A patient with cancer has been receiving codeine and a ...

[RRMR]

A patient with cancer has been receiving codeine and a nonsteroidal anti-inflammatory medication for pain. The patient reports worsening of pain in both intensity and frequency.
 
  The nurse will tell the patient to contact the provider to discuss:
  a. using a fentanyl transdermal patch.
  b. adding an adjuvant analgesic drug.
  c. increasing the dose of the codeine.
  d. using hydrocodone or oxycodone.

Question 2

A patient who has cancer reports pain as burning and shooting alternating with feelings of numbness and coldness. The nurse will contact the provider to discuss the use of which medication?
 
  a. Acetaminophen
  b. Ibuprofen
  c. Imipramine (Tofranil)
  d. Oxycodone (OxyContin)

[Benayers]

Answer to Question 1

ANS: D
As patients have increased pain, it is important to increase the level of analgesia. Hydrocodone or oxycodone is useful as pain increases, after nonopioid analgesics have been tried. Fentanyl transdermal patches are used for chronic, severe pain in patients who are already tolerant to opioids. Adjuvant analgesics can be used at any stage of pain progression but are used for neuropathic pain. Codeine is not recommended for cancer pain, because it has dose-limiting side effects; increasing the dose of codeine is never recommended.

Answer to Question 2

ANS: C
This patient is describing neuropathic pain, which results from injury to peripheral nerves. This type of pain responds poorly to opioid analgesics but does respond to adjuvant analgesics, which include antidepressants such as imipramine. Acetaminophen and ibuprofen are used for mild nociceptive pain, and oxycodone is used for more severe nociceptive pain.

[RRMR]

Both answers were spot on, thank you once again

[Benayers]

Great! Please up vote