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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 20 10 Drugs of Choice Cancer Pain Below
In treating the patient with cancer pain, by using analgesics, there are specific therapeutic strategies in addition to the choice of specific agents. In terms of using opioids, what has been the traditional fear?
- That the patient would become addicted.
Why is this probably not a realistic fear?
- Patients who are in severe chronic pain, from condition such as cancer, apparently do not metabolize the opioids in the same way and have far less risk of addiction. In addition, most of these patients are terminal anyway. So the physician has an ethical requirement to overcome what is probably an irrational fear.
Let’s take a look at some key points in the use of analgesics, particularly opioids in managing these cancer patients. What are the 2 key points in terms of the schedule of administration?
- First, the drug should be administered at a fixed schedule and not based upon what? Based upon the patient’s requests for early administration.
However, what is the second key point?
- The schedule and dosage should be rigorously adjusted in order to prevent the patient from needing to ask for more doses.
What is the problem with giving doses based upon the patient’s requests?
- It never allows you to figure out what schedule of what dosage will actually do the job.
And what is the key point in terms of choosing a pain medication when one drug becomes ineffective?
- Do not transfer to an alternative type; take the next step up to a drug that is definitely stronger.
And what is the key point in terms of drug preparation?
- Use the pure agents; avoid the use of combination pills.
And why is this?
- You want complete control over your choice of medication.
And what is the final key point in terms of your own understanding?
- Learn to use a few drugs very well.
What are the 3 basic analgesics to use in the treatment of cancer pain?
- Aspirin, codeine, morphine.
There are 3 basic steps to a stepwise approach to managing cancer pain, in terms of choosing agents. What is the first step?
- Use a non-opioid, particular aspirin.
What is the second step if this doesn’t work?
- Add a weak opioid to your non-opioid.
And what is your primary weak opioid?
And when you need to take the next step up, what is the 3rd step?
- Go to a strong opioid, and you may or may not wish to continue using opioid.
And what is the primary strong opioid?
There are 6 other classes of drugs which may be useful as adjuvants to the use of non-opioids or opioids in the treatment of cancer pain. What is the anti-convulsant drug of choice for using as an adjuvant drug?
And the trade name for Carbamazepine?
What is the antidepressant drug of choice for use as an adjuvant agent?
And what is probably the best known trade name for Amitriptyline?
And what is the drug of choice that is an anxiolytic for use as an adjuvant to the pain medication?
And the trade name for Diazepam?
And what is the corticosteroid drug of use to use as an adjuvant to pain medication?
And what is the muscle relaxant drug of choice to be used as adjuvant to pain medication (and a hint: this is also the drug of choice for the anxiolytics)?
And finally, what is the psychotropic drug of choice for using as an adjuvant to pain medication in the cancer patient?
And the trade name for Chlorpromazine?
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