Lecture 10 - Palliative Care Flashcards

1
Q

8 Domains of Quality Palliative care

A
  1. structure and process of care
  2. physical aspects of care
  3. psychological and psychiatric aspects of care
  4. social aspects of care
  5. spiritual, religious and existential aspects of care
  6. cultural aspects of care
  7. care of the pt at the end of life
  8. ethical and legal aspects of care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For hospice, life expectance has to be under….

A

6 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of pain

A

Nociceptive
Neuropathic
Existential
Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to asses pain

A

FACES = pictures
Numerical Rating Scale
PQRST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Morphine Dose Adjustments

A

Renal: avoid in severe impairment
Hepatic: favorable w/ monitoring, inc dosing interval if severe impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Oxycodone Dose Adjustments

A

Renal: favorable with monitoring
Hepatic: cation n monitor, reduce dose 50% or inc dosing interval if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hydromorphone Dose Adjustments

A

Renal: favorable with monitoring
Hepatic: caution n monitor, reduce dose 50% or inc dosing interval if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fentanyl Dose Adjustments

A

Renal: preferred opioid in impairment
Hepatic: avoid in severe impairment, reduce doe 50% if mild-moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Methadone Dose Adjustments

A

Renal: preferred opioid in impairment
Hepatic: Avoid liver failure or severe impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Adverse effects opioids

A

constipation
Sedation
Respiratory depression
N/V
Pruritus
Hallucinations
Confusion/delirium
Myoclonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Morphine dosing

A

10mg IV = 30mg Oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hydrocone to morphine

A

30mg Oral = 30mg Morphine Oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hydromorphone dosing equiv

A

1.5mg IV = 7.5mg Oral (= 30mg morphine oral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Oxycodone to morphine equiv

A

20mg Oral = 30mg Oral morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Oxymorphone Dosing equiv

A

1mg IV = 10mg Oral (= 30mg Morphine oral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Daily dosage 60-134mg Morphine Fentanyl equiv

A

25mcg/h patch

17
Q

Daily dosage 135-224mg Morphine Fentanyl equiv

A

50mcg/h patch

18
Q

Daily dosage 225-314mg Morphine Fentanyl equiv

A

75mcg/h patch

19
Q

Daily dosage 315-404mg Morphine Fentanyl equiv

A

100mcg/h

20
Q

Going from Fentanyl patch to morphine

A
  1. remove patch
  2. for 1-12hrs after, use PRN opioid only
  3. at 12hrs, start new scheduled opioid at 50% of dose
  4. at 24hrs, inc new scheduled opioid at 100% of dose
21
Q

If taking methadone w/ enzyme inducer then….

A

might need to inc methadone, use rescue opioid

22
Q

If taking methadone w/ enzyme inhibitor then….

A

reduce calc dose of methadone by 25% or more, encourage use of rescue opioid

23
Q

Appropriate Methadone Candidates

A

True morphine allergy
Sig renal impairment
Neuropathic pain
Opioid-induced adv effects
Pain refractory to other opioids or uncontrolled pain
Cost is an issue
LA opioid preferred
any opioid req patient

24
Q

Supplemental opioids

A

want to use same as Long acting
should be about 10-15% of Total daily dose, can be used Q1-6h PRN

25
Q

Corticosteroids indicated for…

A

moderate to severe somatic and visceral pain as single agent or combo with agents

used in bone pain

26
Q

Bowel Regimen

A

should start stimulant laxative w/ opioids

if no BM in 2+ days, titrate up stim laxative and can add osmotic

inc fluid intake, exercise/mobility and fiber in diet

27
Q

drugs for Dyspnea

A

usually opioids and that conc oral morphine

give really small dose to patients

28
Q

Pharm therapy for anxiety

A

1st line = SSRI/SNRI
2nd = Benzo
3rd = Adjunctives

29
Q

Risk factors for depression in serious illness

A

Age = younger pts
Prior history of depression
Uncontrolled symptoms
Type of illness

30
Q

Gold standard for depression in serious illness

A

PHQ-9
> 10 = indicates likely major depression in general population

in pts w/ serious illness, lower threshold (> 6) should be consideration of txm

31
Q

symptoms clusters

A

when 3 or more concurrent symptoms are related to each other