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Hospice > Hospice and Palliative Medicine > Flashcards

Hospice and Palliative Medicine Flashcards

1
Q

Constant, dull, aching, localized, changing with movement pain

A

Somatic

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2
Q

Deep, aching, cramping, poorly localized pain

A

Visceral

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3
Q

Burning, shooting, tingling, or shock-like pain

A

Neuropathic

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4
Q

Pain levels expected to interfere with function and sleep

A

Moderate (4-6/10) or greater

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5
Q

Pain levels expected to interfere with concentration

A

Severe (7-10)

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6
Q

Opioid selection in renal insufficiency?

A

Fentanyl and methadone

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7
Q

Opioid selection in hepatic insufficiency?

A

Fentanyl, hydromorphone, oxycodone, and methadone with caution

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8
Q

Methadone receptor profile

A

Mu and delta receptor agonist, NMDA receptor antagonist

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9
Q

Methadone re: serotonin

A

Inhibits reuptake

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10
Q

Methadone re: norepinephrine

A

Inhibits reuptake

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11
Q

Methadone Absorption

A

Lipophilic, Through the stomach, No transdermal application

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12
Q

Methadone Metabolism

A

Hepatic, with no known active metabolites

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13
Q

Methadone Elimination

A

Fecal

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14
Q

Methadone EKG effects

A

QT prolongation

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15
Q

Nociceptive Pain Mechanism

A

stimulation of intact pain receptors and transmission along normal nerves

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16
Q

Nociceptive Pain Prevalence

A

Most common type of pain

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17
Q

Nociceptive Pain Quality

A

aching, throbbing, sharp

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18
Q

Nociceptive Pain Examples

A

arthritis, myofascial pain

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19
Q

Neuropathic Pain Mechanism

A

injury to or disease of peripheral or central nerves

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20
Q

Neuropathic Pain Prevalence

A

Less common and often more difficult to treat

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21
Q

Neuropathic Pain Quality

A

tingling, burning, electrical, lancinating

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22
Q

Neuropathic Pain Examples

A

postherpetic neuralgia, diabetic neuropathy, complex regional syndromes

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23
Q

The only valid measure of pain is…

A

Self-report

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24
Q

% elderly with chronic pain?

A

70-80%

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25
Q

% elderly with constant pain?

A

30%

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26
Q

% of elderly with constant pain with regular pain medication available?

A

less than 1/3 (33%)

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27
Q

Verbal Agitation

A

High association with pain or other physical symptoms

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28
Q

PQRST of Pain History “P”

A

Palliative or Precipitating factors

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29
Q

PQRST of Pain History “Q”

A

Quality of life impact

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30
Q

PQRST of Pain History “R”

A

Radiation/distribution

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31
Q

PQRST of Pain History “S”

A

Severity

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32
Q

PQRST of Pain History “T”

A

Temporal patterns

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33
Q

piper methysticum (Kava Extract)

A

Effective in treating anxiety, causes Hepatotoxicity

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34
Q

Cognitive Behavioral Therapy

A

Best risk/benefit ratio for insomnia. Better than relaxation techniques.

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35
Q

Opioid Induced Neuroexcitability Symptoms

A

Increased Agitation, Hyperalgesia, Agitation

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36
Q

Aspiration pneumonia

A

Most common mechanism of death in dementia

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37
Q

Opioid Related Nausea

A

Try antiemetics, then rotate opioids

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38
Q

Complication from Transjugular Intrahepatic Portosystemic Shunt

A

Encephalopathy

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39
Q

Absence of pupillary or corneal response

A

High predictor of mortality in comatose patients

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40
Q

Malignant Spinal Cord Compression Diagnosis

A

MRI for patient with worsening back pain

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41
Q

Malignant Spinal Cord Compression Treatment

A

Surgery followed by radiation

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42
Q

Have opioids or benzos been shown to hasten death?

A

No

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43
Q

Management of Hiccups

A

Gabapentin

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44
Q

Accupuncture

A

Effective in Pain Management

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45
Q

Antihypertensive associated with constipation

A

Verapamil

46
Q

Fee for service Medicare

A

Less likely to be referred to hospice

47
Q

Prevents burnout

A

Activities that enhance mindfulness

48
Q

Continue antibiotics

A

May be compatible with comfort only care

49
Q

Agitated Delirium Treatment

A

Chlorpromazine

50
Q

Status Epilepticus treatment without IV access

A

Midazolam

51
Q

Treatment of myoclonus and seizures related to uremia

A

benzodiazepines

52
Q

Manage secretions and minimize delirium

A

glycopyrrolate

53
Q

Does not improve survival after elective extubation

A

BiPAP

54
Q

Immediate intervention for SVC syndrome

A

Endovascular stent

55
Q

Metabolic abnormalities cause nausea by stimulating this

A

Chemoreceptor Trigger Zone

56
Q

Sensory input, anxiety, meningeal irritation, and increased ICP cause nausea by stimulating this

A

Cerebral Cortex

57
Q

Helpful pain assessment dimension

A

Temporal pattern-pain fluctuations

58
Q

Prognosis after electively stopping dialysis

A

7 to 9 days

59
Q

Mortality after intracerebral hemorrhage

A

50%

60
Q

Meaningful recovery after intracerebral hemorrhage survival

A

20%

61
Q

Noninvasive treatment of pruritis in end stage liver disease

A

Naltrexone

62
Q

Prognosis for independent functional recovery in myoclonus status epilepticus after circulatory arrest

A

1%

63
Q

“Wind-up” pain is mediated by

A

NMDA receptors in the dorsal horn of the spinal cord

64
Q

Most distressing symptoms to parents of dying children

A

low energy and decreased consciousness

65
Q

Olanzapine method of action

A

Blocking dopamine receptors in the CTZ

66
Q

Olanzapine trade name

A

Zyprexa

67
Q

Useful complementary therapy for pain, anxiety, and fatigue and may improve quality of life

A

Massage Therapy

68
Q

Common side effect of Ketamine

A

Psychomimetic symptoms

69
Q

Acute fluctuating pattern and inattention

A

Delirium

70
Q

Useful in treatment of odor in wounds with superficial anaerobic infection

A

Metronidazole

71
Q

Cause of early satiety in cancer patients

A

Neuroendocrine alterations

72
Q

Symptoms of systemic seratonin syndrome

A

Mental status changes, autonomic dysfunction, neuromuscular hyperactivity

73
Q

Relative potency - Morphine (IV) : Morphine (PO)

A

3:01

74
Q

Relative potency - Morphine (PO) : Oxycodone (PO)

A

3:02

75
Q

Relative potency - Morphine (PO) : Hydrocodone (PO)

A

1:01

76
Q

Relative potency - Morphine (PO) : Hydromorphone

A

4:01

77
Q

Oral daily Morphine dose 60 to 134 mg

A

Transdermal Fentanyl 25 mcg/hour

78
Q

Oral daily Morphine dose 135 to 224 mg

A

Transdermal Fentanyl 50 mcg/hour

79
Q

Oral daily Morphine dose 225 to 314 mg

A

Transdermal Fentanyl 75 mcg/hour

80
Q

Hopelessness

A

Frequently associated with requests for hastened death

81
Q

Faster onset than typical oral opioids

A

Fentanyl buccal lozenge

82
Q

Act at the NMDA receptor

A

Methadone, ketamine

83
Q

Three major classes of opioid receptors

A

Mu, kappa, and delta

84
Q

Mechanism of opioid action

A

Bind to receptors that inhibit calcium channels and prevent or induce the release of neurotransmitters

85
Q

Preferred bowel regimen for opioid naive patient

A

Senna and docusate

86
Q

The four components of total pain

A

Physical, emotional, social, spiritual

87
Q

Unreliable markers for chronic and subacute pain

A

Physiologic signs of acute pain such as pulse and blood pressure

88
Q

Meaningful pain relief with intolerable side effects from oral opioid therapy

A

Indication for neuraxial opioid infusion

89
Q

Symptoms of opioid induced hypogonadism

A

Fatigue, erectile dysfunction, and depressed mood

90
Q

Confer higher risk for future aberrant drug use

A

Psychiatric illness, personal or FHx of alcohol or drug abuse

91
Q

causes of cortical nausea

A

CNS tumors, increased ICP, anxiety, uncontrolled pain

92
Q

Have best evidence for use in delayed chemotherapy-induced nausea and vomiting

A

Ondansetron and aprepitant

93
Q

Antineurokinin antiemetic

A

Aprepitant

94
Q

Helpful in management of hypoactive delirium or apathy

A

Methylphenidate

95
Q

First line treatment of nonspecific dyspnea in patients with advanced disease

A

Opioids

96
Q

Always associated with opioid induced respiratory depression

A

Sedation

97
Q

Frequently found in men with cancer cachexia

A

Hypogonadism

98
Q

Effective short-term treatment of malignant colorectal obstruction

A

Self expanding metal stents

99
Q

Opioid Induced Neuroexcitability Treatment

A

Rotate Opioids, add benzos

100
Q

Changes prognosis in pts with advanced dementia with aspiration pneumonia

A

Nothing

101
Q

Generic Percocet

A

Oxycodone/Acetominophen brand name

102
Q

Generic Dilaudid

A

Hydromorphone brand name

103
Q

Generic Vicodin

A

Hydrocodone/Acetominophen brand name

104
Q

Generic Oxyfast, Oxycontin, Oxy IR

A

Oxycodone brand name

105
Q

Generic MS Contin, MS IR

A

Morphine Sulfate brand name

106
Q

ACC/AHA Stage C Heart Failure

A

Prior or current symptoms of heart failure

107
Q

ACC/AHA Stage D Heart Failure

A

Refractory heart failure requiring specialized interventions

108
Q

Lung volume reduction surgery outcome

A

Improved lung function, exercise capacity, and QOL

109
Q

“B” in the BODE index

A

Body Mass Index

110
Q

“O” in the BODE index

A

airway Obstruction (FEV1)

111
Q

“D” in the BODE index

A

Dyspnea (MMRC dyspnea index)

112
Q

“E” in the BODE index

A

Exercise tolerance measured by 6 minute walk

Hospice (1 decks)

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