Recent and upcoming approaches in the management of cancer Breakthrough pain
More than one answer may be correct. Select all that apply.
-
Breakthrough cancer (BTCP) pain:
-
a)
is a transient exacerbation of pain
-
b)
always occurs in patients with stable background pain
-
c)
may occur in the absence of background pain
-
d)
is the same as incident pain
-
e)
may interfere with activities of daily living.
-
a)
-
The ideal medicine to treat BTCP would:
-
a)
be well tolerated by the patient
-
b)
have a profile that matched BTCP time course
-
c)
have an onset of >30minutes
-
d)
be hydrophilic
-
e)
be lipophilic
-
a)
-
Alfentanil:
-
a)
is a naturally occurring opioid
-
b)
I available as a buccal/nasal spray
-
c)
has a shorter onset and duration of action than fentanyl
-
d)
has an elimination half-life of 90 mins
-
e)
is licensed for intravenous injection
-
a)
-
Fentanyl:
-
a)
is a synthetic opioid
-
b)
is derived from thebaine
-
c)
exerts its effects predominantly in the dorsal horn
-
d)
is 100 times more potent than morphine
-
e)
is metabolised to the inactive metabolite norfentanyl
-
a)
-
Different transmucosal route products are available (buccal, sublingual or nasal) - which of the following statements relating to these products is correct:
-
a)
lozenges require dexterity and may be unsuitable for patients with mucositis
-
b)
buccal tablets do not have a distinct taste
-
c)
buccal and sublingual tablets are easy to extract from their respective packaging
-
d)
titrate each patient from the lowest dose
-
e)
buccal and sublingual tablets doses are equianalgesic
-
a)
Transdermal opioids for cancer pain management
More than one answer may be correct. Select all that apply.
-
Concerning oral administration – disadvantages
-
a)
least economical
-
b)
drug taken orally may cause emesis
-
c)
drug taken orally may be destroyed by gastric acidity
-
d)
drug taken orally may be metabolized by gastrointestinal flora
-
e)
drug taken orally may be in consistently absorbed due to the presence of food
-
a)
-
Pharmacokinetic advantages associated with transdermal drug delivery:
-
a)
relatively constant, sustained therapeutic plasma drug concentrations
-
b)
commonly low side-effect incidence
-
c)
good patient compliance
-
a)
-
Roots of administration that avoid “first-pass” hepatic effects:
-
a)
sublingual
-
b)
oral
-
c)
transdermal
-
d)
lower rectal suppositories
-
e)
inhalation
-
a)
-
Buprenorphine is a
-
a)
Partial μ-opioid receptor agonist
-
b)
κ opioid agonist
-
c)
κ opioid antagonist
-
d)
δ opioid agonist
-
e)
δ opioid antagonist
-
a)
Back pain in malignant disease - metastatic spinal cord compression?
Select one correct answer.
-
Metastatic spinal cord compression can be the result of:
-
a)
vertebral collapse
-
b)
hypercalcaemia of malignancy
-
c)
chemotherapy treatment
-
d)
muscular spasm
-
a)
-
Metastatic spinal cord compression occurs most frequently in:
-
a)
prostate cancer, osteosarcoma and myeloma
-
b)
lung, breast and prostate cancers
-
c)
primary cancer of unknown origin
-
d)
both a and c above
-
e)
both b and c above
-
a)
-
Metastatic spinal cord compression occurs most frequently in:
-
a)
the cervical spine
-
b)
the thoracic spine
-
c)
the lumbar spine
-
d)
the cauda equine
-
e)
all of the above
-
a)
-
Signs and symptoms of metastatic spinal cord compression can include:
-
a)
back pain
-
b)
limb weakness
-
c)
decreased quality of life
-
d)
loss of bladder
-
e)
all of the above
-
a)
-
Diagnosis of metastatic spinal cord compression is best made by:
-
a)
isotope bone scan
-
b)
plain film X-ray
-
c)
magnetic resonance imaging
-
d)
computerised tomography
-
e)
clinical impression
-
a)
-
Initial management of metastatic spinal cord compression includes:
-
a)
analgesia and prednisolone 40mg po od
-
b)
intravenous bisphosphonate (e.g. pamidronate 90mg)
-
c)
dexamethasone 16mg po od and proton pump inhibitor cover
-
d)
analgesia and consultation with oncology / neurosurgery experts
-
e)
dexamethasone 16mg po od
-
a)
-
‘Gold standard’ treatment of metastatic spinal cord compression can include:
-
a)
high dose dexamethasone
-
b)
neurosurgical intervention
-
c)
chemotherapy
-
d)
radiotherapy
-
e)
all of the above
-
a)
-
Rehabilitation following diagnosis of metastatic spinal cord compression should commence:
-
a)
once definitive treatment has been completed
-
b)
three days after starting high dose steroid treatment
-
c)
as soon as possible after diagnosis and progressed as appropriate
-
d)
once the patient is more mobile following treatment
-
e)
none of the above
-
a)
-
Prognosis following diagnosis of metastatic spinal cord compression is:
-
a)
longer in patients with lung cancer
-
b)
less than one month
-
c)
linked to their functional ability at the time of diagnosis
-
d)
shorter in patients with breast cancer
-
e)
none of the above
-
a)
-
Metastatic spinal cord compression always occurs in patients:
-
a)
with known metastatic bone disease
-
b)
very quickly over a number of hours / days
-
c)
with severe, unremitting back pain
-
d)
with neurological symptoms at presentation
-
e)
none of the above
-
a)
Pain challenges at the end of life - pain and palliative care collaboration
More than one answer may be correct. Select all that apply.
-
Pain and symptom control at the end of life may be sub-optimal because:
-
a)
Clinicians are afraid of causing addiction
-
b)
Clinicians are afraid of killing patients accidently
-
c)
Pain Medicine specialists are not involved in their care
-
d)
Complex pain may need the services of speciaslists Pain Medicine Physicians
-
a)
-
Factors that contribute, with pain, to suffering at the end of life include:
-
a)
Depression
-
b)
Joy
-
c)
Poor communications
-
d)
Good family relationships
-
a)
-
Examples of how Pain Medicine Specialists can aid in end of life care include:
-
a)
Acupuncture
-
b)
Nerve ablation
-
c)
Spinal Cordotomy
-
d)
Drug therapy
-
a)
-
Which of the following use radio-frequency ablation to help in pain management at the end of life.
-
a)
Facet joint denervation
-
b)
Spinal Cordotomy
-
c)
Frozen Shoulder (Adhesive Capsulitis)
-
d)
Ilio-inguinal Neuropathy
-
a)
-
What is the opioid of choice for intrathecal infusion for pain relief at the end of life?
-
a)
Morphine
-
b)
Fentanil
-
c)
Oxycodone
-
d)
Diamorphine
-
a)
MCQ Answers
Insights into Pain: A Review of Qualitative Research
Cancer breakthrough pain
-
1
a,b,e
-
2
a,b,e
-
3
b,c,d,e
-
4
a,d,e
-
5
a,d
Transdermal Opioids for Cancer Pain Management
-
1
b,c,d,e
-
2
a,b,c
-
3
a,c,d,e
-
4
a,c,e
Back pain in malignant disease – metastatic spinal cord compression?
-
1
a
-
2
e
-
3
b
-
4
e
-
5
c
-
6
c
-
7
e
-
8
c
-
9
c
-
10
e
Pain Challenges at the End of Life - Pain and Palliative Care Collaboration
-
1
a,b,d
-
2
a,c
-
3
a,b,c,d
-
4
a,b,c,d
-
5
d