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HPM Board Review > Odds and Ends > Flashcards

Odds and Ends Flashcards

1
Q

Diltiazem + opioid interaction via CYP

A

Ca-channel blockers increase serum fentanyl by inhibiting 3A4

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2
Q

“Only” drug approved for HIV cachexia

A

dronabinol

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3
Q

“Mild” thrush and can swallow

A

Nystatin over azoles (though less effective)

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4
Q

fleet enema precautions

A

renal failure, CHF, cirrhosis, elderly and frail: can deplete intravascular volume and cause hyperPHOS, hypoK and hypoCa

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5
Q

NK-1 (arprepitant) and steroids may be best for

A

delayed chemo n/v

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6
Q

antipsychotics in morphine toxicity

A

may worsen symptoms

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7
Q

Malignant cord compression first things

A

Steroids and surgery consult! Pick surgery consult before RT

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8
Q

Dementia: dependent in ADLs but not incontinent

A

FAST 6 even if nonverbal!

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9
Q

6 month mortality for dementia plus hip fracture

A

55%

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10
Q

Prevalence of major depression or anxiety at end of life (range)

A

10-40%

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11
Q

depression, insomnia, anorexia, nausea

A

mirtazipine

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12
Q

depression, anxiety, insomnia, neuropathy

A

nortriptyline

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13
Q

activating antidepressants

A

fluoxetine and bupropion

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14
Q

depression, anxiety, neuropathy, advanced age

A

duloxetine (don’t give elders TCAs on the boards)

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15
Q

riluzole

A

in ALS, prolongs median survival 2-3 months, but does not improve symptoms or QoL

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16
Q

Once admitted GIP, one goal must be

A

transition to a lower level of care. No time limit on GIP, but you don’t get to stay for “imminent dying”

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17
Q

Does Medicare require 24h home caregiver for hospice?

A

No

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18
Q

I say burnout, you say

A

mindfulness

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19
Q

defibrilator question

A

tape a magnet to him!

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19
Q

what to tell children

A

truthful disclosure to children of all ages

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20
Q

tx painful bleeding malodourous tongue lesion

A

hypofractionated RT

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21
Q

Even on hospice, nonwhite people

A

get less care, have less pain control, are less likely to receive emotional support

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22
Q

Cultures that prefer death at home

A

Samoan, Vietnamese, Asian Indian

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23
Q

Piperdine metabolism

A

3A4, EXCEPT remifentanil, which has an ester sidechain and is metabolized by erythrocytes

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24
Q

Alfentanil metabolism

A

3A5, polymorphic and highly variable

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25
Q

norfentanil

A

The inactive metabolite the fentanyl becomes after hepatic metabolism (3A4)

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26
Q

fentanyl’s elimination halflife

A

very dependent on total infusion time (even greater than morphine)

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27
Q

complicated grief, fMRI and psychology

A

Increased activation of the nucleus accumbens (reward center); the attachement model

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28
Q

worse prognosis in colon cancer (5)

A

signet, KRAS wildtype, NOT having microsattelite instability, high CEA pre-op, right-sided (proximal(

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29
Q

NSAIDs by half-life, shortest to longest

A

celecoxib (6-12h)
naproxen (14h)
meloxicam (15-20h)
nabumetone (20-24h)
oxeprozen (40-60h)

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30
Q

megestrol AE’s (3)

A

VENOUS thrombosis
Adrenal insufficiency
Androgen insufficiency (males)

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31
Q

“hard stool in the vault”

A

enema first

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32
Q

Common inhibitors of 3A4

A

will increase FENTANYL concentrations!
Valproate
Isoniazid
Disulfiram
Erythro, Clarithromycin (not Azithro)
Omeprazole
Cimetidine
Allopurinol
Sulfonamides
Ethanol (Acute)

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33
Q

pain assessment, patient with dementia

A

PAIDAD: breathing, facial expression, vocalizations, body language, consolability

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34
Q

lowest rate of hospice utilization

A

asian/pacific islander

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35
Q

bupe binding

A

high affinity, low activity (partial agonist); lipophilic,
25-50x more potent than morphine

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36
Q

constipation exam

A

digital rectal more valueable than abdominal exam or xray

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37
Q

metabolite unique to heroin

A

6-MAM
6-monoacetylmorphine

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38
Q

death notice in person

A

if the family is less than 1h away

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39
Q

patients with hallucinations and delirium while dying

A

often develop myoclonus and seizures

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40
Q

Antidepressants with tamoxifen

A

venlafaxine, desvanlafaxine
(NOT SSRIs or bupropion due to 2D6 inhibition)

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41
Q

phenelzine and other MAO cautions

A

need 5+ weeks between SSRI or serotonin syndrome develops; get hypertensive with wine or cheese

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42
Q

one year survival of Child-Pugh C

A

45%, better than MELD 35 (die within months)

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43
Q

pain scale for neonates, infants and kids under 7

A

CRIES for NEONATES
FLACC for children 2-7
6 Faces also works for kids over 3

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44
Q

pruritis of unknown cause tx

A

gabapentin or paroxetine

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45
Q

test before citalopram

A

EKG for QTc

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46
Q

communication dissatisfaction stats

A

white is most satisified, then black, then hispanic,

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47
Q

lung cancer causes after smoking

A

radon

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48
Q

certification must occur

A

within 2 calendar days of hospice admission

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49
Q

meperidine caution

A

normeperidine, toxic metabolite that causes seizures in renal impariment and elderly

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50
Q

herb that causes serotonin syndrome

A

St John’s Wort (acts as an SSRI)

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51
Q

intercostal nerve blocks

A

enter below inferior rib border, hit at least 2 levels

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52
Q

wintergreen oil (bengay) cautions

A

no hot packs! no blood thinners

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53
Q

post-op ibuprofen and tylenol

A

reduce pain and better outcomes in children to give both

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54
Q

complicated grief prevalence spouse versus child

A

10-20% spouse, 60% child

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55
Q

specific phobia and agoraphobia in cancer patients

A

higher than general population

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56
Q

tx pneumothorax at home

A

heimlich valve

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57
Q

gender and depression in cancer patients

A

no difference

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58
Q

octreotide for diarrhea TYPES (3)

A

secretory not osmotic–HIV, chemo-induced and high stoma output

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59
Q

“itching all over” in patient on opioids without cancer

A

diphenhydramine for some reason

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60
Q

Childs-Pugh criteria

A

encephalopathy, ascites
albumin, bili, INR

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61
Q

first line for unspecificied nausea

A

metaclopramide, if not contraindicated

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62
Q

osteosarcoma to lungs only

A

best prognosis for metastatic osteosarcoma, 40% survival

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63
Q

religious beliefs are associated with

A

aggressive care at end of life

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64
Q

Contraindications for organ donations (7)

A

active extracranial cancer, severe untreated sepsis, active HBV, HCV, WNV, rabies, CJD

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65
Q

Most patients on hospice die

A

At home

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66
Q

Medicare recipients who receive hospice

A

51.6%

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67
Q

tx neuropathic stump pain

A

ultrasound guided radiofrequency ablation

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68
Q

STEMI 30d mortality

A

2.5-10%

69
Q

EF with increased risk in sudden cardiac death

A

35%

70
Q

duration for complicated grief

A

1 year

71
Q

most common causes of death associated with bereavement

A

cancer and cardiac disease

72
Q

lower side effect TCAs

A

Nortriptyline, desipramine (secondary amines)

73
Q

centrally acting antitussives

A

opioids, gabapentin (less evidence for TCAs, benzos)

74
Q

dextromethorphan cautions

A

serotonin syndrome

75
Q

CA15-3

A

breast cancer, along with CA 27.29

76
Q

CA19-9

A

pancreatic and GI cancers

77
Q

CA 117

A

GI stroma tumors and seminoma

78
Q

Wound care: powder and cream

A

powder first; no hot water

79
Q

Stark Law

A

limitations on self-referrals and kickbacks

80
Q

myocardial vs pericardial mets

A

melanoma to myocardium, lung cancer to pericardium (and lung cuases more effusions)

81
Q

ramelteon caution

A

CYP450 interactions

82
Q

don’t give benzos in

A

COPD

83
Q

psych disorders caused or worsened by bereavement

A

depression, bipolar, PTSD, SUD, anxiety disorders

84
Q

how TCAs cause sedation, weight gain, tachycardia, blurred vision and dry mouth

A

H1 histamine blockade

85
Q

cancers associated most with recurrence anxiety

A

lung and melanoma

86
Q

causes tachycardia, only used for rigors

A

meperidine (demerol)

87
Q

high risk features of hormone resistant prostate cancer

A

anemia, poor functional status, cord compression

(anemia is worse prognosis than hypoalbumin in prostate ca)

88
Q

elevated beta-2-microglobulin

A

poor prognosis in MM, CLL, some lymphomas

89
Q

elevated AFP

A

poor prognosis in liver cancer and germ cell tumors

90
Q

neuropathic pain and fistulas

A

radiation injury

91
Q

NSAIDs in pregnacy

A

safest before 20 weeks

92
Q

opioids in first trimester

A

increase risk of birth defects

93
Q

acupuncture most validated for this pain syndrome

A

migraine

94
Q

Strontium-89 and Sumarium-153

A

bone-seeking radionucleotides that provide 3-6 months of pain relief from bone mets

95
Q

life expectancy in vascular dementia

A

3-5 years (compared to 7 for LBD, 9 for AD)

96
Q

morphine half-life in neonates and infants

A

increased due to decreased total body clearance

97
Q

early morning awakening and increased total sleep

A

more consistent with depression than grief

98
Q

Potency compared to morphine: hydrocodone

A

3/4 as potent

99
Q

Potency compared to morphine: hydromorphone

A

5-10x

100
Q

Potency compared to morphine: fenantyl and sufentanyl

A

fent is 100x, sufentanyl is 500-1000x

101
Q

Potency compared to morphine: oxymorphone

A

3x

102
Q

secondary amine TCA, unlikely to be antichoinergic

A

desimipramine (desi doesn’t cause urnibary retention)

103
Q

methadone metabolite

A

2-ethylidene-1,5-dimethyl-3,3 diphenylpyrrolidine (EDDP)

104
Q

methadone false positives on a drug test

A

verapamil, quetiapine, diphenhydramine, doxylamine (unisom, an antihistamine sleep aid)

105
Q

6-MAM

A

heroin urine metabolite, clears in 24h

106
Q

hydrocodone is synthesized from

A

thebaine and codeine

107
Q

oxycodone is synthesized from

A

thebaine

108
Q

prevalence of elder abuse/neglect

A

10%

109
Q

best predictor of mortality risk in NAFLD

A

degree of fibrosis

110
Q

nausea, anorexia, dehydration and orthostasis

A

consider adrenal insufficiency

111
Q

L tryptophan caution

A

serotonin syndrome, don’t give with fluoxetine

112
Q

complicated grief

A

doesn’t exist. Prolonged grief disorder (since 2022) 6-12 months after loss

113
Q

Hgb < 3 prognosis

A

4-5 days

114
Q

Most fatal blood transfusion risk

A

TRALI

115
Q

Predict mortality in CKD/ESRD

A

degree of GFR reduction and proteinuria

116
Q

continous care definition

A

8 hours of hospice care per day, >50% done by a nurse

117
Q

AD prevalence over age 85

A

30-50%

118
Q

Sepsis + AKI mortality

A

up to 35%

119
Q

most common delirium subtype

A

mixed

120
Q

morphine, hydromorphone and oxymorphone do not

A

have phase one metabolism, are not metabolized by CYP system

121
Q

central alpha-2 adrenergic agonist, increases presynaptic inhibition of motor neurons

A

tizidanidine

122
Q

Gaba agonist, works in the spinal cord, reduces substance P

A

baclofen

123
Q

hospice at SNF is called

A

“routine home care”

124
Q

celiac nerve fibers are

A

antero-crural, going from pancreas to large intestine (up to transverse)

125
Q

cancer patients who meet criteria for psychiatric disorder

A

50%

126
Q

worse prognosis at stage 4

A

small cell lung cancer

127
Q

5HT antagonist with halflife of 40 hours

A

Palonosetron (note: zofran’s halflife is about 5 hours)

128
Q

loss of motor, pain, light touch and temperature after celiac plexus block

A

anterior cord syndrome

129
Q

NSAID with highest cardiac risk

A

diclofenac

130
Q

first line for cancer cachexia

A

olanzapine, then dex

131
Q

EKG before TCA at what age

A

40+

132
Q

highly emetogenic chemos (3)

A

cisplatin, cyclophosphomide, dacarbazine

133
Q

ramelteon or trazadone

A

trazodone, since ramelteon has not been studied in a palliative setting for insomnia

134
Q

IV NSAIDs (4)

A

meloxicam, ketorolac, ibuprofen and diclofenac

135
Q

best assessment of curative resection in colon cancer

A

histology

136
Q

Calculates risk of death from alcoholic hepatitis

A

Maddrey discrimination function (Lille determines response to treatment)

137
Q

best SC opioid

A

fentanyl

138
Q

days to repeat skin site for butrans

A

21

139
Q

preferred benzo for panic disorder

A

alprazolam

140
Q

common medications causing esophagitis

A

doxycycline, bisphosphonates, iron, potassium, NSAIDs

141
Q

3 day rule

A

Medicare will cover SNF if you have a necessary 3 day hospitalization (hospice would be revoked)`

142
Q

first line for nausea from bowel obstruction

A

haloperidol (by the way is less sedating than thorazine)

143
Q

Behavioral pain scale (BPS) is used for

A

adults on ventilators

144
Q

FLACC score

A

Pain scale for nonverbal children: Face, leg movements, activity, crying, consolability

145
Q

biological / elimination halflife

A

same thing: time it takes a drig to lose 50% of its activity

146
Q

context-sensitve half life

A

decreasing drug concentrations after infusion at steady state

147
Q

most common incontinence

A

urge

148
Q

increased depression risk after surviving cancer

A

smoking, poor body impage (women only)

149
Q

ALS, place feeding tube before

A

VC drops below 50%

150
Q

bupropion is safe with what other antidepressant

A

SSRIs

151
Q

chronic cough most common in

A

head and neck cancer

152
Q

SSRI least likely to cause withdrawal

A

fluoxetine, long half life

153
Q

most families agree to this when asked

A

autopsy (not required at any percent threshold by JCHO)

154
Q

Latino disease where your soul gets scared out of your body

A

susto

155
Q

most common side effect of modafinil

A

headache! can also agitate and disturb sleep but headache is most common

156
Q

respiratory alkolosis and opioids

A

increased nonionized forms and increases CNS penetrance

157
Q

phenytoin and opioids

A

inducer, increases metabolism and decreased effect

158
Q

best steroid for energy in cancer

A

dex

159
Q

does megace increase energy

A

yes

160
Q

screener for complicated grrief

A

inventory of complicated grief (25 is suggestive, 30 is very suggestive)

161
Q

does hospice cover PT/OT

A

yes

162
Q

NMS rather than serotonin syndrome

A

faster onset, clonus

163
Q

metabolized to meprobamate

A

carisoprodol (soma)

164
Q

epidural morphine

A

bimodal, can caused delayed OD, not safe for outpatient

165
Q

ABCD for cultural needs

A

attitudes, beliefs, context, decision-making style

166
Q

morphine decreases minute ventilation by

A

decreasing RR, not tidal volume

167
Q

on opioids, the carbon dioxide curve

A

has decreased slope and RIGHTward shift (central response to CO2 is decreased)

168
Q

HER2 positive

A

unfavorable, as are circulating cancer cells, age <35 at dx

169
Q

naproxen and ibuprofen class

A

propionic acide derivative NSAID (indomethacin is indole derivative and ketorolac is mixed)

170
Q

REAL duration of prolonged grief disorder

A

6 months for children/adolescents
1 year for adults
of yearning OR preoccupation

171
Q
A

HPM Board Review (5 decks)

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