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23 Cards in this Set
- Front
- Back
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Fentanyl Patch Considerations |
Must have adequate subcutaneous fat stores to to ensure even absorption. Should be used only in opiate tolerant. Absorption occurs faster with fever. |
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CKD and Opiates |
Morphine, codiene, and meperidine are contraindicated in GFR <30 |
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Constipation and Opiods |
Should be started on senna or biscodyl with docusate when placed on opioid regimen. If these fail methylnaltrexone, a peripheral opioid antagonist can be used. |
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Nausea and Opioids |
Build tolereance with in 2 to 7 days of use. Can use metoclopramide and prochlorperazine. |
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Viceral Pain |
Glucocorticoids can help with reducing tumor inflammation, as well as peritoneal irritation. |
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Bone Pain |
Typicall occurs at night from bone mets, treat with NSAIDS or steroids. |
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Mechanisms of Nausea |
Gut wall stretching. Gut Mucosal injury. Drugs, metabolic by produts, bacterial toxins. Motion Sickness. Anticipatory nausea. Increased intracranial pressure. |
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Guta Wall Stretching and Nausea |
Caused by consitpation, bowel obstruction, ileus. Mediated by the dopamine type 2 receptors in gut. Treatment with Metoclopramide, prochlorperazine, haloperidol. |
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Gut Mucosal Injury and Nausea |
Caused by radiatoin, chemotherapy, infection, inflammation, direct tumor invasion. Mediated by serotonin receptors. Treated with zofran. |
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Motion Sickness, labyrinthine disorders and Nausea |
Mediated by histamine type 1 receptors, and muscarinic ACH receptors in vestibular system. |
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Anticipatory Nausea Treatment |
Benzodiazepines. |
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Increased Intracranial Pressure and Nausea |
Treat with glucocorticoids |
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Treatment of Anorexia in Palliative Care Setting |
Normal final metabolic course in end of life. Progestins and glucoccorticoids work better than drabinol, but only work in 20 to30% of patients, and do not improve mortality. |
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Delerium and Palliative Care |
Rule out medication, infections, bowel obstruction, pain, and bladder infection. If refractory or no cause found then first generation antipsychotics like haliperidol works the best. |
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Refractory Dyspnea and Palliative Care |
Systemic opioids are standard of care. |
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Allodynia |
Sensitivity to non noxious stimuli |
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Nocioceptive Pain |
Is pain caused by nocioceptors either somatic or viscera. Somatic being in muscles, skin, joints, while vicera are in the internal organs. |
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Types of Pain |
Neurogenic. Nocioceptive. Central. |
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Red Flag Symptoms of Pain |
Noctrunal worsening, weight loss, and fever. |
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Nonpharmological Treatments of Pain |
Exercise. Massage and accupuncture have shown some benifit. Treating underlying psychiatric component. |
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Treatment of Neuropathic Pain |
Lidocaine and capsacin creme. Pregaballin and gabapentin. Duloxetine. |
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Nocioceptive Pain Treatment |
Tylneol first line. NSAIDS can be used in flares for pain with inflammatory component. |
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Pharmacological Management of Central Pain |
Tyricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, gabpentin, pregaballin. |
