74.2 📚 國考版醫垫國考 / PGY OSCE

74.2.0.1 📌 Cram Sheet

74.2.0.1.1 🔥 高 yield 10
  1. WHO 3-step pain ladder + adjuvants
  2. Opioid breakthrough = 10-15% daily total
  3. Renal failure → 避 morphine (改 fentanyl/hydromorphone/methadone)
  4. Bone pain: NSAID + bisphosphonate + RT + radium-223
  5. Neuropathic: TCA / SNRI / gabapentinoid
  6. Opioid + senna + docusate routine
  7. CINV high: 5HT3 + dexa + NK1 + olanzapine
  8. CINV ondansetron QT caveat
  9. Cachexia: anamorelin + olanzapine + exercise
  10. Fatigue: exercise > drug
74.2.0.1.2 🔢 必背
項目 æ•žå­—
Breakthrough opioid 10-15% daily total
Cachexia weight loss > 5%
CRF prevalence 80%+
5HT3 NK1 onset acute + delayed CINV

74.2.0.2 ⭐ 高 yield

74.2.0.2.1 Opioid Equianalgesic Quick
Drug PO eq morphine 30 mg
Morphine 30 PO / 10 IV
Hydrocodone 30
Oxycodone 20
Hydromorphone 7.5 PO / 1.5 IV
Fentanyl IV 0.1 mg (100 ÎŒg)
Codeine 200
Tramadol 100-300
Methadone 變異 (need expert)
74.2.0.2.2 Cross-tolerance Rotation
  • New drug æž› 25-50% equianalgesic dose
74.2.0.2.3 CINV Drugs
Drug Mechanism
Ondansetron 5HT3 (acute)
Palonosetron 5HT3 long-acting (delayed)
Aprepitant NK1 (delayed)
Dexamethasone Anti-inflammation
Olanzapine Multi-receptor
Dronabinol CB1
Metoclopramide D2
74.2.0.2.4 Cachexia Drugs
  • Anamorelin (ghrelin agonist) — Japan/EU
  • Olanzapine — appetite
  • Megestrol — appetite, no muscle
  • Mirtazapine — appetite, sleep
  • Cannabinoid — limited evidence

74.2.0.3 🎯 自我檢枬

  1. WHO ladder steps? → 1-3 + adjuvants
  2. Breakthrough dose? → 10-15% daily
  3. Renal failure 避哪個 opioid? → Morphine
  4. Bone pain treatment 4? → NSAID/bisphosphonate/RT/radium-223
  5. CINV high 4 drugs? → 5HT3 + dexa + NK1 + olanzapine
  6. Cachexia drug 22E? → Anamorelin
  7. CRF best evidence? → Exercise
  8. Mucositis 5-FU prevention? → Oral cryotherapy
  9. Methylnaltrexone? → Opioid-induced constipation
  10. Opioid + 必加 PRN? → Senna + docusate

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