Pain Control

Question 1

Most appropriate next step in managing Opioid Induced Hyperalgesia/allodynia

Answer 1

KETAMINE

Question 2

1.Gabapentin rapid onset hence no.1
2.TCA Amytriptaline more delayed onset
3. SNRI Duloxetine

Answer 2

Neuropathic pain

Question 3

analgesia of choice in Mild-Mod renal impairment

Answer 3

Oxycodone

Question 4

Analgesic of choice in severe renal imp

Answer 4

Alfentanil
transdermal buprenorphine

Question 5

Initial mng in Opioid-Induced Neurotoxicity (hallucination, confusion, myoclonus)

Answer 5

1 Dec. Morphine dose

2. class switching

Question 6

Dexamethasone

Answer 6

initial mng. in brain metastasis causing cerebral edema or spinal compression due to bone mets.

Question 7

Pain relief due to IO

Answer 7

BUSCOPAN (hoisin sauce name): an antispasmodic, NOT metoclopramide: a pro-kinetic

Question 8

Opioid-induced constipation not controlled on laxatives

Answer 8

methylnaltroxone: opioid antagonist
counteracts OIC

Question 9

PERSISTANT nausea

Answer 9

prescribe antiemetic

Question 10

oral codeine to oral morphine
tramadol to morphine

Answer 10

divide by 10

Question 11

oral morphine to oral oxycodone

Answer 11

divide by 1.5-2

Question 12

O Morphine 2 SC morphine

Answer 12

divide by 2

Question 13

O Morphine 2 SC Diamorphine

Answer 13

Divide by 3

Question 14

O Oxycodone 2 SC Diamorphine

Answer 14

Divide by 1.5

Question 15

prostate cancer with bone mets causing pain not controlled by opioids

Answer 15

1. start Bisphosphonates
2. radiotherapy

Question 16

mucositis and oral ulcerations

Answer 16

prescribe Benzydamine hydrochloride mouthwash topical analgesic

Question 17

ORAL morphine 2 SC Diamorphine

Answer 17

Divide by 3

Question 18

Rapid onset medication for sudden episodes of breakthrough pain

Answer 18

transmucosal fentanyl

Question 19

transient opioid SE

Answer 19

Nausea
Drowsiness

Question 20

persistent opioid SE

Answer 20

Constipation