Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical 2 (Part B) > 20 - Cancer Pain > Flashcards

20 - Cancer Pain Flashcards

(75 cards)

Start Studying
1
Q

What are patient barriers in cancer pain?

A

Fears relating to analgesic use:

  • Addiction
  • Side effects
  • Fear of injections
  • Tolerance

Beliefs that affect communication about pain:

  • Disease progression
  • Distract the doctor
  • “Be good”
  • Fatalism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some health care worker barriers?

A

Opiophobia:

  • Fear of addiction
  • Fear of side effects
  • Fear of tolerance

Anxiety about regulation of controlled substances

Poor assessment

Lack of adequate training and pain management experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

___% of cancer patients experienced errors in opioid dosing

A

76

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some cancer pain conclusions?

A
  • Cancer pain is common
  • Cancer pain is often not treated optimally
  • Cancer pain significantly affects patient’s lives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define opioid addiction

A

Is a primary, chronic disease of brain reward, motivation, memory, and related circuitry
-No published reports in CA patients with no previous hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define physical dependence

A

Occurrence of abstinence syndrome when opioid is suddenly stopped
-Fairly common, need gradual withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define Tolerance

A

Decrease is one or more effects of the opioid

-Decreased analgesic effect due to tumor progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nociceptive Pain

A
  • Direct stimulation of intact nociceptors
  • Transmission along normal nerves
  • Somatic (easy to describe and localize)
  • Visceral (difficult to describe and localize)
  • Tissue injury apparent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neuropathic Pain

A
  • Disordered peripheral or central nerves
  • Compression, infiltration, ischemia, metabolic injury
  • Pain may exceed observable injury
  • Less responsive than nociceptive pain
  • Poorly responsive syndromes likely have a neuropathic component

*In the treatment of cancer, we can damage nerves and lead to post-cancer neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe somatic pain type

A

achy, stabbing, throbbing, squeezing, tender and/or deep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe visceral pain type

A

sharp, stabbing, squeezing, cramps, and/or gnawing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe neuropathic pain

A

burning, shooting, tingling sensation, numbness, scalding, may be associated with allodynia and/or hyperalgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some causes of cancer pain?

A

1) The cancer itself: 75-80%
- Tumor involvement of the bone (30-70%)
- Tumor involvement of nervous tissue, visor, blood vessels

2) The treatment of cancer: 15-19%
- Chemotherapy: peripheral neuropathy, mucositis
- Radiotherapy: plexopathy, pelvic pain
- Post-surgical: neuropathies

3) Unrelated to the cancer 3-5%
4) The debility of cancer

  • If it spreads to another area, can get visceral pain
  • If cancer is present on nerves, can have neuropathic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

____ cancer pain is the most complicated

A

bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some pharmacological agents for cancer bone pain?

A
  • Acetaminophen
  • NSAIDs/Cox-2 inhibitors
  • Steroids (don’t use NSAIDs and steroids together)
  • Opioids
  • Neuropathic agents
  • Bisphosphonates (pamidronate, zoledronic acid)

*often bc there is destruction of bone, we add on a bisphosphonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe radiation tx for cancer bone pain?

A
  • Single treatment or multiple treatment
  • Often effective immediately
  • Maximal effect 4-6 weeks
  • 60-80% of patients get relief
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some surgical options for treating cancer bone pain?

A

Pathologic (splint, cast, ORIF)

  • Intramedullary support
  • Spinal cord decompression
  • Vertebral reconstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is best to treat somatic pain?

A
  • Acetaminophen
  • NSAID
  • Opioid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is best to treat visceral pain?

A
  • Opioids
  • Steroids
  • Surgery
  • Chemo - radiation Tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Certain chemo treatments can cause ______

A

neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How else can cancer Tx cause pain?

A

1) Tx-related mucositis (located in whole GI tract)

2) Surgical
- Phantom limb pain
- Post-mastectomy syndrome
- Post-thoractomy syndrome

3) Tx-related immunosuppression
- Example: Post herpetic neuralgia
- Example: Shingles rash
- Example: Herpes Zoster Ophthalmicus

Bc of chemo, they are immunosuppressed, then they can develop shingles (in proper age group and had chicken pox before)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are total pain components?

A
  • Physical source
  • Patient’s emotional status
  • Patient’s personality
  • The family
  • Patient and family context
  • Health care professionals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If person has spinal curve abnormality (spinal cord curving and pressing on nerves), what type of pain is this?

A
  • prob partly somatic and partly neuropathic
  • if it’s actual changes in the back = somatic
  • if it’s pressing on nerves = neuropathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Codeine is metabolized to ______ by CYP2D6

A

morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
___% of patients taking codeine will have NO analgesic effect
5-10
26
___% will have a more pronounced effect
1-29
27
Do not use codeine with which drugs?
- paroxetine, fluoxetine - quinidine, haloperidol *anti-depressants block CYP 2D6 so if they are taking these, they won't have any analgesia effect
28
Do not use codeine in ____ & ____ dysfunction
renal and hepatic
29
Codeine has lots of ____ side effects
GI
30
What type of ppl are more likely to have duplication of CYP 2D6 alleles
african/ethiopian
31
Morphine undergoes ____ metabolism
hepatic
32
What are morphines metabolites?
60% morphine-3-glucuronide: -hyperalgesia, allodynia, hyperactivity 10% morphine-6-glucuronide: -greater analgesic properties, fewer adverse effects 4% normorphine, non-active, non-toxic
33
Avoid morphine in ____ dysfunctional and failure
renal
34
Use with caution in severe liver dysfunction, describe this
- increase dosing interval from q6h to q8h | - dosage conversion from IV to PO becomes 1:1
35
What is hydromorphone metabolized to?
hydromorphine 3-glucuronide
36
When is hydromorphine preferred over morphine ?
- renal failure - elderly (>60) due to decreased renal function - history of rashes - when nausea and constipation are a problem - when sedation is a problem
37
When is fentanyl the preferred agent over morphine and hydromorphone ?
- Elderly (>60 yo) due to decreased renal function - Renal failure and severe liver dysfunction - History of rashes - When nausea and constipation are a problem - When sedation is a problem
38
What drugs should we caution the use of fentanyl with?
Inhibitors of CYP 3A4: -Clarithromycin, Voriconazole, Grapefruit Inducers of CYP 3A4: -Dilantin, Rifampin, Steroids
39
What is the oral bioavailability of methadone ?
> 85%
40
Methadone is metabolized by ____
liver
41
Does methadone have active metabolites?
No
42
Methadone MOA
blocks NMDA receptors
43
Who should a fentanyl patch never be started in?
- an opioid naive patient - < 18 yo - acute pain
44
Correct dose is a compromise between ?
- sufficient pain relief - good cognitive function - acceptable side effect profile
45
If they still have mild pain, increase dose by ___%
25
46
If they still have moderate pain, increase dose by _____%
25-50
47
If they still have severe pain, increase dose by ____%
50-100
48
How much oral codeine is equivalent to morphine 10 mg?
100 mg
49
How much oral oxycodone is equivalent to morphine 10 mg?
5 mg
50
How much oral hydromorphone is equivalent to morphine 10 mg?
2 mg
51
How much oral methadone is equivalent to morphine 10 mg?
1 mg
52
How much IV codeine is equivalent to 5 mg of IV morphine ?
50 mg
53
How much IV hydromorphone is equivalent to 5 mg of IV morphine ?
1 mg
54
How much IV fentanyl is equivalent to 5 mg of IV morphine ?
50 ug
55
How much IV sufentanil is equivalent to 5 mg of IV morphine ?
5 ug
56
What is the starting dose of fentanyl patch?
25 ug/hr
57
What is the 12 ug/hr patch used for?
titrating between doses (say from 25-50)
58
What fentanyl patch do you give for 45-69 mg PO morphine ?
12 ug/hr
59
What fentanyl patch do you give for 60-134 mg PO morphine ?
25 ug/hr
60
What fentanyl patch do you give for 135-179 mg PO morphine ?
37 ug/hr
61
What fentanyl patch do you give for 180-224 mg PO morphine ?
50 ug/hr
62
What fentanyl patch do you give for 225-314 mg PO morphine ?
75 ug/hr
63
What fentanyl patch do you give for 315-404 mg PO morphine ?
100 ug/hr
64
Describe the 5 steps to calculating equianalgesic dosing ?
Step 1: - Calculate total daily opioid intake - Regular and breakthrough doses Step 2: -Convert to morphine equivalents Step 3: -Convert from morphine equivalent to new opioid Step 4: -Start new product at 50-75% of calculated dosage Step 5: -Evaluate frequently for uncontrolled pain and re-titration, if needed.
65
Breakthrough dose = ___% of daily dose
10-15
66
It takes ___ hours to achieve therapeutic fentanyl serum levels. Therefore must provide the patient with opioid coverage during the conversion period
12-16
67
When switching to fentanyl, should be given _____ immediate release 2 mg at time zero (time of patch application), 4 hours after patch application, and 8 hours after patch application
hydromorphone
68
Upon system removal, ___ hours or more are required for a 50% decrease in serum fentanyl concentrations
17
69
Can you try long acting morphine before short acting?
No
70
Common SE of Opioids
- constipation - nausea - somnolence, mental clouding
71
Less Common SE of Opioids
- urinary retention - pruritus - myoclonus - amenorrhea - sexual dysfunction - headache
72
What are symptoms of opioid induced neurotoxicity?
- nausea - twitching, myoclonus, seizures - sleeping a lot - change in mental status, delirium, hallucinations - hyperalgesia
73
What is the Tx for opioid induced neurotoxicity?
- hydration - change opioid, reduce opioid dose - treat symptoms: hallucinations/agitation
74
What pharmacologic Tx do we have for neuropathic pain?
- Opioids - Steroids - dexamethasone, prednisone - Anticonvulsants: gabapentin, pregabalin, carbamazepine - Antidepressants: amitriptyline, desipramine, nortriptyline, venlafaxine, duloxetine - NMDA-R antagonists: methadone, ketamine, cannabinoids
75
Describe inhibitors of CYP 3A4 that interact with codeine metabolism and what happens
clarithromycin & voriconazole *bc these inhibit CYP 3A4, then it all gets metabolized by CYP 2D6 which goes to morphine and then morphine-6-gluc and morphine-3-gluc

Clinical 2 (Part B) (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions