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28 Cards in this Set

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Radiation causes acute and chronic pain b/c alters tissues in these ways (6)
- Inflammation
- Fibrosis
- Direct injury to peripheral nerve plexus
- Induction of neurogenic tumors (fibrosarcoma)
- Soft tissue ischemia
- Necrosis
Fibrosis from radiation can cause pain and dysfx because of _______
compression of surrounding nerves
Opioids are not effective for _______ pain
Neuropathic
Oral complications of cancer radiation (4)
- Mucositis
- Xerostomia
- Trismus
- Osteoradionecrosis
Aka dry mouth
Xerostomia
inability to open the mouth
Trismus
From radiation to muscles of mastication and TMJ
- Cell destruction and fibrosis
- More common with combo radiation + surgery
Trismus
Loss of osteocytes from cancer radiation
Osteoradionecrosis
Methods to reduce osteoradionecrosis from cancer radiation in mouth (3)
- Daily topical flouride
- Topical anesthetics (but if accompanied by mucositis, not good b/c can cause systemic absorption --> death)
- Pre-radiation NSAIDs (prevents inflm)
Oral complication of cancer radiation
-Most severe
-Loss of osteocytes
-Progressive obliterative endarteritis
-Hyaliniation of bv's
-Inc chance of bone infection
-Impaired healing
-Fractures
Osteoradionecrosis
2 major causes of pain from chemotherapy tx
- Polyneuropathy
- Oral Mucositis Pain
2 chemotherapy agents that cause polyneuropathy burning pain and allodynia
- Vincristine
- Cis-platinum
Chemotherapy agent that causes polyneuropathy
- Dose-related
- Sensory --> pain
- Motor --> weakness from denervation
Vincristine
Chemotherapy agent that causes polyneuropathy
- Primarily sensory --> pain
- Demyelination (very serious)
Cis-platinum
Tx of polyneuropathy in chemotherapy (4)
- TCA's
- Anticonvulsants
- Topical Capsaicin
- Clonidine
2 TCAs that may stablize nerve membranes to tx polyneuropathy from chemo
- Amitryptiline
- Depsipramine
Anticonvulsant used to tx polyneuropathy in chemo
Carbamazepine
All these chemo agents cause:
- Bleomycin
- Dactinomcin
- Danorubicin
- Doxorubicin
- 5 Fluorouracil
- Methotrexate
Oral Mucositis Pain
Oral Mucositis Pain from chemo is more severe when
Combined with radiation tx
Chemo ADR
- Inflm lesions --> ulceration --> sloughing
- May be in esophagus and rectal area too
Oral Mucositis
Tx of oral muositis from chemo
Rinsing with local anesthetics
Steroid in Cancer tx ADRs (2)
- Bone pain secondary to fx
- Aseptic necrosis of femoral and humeral joints
Treatment of of steroid adrs in cancer pt
- Dec dose of steroids, NSAIDs and opioids
Factors that influence dosage conversion of narcotics in a patient (8)
- Current narcotic dose
- Length of time on opioids
- Dosing schedule
- Pathologic changes (hepatic and renal)
- Presence of other CNS depressants
- Concurrent NSAIDS or acetominophen
- Psych status
- Present degree of pain relief
Other CNS depressants that may have an affect on narcotics (3)
- Antidepressants
- Anxiolytics
- Sedatives/hypnotics
Antidepressants may increase narcotic analgesia by (3)
- Direct stimulation of opioid R's
- Reducing biotransformation of narcotics
- Inhibition of pre-synaptic serotonin uptake
If switching from one narcotic to another, best to calculate approximate equivalent dose of 2nd narcotic and then
Decrease it for initial doses
______ is not complete for narcotics --> so giving a different narcotic at 100% dose may dec CNS depression
Tolerance