palliative

Question 1

Who are allowed to dispense MAID?

Answer 1

Hospital pharmacies only

Question 2

Are pharmacists permitted to be involved in MAID process?

Answer 2

Only if MAID certified practitioner requests them

Question 3

What is conscientious objection?

Answer 3

can say no to DOCTOR but must refer if needed

Question 4

If you have a script and are unsure if its MAID or not what do you do?

Answer 4

call MAID program

Question 5

What is palliative care?

Answer 5

appropriate sx care for people with life limiting illnesses

Question 6

What are the goals of palliative care?

Answer 6

limit physical and emotional suffering through pain and sx management
support ability to enjoy remaining life by avoiding inappropriate death

Question 7

As a pharmacist, what role do we play in palliative care?

Answer 7

proper route
stop non-essential drugs
manage sx

Question 8

What is usually the first sign of dying process?

Answer 8

loss of appetite

Question 9

How can we help hydration and nutrition?

Answer 9

moisten lips, offer food they want
fluids

Question 10

Why do we want to avoid IV hydration long term?

Answer 10

vomiting, choking, edema and lengthen dying process

Question 11

How can we help dysnpea?

Answer 11

opioids

Question 12

If patient has death rattle should we give opioids?

Answer 12

only if dyspnea is present
often not distressing

Question 13

How can we help with constipation?

Answer 13

enemas or suppositories

Question 14

How can we help with vomiting?

Answer 14

anti emetics duh

Question 15

WHat route do we prefer for opioids?

Answer 15

oral >SQ>IV

Question 16

Preferred analgesic in palliative setting?

Answer 16

hydromorphone due to higher potency and no active metabolite
or fentanyl

Question 17

What are s/e of opioids to manage?

Answer 17

nausea, constipation, sedation

Question 18

How can we help with sedation from opioids?

Answer 18

tolerance after 2-4 days, swithc or decrease dose or methylphenidate

Question 19

How can we help with delirium from opioids?

Answer 19

resolves in 3-4 days
rule out other causes
haloperidol if needed

Question 20

How can we help with pruritis from opioids?

Answer 20

reduce dose, switch or give antihistamine

Question 21

Is pruritis from opioids an allergy?

Answer 21

NOOOOO

Question 22

What antihistamine should be given for pruritis from opioids?

Answer 22

second gen if take oral
diphenhydramine if cant

Question 23

How can we help with dry mouth from opioids?

Answer 23

mouth care, ice chips, sips,
Pilocarpine

Question 24

How to administer pilocarpine?

Answer 24

eye drops orally

Question 25

How can we help with urinary retention from opioids?

Answer 25

improves after a week catheter

Question 26

How can we help with respiratory depression from opioids?

Answer 26

rare naloxone or hold doses

Question 27

WHat is severe respiratory depressiojn?

Answer 27

<8 breaths/min

Question 28

How can we help with myoclonus from opioids?

Answer 28

add benzo, decrease dose or switch

Question 29

How can we help with hyperalgesia from opioids?

Answer 29

add NMDA antagonist reduce dose or switch

Question 30

If neuropathic pain what agents?

Answer 30

anticonvulsants or duloxetine

Question 31

What could dexamethasone be used for?

Answer 31

help with pain, stim appetite, wake up

Question 32

First line for nausea?

Answer 32

haloperidol metoclopramide

Question 33

Issue with ondansetron for nausea?

Answer 33

constipation, dry mouth and qt prolonging

Question 34

How do opioids help with dyspnea?

Answer 34

reduces effort of breathing, sedative, reduce O2 consumption, cant tell they have dyspnea

Question 35

If we have an opioid-tolerant person needing opioids for dyspnea what do we do with dose?

Answer 35

increase by 25-50%

Question 36

If patient is experienced altered breathing what do we say to family?

Answer 36

reassure that it is not distressing to patient

Question 37

When would we need antipsychotics for delirium in palliative care?

Answer 37

only if aggressive or distressed

Question 38

Treatment for delerium?

Answer 38

haloperidol

Question 39

What meds need to be reconsidered in palliative care?

Answer 39

hypoglycemics, diuretics, antihypertensives, vitamins, supplements, hormone replacement therapy

Question 40

What do things commonly occur in the last few days of life?

Answer 40

the rally seeing loved ones or pets who have passed

Question 41

True or false: Artificial hydration stops thirst

Answer 41

NO

Question 42

Why does respiratory congestion happen before death?

Answer 42

body is able to remove secretions

Question 43

How can we help with respiratory congestion?

Answer 43

reposition, stop IV fluids anticholinergics AT FIRST SIGN

Question 44

WHy must anticholinergics be given at first sign of respiratory congestion?

Answer 44

because they do not dry up secretions already present

Question 45

When do we do palliative sedation?

Answer 45

when all possible treatment has failed

Question 46

What is the regimen for palliative sedation?

Answer 46

opioid, midazolam, methotrimeprazine