End of Life

Question 1

What two lists outline inappropriate medications in older adults?

Answer 1

BEERS list and STOPP criteria

Question 2

For a palliative patient, what would be the first line pharmacological medication to prescribe?

Answer 2

Morphine 2.5 mg PO q4h PRN

Question 3

What is the best option for a patient who is experiencing respiratory/terminal congestion?

Answer 3

Reposition the patient onto their side, maintain their airway, avoid suctioning

Question 4

When to consider pharmacological options for patients experiencing terminal or respiratory congestion?

Answer 4

When causing patient distress- varying degrees of evidence. Can consider anticholinergics, glycopyrrolate, scopolamine

Question 5

First line treatment for older adults with chronic insomnia?

Answer 5

CBT-i

Question 6

For older adults with insomnia, which drug classes are not recommended?

Answer 6

Z-drugs, benzodiazepines, antihistamines

Question 7

What are the goals of insomnia therapy for older adults?

Answer 7

Relieve distress and improve daytime impairments due to insomnia, improve sleep quality, improve sleep efficiency, avoid dependence of medications, improve QOL, provide education

Question 8

What are some AE of Z-drugs?

Answer 8

Dizziness, headache, GI issues, complex sleep behaviours, memory disturbance, psych-related AE, depression, accidents, migraine, dry mouth myalgia

Question 9

What are some of the pharmacological classes that can be considered for use in insomnia?

Answer 9

Z-drugs, benzodiazepines, OX-antagonists, anti-psychotics, antidepressants

Question 10

What are the two drugs used as appetite stimulants for anorexia-cachexia syndrome?

Answer 10

Dexamethasone 2-4 mg daily PO x2-8 weeks or megestrol acetate 160 mg PO daily

Question 11

What is first line pharmacologic therapy for dyspnea in end of life care?

Answer 11

Opioids