sure
What are the principles of a fentanyl patch?
Needs to be changed every third day
Takes 12-24 hours to achieve steady state pain relief
Give additional oramoprh PRN
What are the CF of opioid toxicity and what are some causes?
CF - miosis, hallucination, drowsy, vom, confusion, myoclonic jerks, resp depression
Causes - escalated dose too quickly, renal impairment, pain doesn’t respond to opioid but escalated anyway
What do you need to write for a controlled drug prescription?
Drug name, form eg. capsules or oral solution, strength, brand name too
Number of tablets or bottles
Total in words and figures - 1(one)
What is intractable breathlessness? How can it be treated?
Untreatable fixable breathlessness
Normally use morphine ~2.5-5mg
What are the anticipatory meds?
Morphine 2.5-5mg SC PRN - pain and breathlessness
Midazolam 2.5-5mg SC PRN - agitation
Levomepromazaine 2.5-5mg SC PRN - N+V
Glycopyrronium 200-400 mcg SC PRN - resp secretions
