Palliative Care Flashcards
palliative care focuses on total care, including
physical, psyc, social, spiritual, practical
what assessment tool is used for palliative care
edmonton sx assessment system (ESAS-r)
which of the following is false about cancer related fatigue
1. is subjective and distressing
2. can take years to improve after tx completes
3. may never return to baseline
4. may be due to a decreased inflammatory state
4 (increased)
pharm management for cancer related fatigue
methylphenidate
costicosteroids- dexamethasone
antidepressants
how well does methylphenidate work for cancer related fatigue? when should it be avoided and why?
slight improvement with ST use, effects within 48hsr
avoid if brain mets due to seizure risk
how well does dexamethasone work for cancer related fatigue?
improvement in fatigue and QoL
LT AEs
how well do SSRIs work for cancer related fatigue?
only helps with depressive component
what are some symptoms of bowel obstruction
abdominal cramping, bloating, early satiety, nausea, inability to pass gas, constipation, overflow diarrhea
what is the treatment for partial obstruction (bowel)_
motility agents like metoclopramide
what is the general tx for bowel obstruction
NG tube to suction stomach contents out
dexamethsone to decrease inflammation
what is the treatment for complete bowel obstruction
surgery or stenting- avoid motility agents as they can cause perforation
how to correct chronic N/V from hypercalcemia
BPs, RANKLi
how to correct chronic N/V from opioids/ meds
metoclopramide, dex, med assessment
how to correct chronic N/V from radiation/ chemo
metoclopramide, ondansetron, dex
how to correct chronic N/V from brain mets
radiation + corticosteroids
how long does it take to build tolerance to opioid induced nausea
3-5 days
how to combat opioid induced nausea
use antiemetics like metoclopramide (prokinetic effect), instead of ondansetron (constipating)
what is cachexia
involuntary loss of body weight that cannot be completely reversed by nutritional support (>5% loss of body weight = worse prognosis)
Depletion of skeletal muscle is a key feature
what is the key feature of cachexia
depetion of skeletal muscle
treatments for cachexia/ anemia
progsetins
corticosteroids
cannabinoids
mirtazapine
megestrol efficacy for cachexia/ anemia
improved weight gain and appetite
simillar efficacy to corticosteroids
which is better for appetite: megestrol or medroxyprogesterone
megestrol
what is the overall efficacy of progestins and cachexia/ anorexia
Overall improvement in appetite, but
Weight gain associated with fat mass + ↑ muscle atrophy
No QoL improvement
↑ risk of thrombotic events (↑ with cancer, weight gain, progestin
what corticosteroids are used in cachexia/ anorexia
dexamethasone
methylprednisolone
prednisolone
overall efficacy of CS in cachexia/ anorexia
overall improvement in appetite, not weight gain
- short term response that is not sustained
may cause issues in LT due to muscle atrophy + CS SEs
dronabinol efficacy in C/A
no improvement, inferior to megestrol
nabilone efficacy in C/A
improved caloric intake and QoL, but not in appetite or weight
mirtazapine effect on C/A
no improvement in eating/ weight
increased sleepiness
improvement in depressive sx
dyspnea is more common in _____ pts
lung cancer pts or those with lung metastasis
tx for pleural effusion/ ascites
drainage
tx for airway obstruction
RT, corticosteroids
tx for lymphangitic carcinomas
CS
if a dyspnenic pt is hypoxic, O2 should be kept
> 90%
what is first line tx for dyspnea
opioids to decrease perception of breathlessnses
- use morphine or hydromorphone
what can be used for dyspnea if there is a component of COPD or obstruction
bronchodilators
what can be used for dyspnea with pulmonary congestion
diuretics
delirium happens in ___% of terminal cancer patients in the last weeks of life
85%
T or F: some episodes of delirium are reversible
T
end of life delirium is usually
1. quick onset and transient
2. slow onset and permanent
3. slow onset and transient
4. quick onset and permanent
1
what delirium subtype would an agitated and confused patient fall under
hyperactive
what delirium subtype would a confused and withdrawn patient fall under
hypoactive
what is mixed delirium
pt with features of both hyper and hypoactive delirium
what psyc med to give for agitation/ hallucinations
haloperidol
what combo to give for delirious + combative/ agitated pts
haloperidol + lorazepam
methotrimeprazine is used in cancer delirium for
persistent symptoms
what is palliative sedation
inducing and maintaining deep sleep (not purposely causing death)
To relieve sx when all other possible interventions (that do not compromise consciousness) have failed + pt is perceived close to death
why is timing of palliative sedation critical
cause tachyphylaxis can occur
_____________: distinguishes between primary therapeutic intent (relieve suffering) and unavoidable untoward consequence (can compromise patient ability to protect airway)- recognized by law
principle of double effect
what med is given for palliative sedation? what other measures should be in place?
midazolam
- D/C all PO meds, continue analgesics IM/SQ
quiet + peaceful environment
make sure pt has a catheter
