Palliative

Question 1

Contraindication to palliative surgery:
a) DNR
b) hemodynamic instability
c) incarcerated hernia
d) bowel obstruction

Answer 1

b) hemodynamic instability

Question 2

Medication for end of life distress and agitation not relieved with benzos and antipsychotics

Answer 2

Phenobarbital. Large doses of opioids are not appropriate for sedation of the dying

Question 3

Morphine is used during what emergency events

Answer 3

acute cardiac events

Question 4

Most common side effects of gabapentin/neurontin
(duplicate)

Answer 4

dizziness and drowsiness

Question 5

Rare side effect of methadone

Answer 5

Prolongation of QTc

2-10%

Question 6

Most likely to be helpful in n/v from gastric outlet obstruction
a) Somatostatin
b) 5HT blocker
c) narcotic

Answer 6

a) somatostatin

AVM: I don’t see any specific literature for this

MLH: Somatostatin is a potent inhibitor of gastrin release. Gastric acid secretion is inhibited by both the paracrine and circulating peptide (hormonal) effects of somatostatin

Hypergastrinemia is also associated with gastric outlet obstruction or gastric dysmotility states

Also 5HT blockers and narcotics cause constipation as AE

Question 7

Best opioid for renal failure ?

Answer 7

Fentanyl

Not methadone because:
Patients with ESRD are more likely to have multiple comorbidities, a prolonged QT interval, and take sodium bicarbonate supplements (alkalinization of the urine can prolong methadone excretion) and other concomitant therapies increasing the risk of drug-drug interactions

Question 8

Which opioid has longest half-life?

Answer 8

Methadone

Question 9

Best way to treat bone pain and improve QoL in bone mets in patients in hospice?

A Gabapentin
B IV fluids
C Tylenol
D zolendronic acid

Answer 9

Answer - zometa (zolebdronic acid)

https://pubmed.ncbi.nlm.nih.gov/15870721/

B&H: NSAIDs first line, bisphosphonates or denosumab but they are expensive. RT, surgery.

Question 10

Best drug to treat pulmonary secretions on hospice

Answer 10

Atropine

Question 11

Best treatment of air hunger for end of life?

Answer 11

Morphine / opioids in general

(Benzos can relieve anxiety associated with dyspnea/SOB, but not the actual feeling)

Question 12

What narcotic is least constipating

Answer 12

Transdermal (TTS) fentanyl (B&H)

Question 13

What opioid is recommended for patients with severe hepatic impairment?

Answer 13

Fentanyl (B&H)