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HPM Board Review > Flashcards MD > Flashcards

Flashcards MD

1
Q

Define the mechanism of action of tiagabine.

A

Tiagabine is an antiepileptic drug that acts as a selective GABA reuptake inhibitor.

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2
Q

Define the primary means of assessing pain in children under four years old.

A

behavioral scales such as the CHEOPS, FLACC, CRIES

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3
Q

Define the superior hypogastric plexus and its significance in pain management.

A

The superior hypogastric plexus contains sympathetic nerves from various pelvic organs and can help alleviate pain in regions such as the descending colon, rectum, and reproductive organs.

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4
Q

Drugs that increase and decrease methadone levels

A

Increase: cipro azoles prozac
phenobarbital carb

Decrease: rifampin ART phenytoin

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5
Q

Describe the method for converting morphine to methadone for doses less than 100 MEDDs.

A

For doses less than 100 MEDDs, it is recommended to divide the morphine dose by 4 to obtain the equivalent dose of methadone.

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6
Q

Describe the pediatric Memorial Symptom Assessment Scale.

A

The pediatric Memorial Symptom Assessment Scale is a tool available for children in two age ranges: 7-12 years and 10-18 years, measuring multiple symptoms in addition to pain.

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7
Q

Describe the relationship between visceral pain and the celiac plexus.

A

Visceral pain, such as that originating from the liver, can be managed with a celiac plexus block, which is located in front of the aorta at the L1 level.

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8
Q

Mechanism of benzodiazepines, zolpidem, and baclofen

A

They are selective GABA agonists.

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9
Q

Describe the role of sympathetic stimulation in post herpetic neuralgia.

A

Intense sympathetic stimulation and activation of adrenergic receptors may contribute to both acute zoster pain and chronic post herpetic neuralgia, potentially leading to decreased neuronal blood flow and ischemia.

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10
Q

Describe the role of the pain thermometer in pediatric pain assessment.

A

The pain thermometer is a color visual analog scale used by children to express their pain levels, aiding in effective pain assessment.

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11
Q

Discuss the safety of using opioids in patients with renal failure.

A

In patients with renal failure, the accumulation of oxycodone and its metabolites can lead to neurotoxic effects, making morphine, hydromorphone, and codeine unsafe or requiring caution.

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12
Q

Do behavioral scales play a role in pain assessment for young children?

A

Yes, behavioral scales such as the CHEOPS are the primary means of pain assessment for children under the age of four and for those with developmental disabilities.

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13
Q

Explain the anatomical location of the superior hypogastric plexus.

A

The superior hypogastric plexus is located anterior to the vertebral column between the lower third of L5 and the upper third of the S1 vertebral bodies.

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14
Q

venlafaxine dose for polyneuropathy.

A

At a dosage of 150 mg or greater, venlafaxine, a selective serotonin-norepinephrine reuptake inhibitor, is effective in treating painful polyneuropathy, including diabetic neuropathy.

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15
Q

How do children ages 3-7 typically rate their pain?

A

Children ages 3-7 typically use versions of the faces scale, such as the Oucher or Baker Wong scale, and color visual analog scales like the pain thermometer to rate their pain.

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16
Q

How do gabapentin and pregabalin work?

A

They bind to voltage-gated calcium channels and decrease the release of glutamate, norepinephrine, and substance P.

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17
Q

How does morphine-6-glucuronide differ from morphine-3-glucuronide?

A

Morphine-6-glucuronide is an agonist at μ-opioid receptors and exerts antinociceptive activity, while morphine-3-glucuronide has no antinociceptive effect.

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18
Q

How does the stellate ganglion block relate to pain management?

A

The stellate ganglion block is used to cover pain regions of the face and upper extremity.

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19
Q

How should a patient with an allergic reaction to phenanthrene opioids be managed?

A

If a patient has an allergic reaction to phenanthrene opioids (like morphine or codeine), it is recommended to try an opioid from a different class, such as phenylpiperidines (e.g., fentanyl) or phenylheptylamines (e.g., methadone).

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20
Q

Identify the areas where the ganglion impar is effective for pain relief.

A

The ganglion impar is effective for pain originating in the rectal area.

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21
Q

What are the common opioids that belong to the phenanthrene class?

A

Common opioids in the phenanthrene class include morphine, codeine, hydrocodone, hydromorphone, oxycodone, and oxymorphone.

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22
Q

What is the function of the celiac plexus in pain management?

A

The celiac plexus helps manage pain originating from the lower esophagus to the mid-transverse colon.

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23
Q

What is the significance of methadone in the context of renal failure?

A

Methadone and its metabolites are excreted into the gut, making methadone a safer option in the presence of renal failure.

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24
Q

What is the significance of the splanchnic nerve block in pain management?

A

The splanchnic nerve block is appropriate for managing pain from upper abdominal viscera and is located at the anterolateral part of the T12 vertebra.

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25
Q

What role does CYP3A4 play in drug metabolism?

A

CYP3A4 is responsible for the metabolism of approximately 60% of all clinically used drugs, including many opioid analgesics, with significant variability in metabolism among individuals.

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26
Q

Metabolized at least in part by 3A4 (7)

A

Codeine, oxycodone
fentanyl, buprenorphine, methadone
Tramadol and dextromethorphan

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27
Q

Morphine and hydromorphone are metabolized mainly by

A

Glucuronidation

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28
Q

UGT 2B7 polymerizations impact metabolism of

A

Morphine and hydromorphone

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29
Q

Lumbar sympathetic block

A

Sympathetic leg pain

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30
Q

Psoas compartment black

A

Lower extremity, L1,2 3

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31
Q

A major contributor to opioid neurotoxicity

A

Dehydration

32
Q

WHO step 2, mild opioids

A

Hydrocodone, codeine and tramadol

33
Q

NMDA receptor molecule

A

Glutamate (excitatory)

34
Q

Major methadone metabolizers

A

3A4, then 2D6

35
Q

Death is temporary and reversible

A

Ages 2-6

36
Q

GFR in neonates

A

Reduced. In renally cleared meds, lower doses, longer intervals

37
Q

Liver size in ages 2-6

A

Increased, need higher

38
Q

Constipation and confusion, rule out

A

Hypercalcemia

39
Q

How reglan increases motility

A

Blocks serotonin receptors, increasing gut tissue response to acetylcholine, increasing peristalsis

40
Q

ACC/AHA heart failure stages

A

A: risk of developing, B: structural abnormalities or reduced EF without symptoms, C: Prior or current symptoms D: needs transplant, LVAD or chronic pressers

41
Q

LVAD prognosis

A

1-2y versus 6 months without

42
Q

Physical symptoms, depression and spiritual well being are lower

A

in advanced CHF than in cancer

43
Q

Survival in stage 4 CHF

A

10 months

44
Q

Survival in stage 4 CKD

A

2-3 years

45
Q

Survival in COPD w/FEV1 35%

A

2-4 years

46
Q

Survival from death rattle, mandibular breathing, cyanosis, radial pulselessness

A

In hours: 57, 7, 5 and 2

47
Q

Death rattle grading

A

0 Inaudible, 1 near patient, 2 end of bed, 3 at the door

48
Q

Worst grief symptoms

A

Yearning then depression, depression peaks at 6 months

49
Q

Increased risk of EPS from reglan

A

Young male patients, prolonged use

50
Q

Anticholinergics like TCAs and Reglan

A

Don’t mix—cancels out pro kinetic effects

51
Q

Home oxygen in COPD

A

Improves survival, but not proven to improve dyspnea

52
Q

BiPAP in COPD

A

Does not improve QoL (does in ALS)

53
Q

Vegetative or minimally conscious?

A

In MCS, patients track, follow commands, have purposeful movements (like scratching an itch)

54
Q

GOLD/ABCD

A

Prognosis in COPD, includes # of hospitalizations, mMRC dyspnea scale and COPD assessment test

55
Q

2 drugs good for pruritus but not cholestatic

A

Antihistimines (allergy only) and gabapentin (uremic pruritis)

56
Q

Alginate dressings

A

Wounds with exudates or bleeding

57
Q

Hip fracture rehab in hospice

A

Yes if it was mechanical, no if it was metastatic/pathological

58
Q

Respite care for symptom management

A

Nope. 5 days rest when symptoms are well controlled

59
Q

FTF waved

A

in an emergency (do later), if patient dies within 2 days (waived)

60
Q

Is failure to thrive a hospital diagnosis

A

no

61
Q

Does hospice pay for medication for chronic conditions (e.g. synthroid?)

A

Nope. Medicare Part D

62
Q

Hospice criteria for HIV

A

End stage complication (refractory cancer or infection), CD <25, persistent viral load > 100,000

63
Q

HIV cancer prognoses

A

Hodgkins prognosis is same, NSCLC and anal cancer have shorter prognoses in HIV

64
Q

Olanzapine receptors blocked

A

serotonin, dopamine, acetylcholine and histamine

65
Q

Acupuncture proven benefits

A

Acute and chronic pain, post-operative pain, nausea and vomiting,

66
Q

Metabolic causes of nausea via

A

CTZ

67
Q

Sacral plexopathy symptoms

A

Sensory loss, sphincter control loss, dull aching and neuropathic pain

68
Q

Risks of licorice

A

Glycyyrhizic acid, which causes pseaudohyperaldo (hypertension, fluid retention, hypokalemia)

69
Q

Do antivirals or antibiotics prevent mucositis

A

No

70
Q

Best treatment for pediatric bereavement and trauma

A

Play therapy

71
Q

Alprazolam metabolizer and common interaction

A

3A4, inhibited by diltiazem

72
Q

Opioids activated by 2D6 (4) and their metabolites

A

codeine, oxycodone, hydrocodone and tramadol (to morphine, oxymorphone, hydromorphone and O-desmethyl tramadol)

73
Q

codeine, oxycodone, hydrocodone and tramadol activated forms

A

morphine, oxymorphone, hydromorphone and O-desmethyl tramadol

74
Q

Auto induction of methadone metabolism

A

Causes spontaneous sudden loss of efficacy of methadone dosing due to increased metabolism

75
Q

Who is billed for radiation on hospice?

A

Medicare A, if physician has agreement with hospice

76
Q

Who is billed if attending is a covering or is serving as attending but not affiliated with hospice

A

Medicare B.

77
Q

Nonopioid cough treatments

A

Sodium cromoglycate, brachytherapy, high intrathoracic vagotomy

HPM Board Review (5 decks)

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