Palliative Care

Question 1

palliative care focuses on total care, including

Answer 1

physical, psyc, social, spiritual, practical

Question 2

what assessment tool is used for palliative care

Answer 2

edmonton sx assessment system (ESAS-r)

Question 3

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

Answer 3

4 (increased)

Question 4

pharm management for cancer related fatigue

Answer 4

methylphenidate
costicosteroids- dexamethasone
antidepressants

Question 5

how well does methylphenidate work for cancer related fatigue? when should it be avoided and why?

Answer 5

slight improvement with ST use, effects within 48hsr
avoid if brain mets due to seizure risk

Question 6

how well does dexamethasone work for cancer related fatigue?

Answer 6

improvement in fatigue and QoL
LT AEs

Question 7

how well do SSRIs work for cancer related fatigue?

Answer 7

only helps with depressive component

Question 8

what are some symptoms of bowel obstruction

Answer 8

abdominal cramping, bloating, early satiety, nausea, inability to pass gas, constipation, overflow diarrhea

Question 9

what is the treatment for partial obstruction (bowel)_

Answer 9

motility agents like metoclopramide

Question 10

what is the general tx for bowel obstruction

Answer 10

NG tube to suction stomach contents out
dexamethsone to decrease inflammation

Question 11

what is the treatment for complete bowel obstruction

Answer 11

surgery or stenting- avoid motility agents as they can cause perforation

Question 12

how to correct chronic N/V from hypercalcemia

Answer 12

BPs, RANKLi

Question 13

how to correct chronic N/V from opioids/ meds

Answer 13

metoclopramide, dex, med assessment

Question 14

how to correct chronic N/V from radiation/ chemo

Answer 14

metoclopramide, ondansetron, dex

Question 15

how to correct chronic N/V from brain mets

Answer 15

radiation + corticosteroids

Question 16

how long does it take to build tolerance to opioid induced nausea

Answer 16

3-5 days

Question 17

how to combat opioid induced nausea

Answer 17

use antiemetics like metoclopramide (prokinetic effect), instead of ondansetron (constipating)

Question 18

what is cachexia

Answer 18

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

Question 19

what is the key feature of cachexia

Answer 19

depetion of skeletal muscle

Question 20

treatments for cachexia/ anemia

Answer 20

progsetins
corticosteroids
cannabinoids
mirtazapine

Question 21

megestrol efficacy for cachexia/ anemia

Answer 21

improved weight gain and appetite
simillar efficacy to corticosteroids

Question 22

which is better for appetite: megestrol or medroxyprogesterone

Answer 22

megestrol

Question 23

what is the overall efficacy of progestins and cachexia/ anorexia

Answer 23

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

Question 24

what corticosteroids are used in cachexia/ anorexia

Answer 24

dexamethasone
methylprednisolone
prednisolone

Question 25

overall efficacy of CS in cachexia/ anorexia

Answer 25

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

Question 26

dronabinol efficacy in C/A

Answer 26

no improvement, inferior to megestrol

Question 27

nabilone efficacy in C/A

Answer 27

improved caloric intake and QoL, but not in appetite or weight

Question 28

mirtazapine effect on C/A

Answer 28

no improvement in eating/ weight increased sleepiness improvement in depressive sx

Question 29

dyspnea is more common in _____ pts

Answer 29

lung cancer pts or those with lung metastasis

Question 30

tx for pleural effusion/ ascites

Answer 30

drainage

Question 31

tx for airway obstruction

Answer 31

RT, corticosteroids

Question 32

tx for lymphangitic carcinomas

Answer 32

CS

Question 33

if a dyspnenic pt is hypoxic, O2 should be kept

Answer 33

>90%

Question 34

what is first line tx for dyspnea

Answer 34

opioids to decrease perception of breathlessnses - use morphine or hydromorphone

Question 35

what can be used for dyspnea if there is a component of COPD or obstruction

Answer 35

bronchodilators

Question 36

what can be used for dyspnea with pulmonary congestion

Answer 36

diuretics

Question 37

delirium happens in ___% of terminal cancer patients in the last weeks of life

Answer 37

85%

Question 38

T or F: some episodes of delirium are reversible

Answer 38

T

Question 39

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

Answer 39

1

Question 40

what delirium subtype would an agitated and confused patient fall under

Answer 40

hyperactive

Question 41

what delirium subtype would a confused and withdrawn patient fall under

Answer 41

hypoactive

Question 42

what is mixed delirium

Answer 42

pt with features of both hyper and hypoactive delirium

Question 43

what psyc med to give for agitation/ hallucinations

Answer 43

haloperidol

Question 44

what combo to give for delirious + combative/ agitated pts

Answer 44

haloperidol + lorazepam

Question 45

methotrimeprazine is used in cancer delirium for

Answer 45

persistent symptoms

Question 46

what is palliative sedation

Answer 46

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

Question 47

why is timing of palliative sedation critical

Answer 47

cause tachyphylaxis can occur

Question 48

_____________: distinguishes between primary therapeutic intent (relieve suffering) and unavoidable untoward consequence (can compromise patient ability to protect airway)- recognized by law

Answer 48

principle of double effect

Question 49

what med is given for palliative sedation? what other measures should be in place?

Answer 49

midazolam - D/C all PO meds, continue analgesics IM/SQ quiet + peaceful environment make sure pt has a catheter