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HPM Facts Review > HPM Random Facts Review > Flashcards

HPM Random Facts Review Flashcards

1
Q

What should you always consider for first line pharmacotherapy of delirium?

A

Consider antipsychotic Haloperidol

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2
Q

For delirium should meds be routine or prn?

A

PRN!

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3
Q

What other drugs do we consider for escalating delirium, not responding to antipsychotics in patients who are a risk to themselves or others?

A

Rescue doses of midazolam or lorazepam in addition to antipsychotic

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4
Q

What med do you use in Lewy Body Dementia and Delirium ?

A

Quetiapine, low dose prn q4hrs

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5
Q

what are imaging signs of pneumonitis?

A

similar to pna, new focal airspace opacities

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6
Q

how can pneumonitis present clinically?

A

dry cough, SOB, likely afebrile

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7
Q

If pneumonitis is suspected, what is the work up or plan of care?

A

work up should be bronchoscopy with bronchoalveolar lavage to rule out infection, then treat with steroids

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8
Q

what symptoms of SVC are emergent requiring immediate surgical/XRT intervention for stent placement or radiation therapy?

A

AMS from cerebral edema, and stridor from central airway obstruction.

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9
Q

When do you consider a catheter for malignant pleural effusion?

A

Rapid filling in < 1 week

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10
Q

When are recurrent thoracentesis okay?

A

Slow fill > 1 month
Life span < 3 months
Low Performance Status

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11
Q

What do you use for relief of dyspnea in patients with advanced terminal disease?

A

Systemic opioids - optimally long acting with any break through controlled with short acting narcotics

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12
Q

what are risks for aspiration pneumonia

A

dysphagia, choking, coughing, excessive sedation, OSA with obesity compromising glottis closure or cough reflex during sleep

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13
Q

How does Heliox work?

A

Decrease turbulent air flow, therefore decreases airway resistance, and makes less work of breath!

Remember it’s temporary!

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14
Q

Name 4 steps to approaching hemoptysis management

A
  1. Locate the bleed
  2. Reverse any coagulopathy
  3. Bronchoscopy with interventions (ice saline, balloon tamponade, topical vasoconstrictor such as epi)
  4. if bronch fails, IR embolization/surgery
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15
Q

when can you not use Non invasive positive pressure ventilation?

A

if the patient is confused or obtunded

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16
Q

When should you use direct thrombolysis for a PE?

A

If patient is unstable, or has right heart strain

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17
Q

Which anticoagulation is perferred for active cancer and thromboembolism?

A

LMWH preferred over coumadin

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18
Q

in constipation in the cancer patient with bone mets what is the first step?

A

look for underlying cause, RULE OUT hypercalcemia prior to assuming OIC or treating.

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19
Q

When do you avoid bulk fiber?

A

If poor oral intake and or history/risk of fecal impaction

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20
Q

When is methylnaltrexone contraindicated?

A

If obstruction suspected, or for patients with any compromise of bowel integrity such as prior bowel obx.

21
Q

what is a bad side effect of methylnaltrexone?

A

bowel perforation

22
Q

what is the mechanism of methylnaltrexone?

A

Opioid antagonist that targets the mu receptors of the GI tract without crossing blood brain barrier or impairing analgesia by opioids.

23
Q

What type of agents are the following:

  1. Psyllium
  2. senna and bisacodyl
  3. docusate sodium
A
  1. Bulk forming agents
  2. increase intestinal peristalsis and secretions
  3. soften stool by increasing water penetration
24
Q

What is the best treatment for hypercalcemia

>14?

A
  1. IVF with (0.9% NaCl)
  2. Calcitonin
  3. Zoledronic acid
25
Q

how much IVF with (0.9% NaCl) do you use for hypercalcemia?

A

use 2-4L/day for 2-3 days

26
Q

How much calcitonin do you use for hypercalcemia?

A

4-8u/kg subQ every 6-12hours for 2-3 days

27
Q

which bisphosphonate is best for renal insufficiency?

A

zoledronic acid is better than pamidronate

28
Q

when someone has hemorrhage/hemoptysis how do you lay the patient?

A

Good side up!

lateral decubitus position with the affected lung in the dependent position

29
Q

When should you do surgery in metastatic bone disease?

A

If life expectancy >1mo

30
Q

What areas of fracture should you consider surgical repair if life expectancy is >1mo?

A

Tibia, Femur, Pelvis.

Spinal instability.

31
Q

what is used to treat hypercalcemia due to lymphoma, sarcoid, or other granulmoatous diseases?

A

glucocorticoids

32
Q

What can make SVC worse?

A

IVF

33
Q

When do you need seizure prophylaxis in primary or secondary brain mets?

A

If post op from resection, up to 3 months

OR

If the patient has had a seizure

34
Q

what is pharm agent contraindicated if suspected bowel obstruction?

A

metoclopramide - it is a prokinetic and may increase severity of symptoms.

Use bowel rest! IVF, Steroids, Hyoscine, NG, venting peg or surgery

35
Q

when do you use O2 in patients?

A

When they are HYPOXIC

36
Q

The vomiting center sits in the ____.

A

Medulla

37
Q

What is the receiving part of the vomiting center called?

A

The NTS

Nucleus Tractus Solitarius

38
Q

Where is the emitogenic signal coming from for nausea/emesis?

A

the DMV

Dorsal Motor Nucleus of Vagus

39
Q

Name 4 parts of the body go to the NTS (receiving center)?

A
  1. Higher cortical centers - increase ICP (anticipatory nausea)
  2. Chemoreceptor Trigger Zone (in medulla outside of BBB) - Uremia, toxins, hypercalcemia
  3. GI tract (obx, stasis, mets, chemo agents/radiation)
  4. Vestibular Apparatus (motion, opioids)
40
Q

What peripheral area of nausea goes to the CTZ or to the NTS directly?

A

the GI tract

41
Q

What is the most common cause of death in pts with ALS ?

A

Respiratory failure

42
Q

What is a predictor of sudden death in patients with ALS?

A

decreased heart rate variability

43
Q

When should you consider a PEG in pts with ALS?

A

If VC is >50%

early in the course can stabilize weight and BMI and prolong survival if early.

44
Q

Anticholinergic does what to the pupils?

A

Mydriasis - Dilates

45
Q

what are the main presentations in Serotonin syndrome (4) ?

A

Hyper reflexia
Hyper tonia (myoclonus)
Hyper thermia

Midriasis!

46
Q

What neurotransmitter is affected in NMS?

A

Dopamine (dopamine becomes LOW)

47
Q

What medications cause NMS?

A

Anti-psychotics like olanzapine and chlorpromazine

48
Q

What are the main presentations in NMS?

A

BRADY kinesia
Brady reflexia
Muscle rigidity
tachycardia and fever (HTN or variable)

HPM Facts Review (2 decks)

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