Exam 4 - Palliative & Hospice Care Flashcards
what is palliative/hospice care?
compassionate care for the dying that is focused on caring for (treating symptoms) & not curing the patient that often occurs at home
what is the goal of palliative/hospice care?
provide a good end of life experience for the patient & their family
what are some examples of treatments that wouldn’t be allowed for palliative/hospice care?
nothing to prolong their life - no feeding tubes, IVF (would still treat concurrent conditions like a UTI that was making them feel worse)
does hospice/palliative care preclude euthanasia?
nope
what is important for client education/communication for pets in palliative/hospice care?
they must actively participate for it to work
clients need to be educated about hospice & understand that we aren’t treating the underlying disease
they need to know how to keep the patient as pain free & sanitary as possible (urine scald, fecal scald, bed sores, etc)
what are the 4 key features of hospice/palliative care?
- vets should have contact with the patient on a regular basis (weekly to daily visits)
- staff tending to them should have appropriate insurance to cover travel/liability coverage
- care should always be available & euthanasia should be available at any time when the client is ready
- confirmation of death by vet may be needed by the owner in the event of a home death
how is concurrent illness approached for patients receiving hospice/palliative care?
concurrent disease doesn’t disqualify the patient from receiving anti-cancer therapy
diagnosis of cancer doesn’t mean that concurrent disease should no longer be managed!!!!
how do cancer patients have a weakened immune system?
they have high levels of tregs, IL-8, IL-10, etc - affects animals immune system & affects them systemically
chemo weakens their immune system
opportunistic infections such as UTIS, pyoderma, & demodex are common
what is the chronic pain cycle we are trying to break for patients in hospice/palliative care?
chronic pain is difficult to break
pain -> muscle tension -> reduced blood flow -> muscle inflammation -> animal doesn’t want to move -> cycle repeats
what are some examples of sources from pain from cancer that may be difficult for us to appreciate clinically?
stretching of organ capsules - reported to be very painful
intra-abdominal adhesions
tissue/bone invasion
nerve compression
what are some behaviors seen in hospice/palliative care patients that indicate pain?
decreased activity/reluctance to do specific things
decreased appetite
attitude changes - aggressiveness, clinginess, increased dependance
lower head carriage, squinting (cats), & tragic facial expression
decreased grooming - cats
self-induced injuries - seen in dogs, over-grooming the painful area & causing traumatic wounds
aversion behaviors in certain areas associated with pain - not wanting their heads touched
when looking at COX inhibitors for hospice/palliative care patients, which ones may be better suited? what are some examples?
non-selective options for COX inhibitors are better for cancer cells
anti-cancer NSAIDS = aspirin, piroxicam (mostly COX-1 inhibitors which is the best anti-cancer option)
what is acetaminophen beneficial for in hospice/palliative care?
best for treating fever - blocks IL-6
not for cats though!!!!
what NSAIDS are good for pain control in hospice/palliative care patients?
COX-2 inhibitors - meloxicam, rimadyl, the coxibs
what opioid receptor is targeted for reducing pain?
mu receptors are the most effective for decreasing pain
how is codeine used for hospice/palliative care patients?
mu agonist that is weaker than morphine - often paired with acetaminophen
how is tramadol used for hospice/palliative care patients?
derivative of codeine, variable efficacy - not too sure
how is buprenorphine used for hospice/palliative care patients?
partial mu agonist that is a great option for cats because of transmucosal absorption
what is the mechanism of action of amantadine? how is it used for hospice/palliative care patients?
NMDA antagonist - similar to ketamine - works best for chronic pain & in conjunction with NSAID!!!!
potentiates opioids
takes several days to reach effectiveness - need to give it at least 1 week before giving up
how is ketamine used for hospice/palliative care patients? what is the risk associated with it?
potent NMDA antagonist that has many potential routes for administration
potential for abuse - scheduled drug in the USA
what is the mechanism of action of gabapentin/pregabalin? how is it used for hospice/palliative care patients?
blocks voltage gated Ca channels which modulates excitatory neurotransmitter release - which inhibits nociception (decreasing pain)
best for neurologic pain!!! brain tumor pressing on stuff!
what is the mechanism of action of tricyclic antidepressants? how are they used for hospice/palliative care patients?
may interact with peripheral noradrenergic receptors - may inhibit reuptake of monoamines (noradrenaline)
controversial for pain control - it may just be improving mood/awareness instead of actually stopping pain, so best if used in combo with something else!!!
what is the mechanism of bisphosphonates? how are they used for hospice/palliative care patients?
they inhibit osteoclast activity & promote osteoclast apoptosis - useful for bone pain! (osteosarcoma)
along with radiation therapy - super effective at controlling bone pain!
how is radiation therapy used for hospice/palliative care patients as a non-drug pain management option?
radiation therapy is often used for bone pain, OA, oral tumors, large soft tissue sarcomas, & lymphoma - we use a high dose for a few treatments
good for primary & secondary bone lesions, decreases pleural & abdominal effusions, & decreases metastatic lesions in the lungs/lymph nodes that can cause symptomatic pain (swelling, coughing, etc)
