Supportive Care II (Weddle)

Question 1

Describe nociceptive pain.

Answer 1

tissue injury that activates specific pain receptors (nociceptors) that are sensitive to stimuli

Question 2

What are the two subtypes of nociceptive pain?

Answer 2

somatic and visceral pain

Question 3

Describe somatic pain.

Answer 3

associated with receptors on surface tissues/deep tissues such as bones, joints, muscle, or connective tissue

Question 4

Describe visceral pain.

Answer 4

associated with receptors located in the viscera (internal organs)

Question 5

A patient presents to your pharmacy complaining of a burning feeling in his right leg. Is this pain most likely nociceptive or neuropathic?

Answer 5

neuropathic

Question 6

A patient presents to your pharmacy complaining of stabbing abdominal pain. Is this pain most likely nociceptive or neuropathic?

Answer 6

nociceptive

Question 7

Many cancer patients will have a combination of ________ and ________ pain.

Answer 7

acute; chronic

Question 8

What does OPQRSTU stand for?

Answer 8

• What is the onset of the pain?
• What provokes it?
• What is the quality of the pain?
• Does the pain radiate?
• How severe is the pain?
• Time of the pain
• Understanding and impact

Question 9

Can morphine be used in renal insufficiency? Hepatic insufficiency?

Answer 9

no; use caution

Question 10

Can hydromorphone be used in renal insufficiency? Hepatic insufficiency?

Answer 10

yes but use lower doses/longer intervals; use caution

Question 11

Which opioid product is not available in an IV formulation?

Answer 11

oxycodone

Question 12

What adverse effects are associated with the use of oxycodone in renal failure patients?

Answer 12

oversedation and CNS toxicity

Question 13

What is the only opioid that is safe for renal and liver dysfunction?

Answer 13

fentanyl

Question 14

What is (arguably) the #1 benefit of methadone?

Answer 14

low cost

Question 15

Can methadone be used in patients with renal failure? Liver dysfunction?

Answer 15

yes; not advised

Question 16

What potential adverse event can occur with methadone?

Answer 16

QT prolongation

Question 17

True or false: each opioid has a maximum dose.

Answer 17

false

Question 18

Why should you reduce the dose by 25% when switching between two opioids?

Answer 18

cross-tolerance

Question 19

How can you combat opioid-associated constipation?

Answer 19

mild stimulant laxative +/- a stool softener

Question 20

With which opioid is pruritis most often seen?

Answer 20

morphine

Question 21

What drug should be administered for opioid-induced respiratory depression?

Answer 21

naloxone

Question 22

PCAs should be used in with caution in patients with ____________.

Answer 22

sleep apnea

Question 23

Cardiac plexus block is used commonly in patients with _________ cancer.

Answer 23

pancreatic

Question 24

When would a patient warrant intrathecal pain medication?

Answer 24

if they are refractory to other opioid therapy or increased toxicities

Question 25

On-Q pumps deliver medication \_\_\_\_\_\_\_\_\_\_\_.

Answer 25

locally

Question 26

Cancer patients are considered to be in a ____________ state.

Answer 26

hypercoagulable

Question 27

What VTE treatment option is best for patients without gastric/gastroesophageal lesions?

Answer 27

DOACs (apixaban, rivaroxaban)

Question 28

What VTE treatment option is preferred in patients with gastric/gastroesophageal lesions?

Answer 28

LMWH (dalteparin, enoxaparin)

Question 29

What were the results of the CLOT trial?

Answer 29

dalteparin was more effective than warfarin in reducing risk of recurrent VTE without increasing bleeding risk

Question 30

What was the conclusion reached in the SELECT-D trial?

Answer 30

rivaroxaban was associated with relatively low VTE recurrence but higher CRNMB compared with dalteparin

Question 31

What conclusions were reached with the Hokusai VTE cancer trial?

Answer 31

PO edoxaban was noninferior SQ dalteparin in regards to recurrent VTE/major bleeding edoxaban had higher rate of major bleeding, but lower rate of recurrent VTE

Question 32

What are some absolute contraindications for DOAC use?

Answer 32

* stage IV/V CKD * active/significant liver disease * strong dual inhibitors/inducers of CYP3A4 + PGP * PGP inducers/inhibitors

Question 33

What is a vesicant?

Answer 33

drug/agent capable of producing blistering and/or serious tissue damage when infiltration into the tissue occurs

Question 34

Give four examples of injection site necrosis antidotes.

Answer 34

1. DMSO 2. Dexrazoxane 3. Hyaluronidase 4. Sodium thiosulfate