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A 62 year-old presenting with complaints of new pain in her feet that she describes as "feeling like electric shocks" when she walks. She does not remember when the pain started, but knows that she started experiencing it after the third time receiving paclitaxel.

A. Somatic pain

B. Visceral pain

C. Nociceptive pain

D. Neuropathic pain

D. Neuropathic pain likely due to axonal nerve damage from paclitaxel. Peripheral neuropathy is a dose limiting toxicity associated with paclitaxel. Usually starting as "pins and needles" and left unaddressed can leave to significant neuropathic pain.

A. Somatic pain is more of generalized aching pain,

B. visceral pain more sharp piercing

C. nociceptive pain is associated with inflammation/injury.

A 68-year old female with newly diagnosed advanced lung cancer. At presentation she is experiencing severe uncontrolled pain. You prescribe a regimen including morphine immediate release tablets, planning to convert to extended release morphine after a week of determining her use of immediate release pain control. What additional medications should you recommend to start with her pain regimen today?

A. Diphenhydramine

B. Senna/docusate sodium

C. Tramadol

D. Methylphenidate

B. Senna/docusate sodium. Constipation is a predictable side effect of opioid associated with blocking the mu-receptor in the gut. All patients should go home with a bowel regimen that includes a mild stimulant like senna and stool softener like docusate sodium.

There is no need for an antihistamine, additional tramadol or stimulant at this time.

Most individuals on chronic opioid treatment will develop tolerance to the effects listed below EXCEPT:

A. Analgesia

B. Nausea

C. Constipation

D. Respiratory depression

C. Constipation. Constipation is a predictable side effect of opioid associated with blocking the mu-receptor in the gut and will not go away while opioids continue.

Patients will grow tolerant to analgesia due to up regulation of receptor expression, nausea will subside once stomach is use to medication and respiratory depression risk significantly decreases as patient continues on opioids.

A 58-year old female newly diagnosed with limited stage small cell lung cancer. She is seen today in clinic to plan her chemotherapy treatment. She ...

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