Supportive Care 2 - Weddle

How to get an assessment of pain?

OPQRSTU: onset of pain, what provokes the pain, quality of pain, severity of pain, time of pain, and understanding of pain. Does it affect daily living/interactions with family? Appetitie, sleep, mood/anxiety? Do you have regular bowel movements? Any other symptoms? What meds have you used in the past and any med allergies?

Morphine

1) Where is it metabolized

2) How is it excreted

3) caution

Metabolized in the liver, excreted renally, caution with liver dysfunction

Hydromorphone

1) Where is it metabolized

2) Where is it excreted

3) Dosing

4) Caution

Metabolized in the liver, renally excreted, lower dose or longer dosing intervals in renal insuffciency, caution with liver dysfunction

Oxycodone

1) Metabolized by

2) Warning

3) caution

4) Significance regarding dosage form

Metabolized by CYP2D6, over sedation and cns toxicity reported in renal failure patients, caution in liver dysfunction, no IV form

Fentanyl

1) Where is it metabolized

2) Who can use it

3) BBW

Metabolized in the liver. Safe to use in renal and liver dysfunction. BBW for opioid naive pts, risk of addiction, abuse, and misuse, respiratory depression, and avoid direct external heat sources

Methadone

1) Consider for

2) Avoid in

Consider for those with true morphinea allergy, opioid-induced ADRs, neruoapthic pain, and those who need a long acting oral dose at low cost. Avoind in drug interactions, those at risks for syncope or arrythmias, those with history of unpredicatable adherence, and those with poor cognition

Methadone:

1) excreted how

2) Avoid in

3) Risk

Excreted in urine and feces. Avoid in severe liver dysfunction, risk of QTc prolongation

What should you do if a patient is on opioids and experiences hallucinations, confusion/delirium

Decreased dose or change opioid. Consider adding neuroleptic med

What should you do if a patient is on opioids and experiences constipation

Add a mild stimulant laxative and a stool softener

What should you do if a patient is on opioids and experiences nausea/vomiting

Change opioid and consider anti-emetic

What should you do if a patient is on opioids and experiences pruritus (itch)

Seen with morphine but decrease dose or change opioid

Myolonic Jerking is a sign of what and what should you

Sign of opioid toxicity. Change opioid or treat underlying disease

Respiratory depression with opioid use is presented how? What must you do?

Sedation precedes respiratory depression. Hold the opioid and give low dose narcan

Define Celiac plexus and when is a celiac plexus block used

It is a group of nerves that supply organs in the abdomen and a block is used in pancreatic cancer

Morphine is metabolized in the liver to what

morphine-3-glucoronide, morphine-6-glucoronide, normorphine, and codeine

Intrathecal Pain Pumps

1) Used for

2) How to use

3) Before procedure

Used for refractory pain or when toxicities are greater than the benefits. Used with smaller doses of opioids. Use test dose before procedure

What is radiation therapy sued for

painful bone metastases, brain metastases, or spinal cord compression

What scales can be used to measure performance status?

Karnofsky and ECOG

How do you read an ECOG status? only list the ones where they change

0 is fully active, 3 is limited self care, 4 is completely disabled, 5 is dead

What criteria do we use to evaluate treatment response? What are the different categories?

Recist criteria. CR is complete response where there is complete disappearance. PR is partial response where there is 30% decrease in the sum of the longest diameter of target lesions. PD is progressive disease where there is a 20% increase in the sum of the longest diameter of target lesions, and SD which is stable disease where there are small changes that don’t meet above criteria

What is used to assess toxicity? How do you read it?

NCI CTC. scale of 0-4 with 4 being most severe toxicity. Grade 3 and 4 is dose limiting toxicity