Lesson 4 Flashcards
ALS feeding tube placement
should be placed before vital capacity drops below 50% predicted
Hypercalcemia rx
first step: IV hydration
then, diuretics and bisphosphonates
most common type of delirium for hospitalized elderly
mixed delirium
TCA with less anti-cholinergic effects
desipramine
nortriptyline
neonate pain rating scale
CRIES
FLACC pain scale rating
2 months to 7 years old
methadone maintenance therapy
dose methadone q6 to q8
opioid prn
hard stool in rectal vault rx
enema
most closely correlated to driving performance
Clock Drawing Test
opiate
any drug that is natural product of opium poppy plant
list of opiates
morphine
codeine
thebaine
synethic opioid
fentanyl
Buddhist beliefs re: meds
meds that contain animal byproducts may be resitrictdd
Buddhist beliefs re: death
believe patient is not completely dead until several hours after pronounced, so don’t want body to be moved quickly
depression meds with increased risk of seizures
bupropion
maprotiline
depression rx
SSRI
then try another SSRI
then try another med
first-line rx for neuropathic pain
SNRIs
TCAs
gabapentinoids
NSAIDs
COX inhibitors
prolong bleeding time
methadone mechanism of action
NMDA antagonist
full mu receptor agonist
MAO inhibitor
methadone oral bioavailability
80%
methadone metabolites
no active metabolites
adjust methadone dose at what CrCl?`
<10%
atheist/agnostic physicians more likely to
make decisions to hasten death
more religious physicians less likely to
discuss end of life decisions with patients
fatigue steroid treatment
dexamethasone most studied
fatigue med
megestrol
stimulants for fatigue studied in what patient population?
cancer patients
SVC syndrome management for patient on hospice
elevated head
supplemental O2
consider steroids, diuresis
consider outpatient radiation
WHO pain ladder
non-opioids
weak opioids
strong opioids
weak opioid examples
codeine
tramadol
hip fracture in hospice patients, traction
does not reduce pain
not recommended
hip fracture in patient >75 with hgb<12
transfuse
majority of hospice patients with hip fracture who go to hospital
get surgery
pancreatic cancer pain management
celiac plexus block
celiac fibers
antero-crural
splanchnic fibers
retro-crural
headache due to increased ICP
NSAIDs
corticosteroids
clarithromycin effect on cyt p450
suppression
fentanyl patch onset of pain relief
12 hours
may take 24 to 48 for full pain relief
dosing interval for fentanyl patch
q72 hours
skin care
avoid hot water
powder applied first, then cream
cultural preference scale
ABCD
neuroma-related pain from amputated limb
ultrasound guided radio frequency ablation
non-specific nausea first line treatment
metoclopramide
NSAIDs available in IV form
meloxicam
diclofenac
ibuprofen
ketorolac
FICA
results have been shown to closely correlate with QOL tools assessing spirituality
FICA stands for
Faith and belief
Its importance
Community (religious/spirituality)
Addressing how patient would want you to incorporate this
Naproxen
propionic acid derivative (same class as ibuprofen)
Citalopram side effect
QTc prolongation
check EKG before and after starting med
dose not to exceed 40 mg
Tramadol should not be
stopped abruptly
Tramadol method of action
mu-opioid agonist
most validated instrument to assess functional level in palliative care patients
Palliative Performance Scale
ECOG used for
performance status in cancer patients
Lansky score
functional status for children
methylnaltrexone used for
constipation, itching
prevalence of elder abuse/neglect in last year
10%
steroid which causes hiccups
dexamethasone
first line rx for hiccups
chlorpromazine
relational risk for addiction
having a friend with addiction
NSAID with highest CV risk
diclofenac
opioid effect on respiratory system
morphine decreases minute ventilation by decreasing RR
sodium phosphate enema side effects
dehydration
hyperphosphatemia, hypocalcemia, hypokalemia
avoid in those with CHF, renal dysfunction, cirrhosis
anterior cord syndrome
can be side effect of celiac plexus block
loss of motor, pain, light touch, temp sensation
CCB side effect
constipation
dextromethorphan can cause
serotonin syndrome
post-mastectomy pain syndrome associated with
younger age
prior history of headaches
more extensive disease
immediate post-op pain
weak opioids
codeine
tramadol
hydrocodone/acetaminophen
pain assessment Likert scale
any change is considered clinically significant
change of 2 points on numeric pain rating scale
considered clinically significant
antidepressant discontinuation syndrome
flu-like sx
electric zaps/shock sensation in head
pill esophagitis causes
tetracyclines
potassium
iron
NSAIDs
bisphosphonates
reiki
hands/touch transfer “universal energy” from practitioner’s palms to encourage healing
context-sensitive half-life
time taken for blood plasma concentration of drug to decline by one half following infusion at steady state
highest rate of suicide
non-hispanic Native American youth have highest rate
bereaved suicide rate (males vs. females)
higher in males
use of antipsychotics in individuals with dementia associated with
increased mortality
increased risk of stroke
constipation as side effect of opioids occurs in what percent of patients?
40-95%
melanoma poor prognostic findings
elevated LDH
elevated serum calcium
NSAID with highest CV risk
diclofenac
POLST
more details than advance directives
GBM poor prognostic lab findings
thrombocytosis
anemia
MELD components
INR
bilirubin
creatinine
etiology of cirrhosis
sodium
Child Pugh components
INR
albumin
bilirubin
ascites
encephalopathy
minimum life expectancy for placement of intrathecal pain pump
three months
