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Pharm Exam 4 Ch29
Pain Management in Patients with Cancer
| Question | Answer |
|---|---|
| define neuropathic pain | pain that results from injury to peripheral nerves |
| define nociceptive pain | pain from injury to tissues |
| forms of nociceptive pain x2 | somatic visceral |
| define somatic pain | pain that results from injury to somatic tissues (bone, joints, muscles) |
| define visceral pain | pain from injury to visceral organs (eg, small intestines) |
| drug class(es) effective for nociceptive pain | opioid analgesics may respond to nonopioids |
| drug class(es) effective for neuropathic pain | adjuvant analgesics: certain antidepressants anticonvulsants local anesthetics/antidysrhythmics |
| drug class not effective for neuropathic pain | opioids |
| define pain | Unpleasant sensory and emotional experience associated with actual or potential tissue damage |
| most reliable pain assessment method | patient description |
| causes of pain in cancer patients x2 | the cancer itself therapeutic interventions (chemo) |
| adverse effects from chemotherapy | mucositis diffuse neuropathies aseptic necrosis of joints |
| adverse effects from radiation | osteonecrosis chronic visceral pain peripheral neuropathy |
| adverse effects of surgery | pain syndromes: phantom limb syndrome postmastectomy syndrome |
| 'A' of pain management strategy | ASK/assess pain regularly ASSESS pain systematically |
| 'B' of pain management strategy | BELIEVE the patient's reports of pain |
| 'C' of pain management strategy | CHOOSE pain control options appropriate for patient |
| 'D' of pain management strategy | DELIVER interventions in a timely, logical, and coordinated fashion |
| 'E' of pain management strategy | EMPOWER patients and families by ENABLING them to control as much of treatment as possible |
| Components of Comprehensive Initial [pain] Assessment x5 | Intensity/character (patient report) Physical and Neurological exams Diagnostic tests Psychosocial assessment Pain intensity scales |
| frequent reassessment of pain after implementation of treatment plan | "Ongoing Evaluation" to determine efficacy of treatment early diagnosis and treatment of new pain |
| barriers to pain assessment x4 | inaccurate report of pain (under/exaggerated) language/culture inaccurate reading of behavior/facial expressions young children/nonverbal patients |
| Steps to Drug therapy | 1: mild-mod; non-opioid/NSAIDS/APAP 2: more severe; add opioid analgesic 3: severe; replace w/ powerful opioid |
| nonopioid analgesic drugs | NSAIDS Acetaminophen |
| Opioid analgesic drug selection | pure opioid agonists preferred |
| opioid rotation | to minimize adverse effects while maintaining good analgesia stop old abrupt; replace immidiately |
| use of codeine (relief vs. safety) | degree of pain relief achieved safely is low because side effects limit the dose |
| opioids to avoid | Meperidine (toxic metabolites) agonist-antagonists: prevents opioid agonist from working in pts with physical dependence to opioids (block analgesia and precipitate withdrawal) |
| therapeutic effects of NSAIDs | pain relief suppression of inflammation reduction of fever |
| adverse effects of NSAIDs | gastric ulceration acute renal failure bleeding thrombotic events (except aspirin) |
| therapeutic effects of acetaminophen | pain relief reduction of fever |
| drug interactions of acetaminophen | alcohol: potentially fatal liver damage warfarin: increased risk of bleeding |
| what is a equianalgesia table | it indicates equivalent analgesic doses for different opioids and their different routes |
| 7.5 mg of oral hydromorphone parenteral equivalent (specific example from book, know just in case) | 10 mg parenteral morphine |
| preferred route for chronic pain | oral: cheap, convenient, noninvasive |
| preferred route for pts who cannot take drugs by mouth | rectal |
| preferred alternative to oral route; allows for steady analgesia | transdermal |
| acceptable alternatives when oral, rectal, and transdermal cannot be used | IV and SubQ: onset quick permit rapid dose escalation |
| conditions to use IV or SubQ administration x5 | nausea and vomiting (preclude oral) not able to swallow (preclude oral) delirium or stupor (preclude oral) pain requires large number of pills (makes oral inconvenient) unstable pain: requires rapid escalation of dosage |
| Brainthrough pain: onset duration frequency precipitated by | random pain episodes even medicated develops quickly minutes to hours typically 1-4 times a day coughing or other movements |
| rescue medication | strong opioids with rapid onset and short duration to treat breakthrough pain |
| respiratory depression vs. pain relief (end of life) | opioids should be given to pts who are near death even with the risk of respiratory depression because when death is imminent comfort is more important than prolonging life |
| managing constipation | increase dietary fiber and fluid stool softeners (docusate) laxatives (senna, sodium phosphate) methylnaltrexone (op antagonist selective for op rec in intestine) |
| managing sedation | Tolerance develops quickly, but can give lower dose more frequently. If needed, CNS stimulant: caffeine, methylphenidate, dextroamphetamine, modafinil |
| managing nausea and vomiting | pretreatment with antiemetic |
| managing itching | diphenhydramine |
| managing orthostatic hypotension | moving slowly when changing position |
| managing neurotoxicity | hydration dose reduction opioid rotation |
| adjuvant analgesics use | used to complement effects of opioids |
| antidepressants as adjuvant | tricyclic antidepressant (Amitriptyline) can reduce neuropathic pain |
| antiseizure drugs as adjuvant | (carbamazepine) to relieve neuropathic pain |
| Local anesthetics/antidysrhythmics as adjuvant | (lidocaine/mexiletine) appropriate for rapidly escalating neuropathic pain |
| CNS stimulants as adjuvant | enhance analgesia counteract sedation |
| Antihistaine as adjuvant | (hydroxyzine) promotes drowsiness reduces anxiety |
| Glucocorticoids as adjuvant | emergency management of intracranial pressure and epidural spinal cord compression can improve appetite can impart general sense of well-being |
| Bisphosphonates as adjuvant | (etidronate/pamidronate) can reduce bone pain by inhibiting bone resorption |
| neurolytic nerve block | destroys neurons that transmit pain from limited areas |
| neurosurgery | nerve block opioid infusion systems neuroaugmentation (electrodes to stimulate neurons that release opioid peptides |
| tumor surgery | debulk tumor to relieve pain |
| radiation therapy | relieves pain by causing tumor regression |
| risks of pain management in the elderly patient x3 | heightened drug sensitivity undertreatment of pain increased risk of side effects and adverse interactions |
| assessment of pre- and non-verbal children | behavioral observation (observing pain cues) |
| pain treatment risk for neonates and infants | heightened drug sensitivity underdeveloped BBB underdeveloped kidneys and liver (slow drug elimination) |
Created by:
tmbobe11
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