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444-Oncology and Neurology > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

palliative care focuses on total care, including

A

physical, psyc, social, spiritual, practical

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2
Q

what assessment tool is used for palliative care

A

edmonton sx assessment system (ESAS-r)

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3
Q

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

A

4 (increased)

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4
Q

pharm management for cancer related fatigue

A

methylphenidate
costicosteroids- dexamethasone
antidepressants

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5
Q

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

A

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

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6
Q

how well does dexamethasone work for cancer related fatigue?

A

improvement in fatigue and QoL
LT AEs

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7
Q

how well do SSRIs work for cancer related fatigue?

A

only helps with depressive component

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8
Q

what are some symptoms of bowel obstruction

A

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

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9
Q

what is the treatment for partial obstruction (bowel)_

A

motility agents like metoclopramide

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10
Q

what is the general tx for bowel obstruction

A

NG tube to suction stomach contents out
dexamethsone to decrease inflammation

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11
Q

what is the treatment for complete bowel obstruction

A

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

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12
Q

how to correct chronic N/V from hypercalcemia

A

BPs, RANKLi

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13
Q

how to correct chronic N/V from opioids/ meds

A

metoclopramide, dex, med assessment

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14
Q

how to correct chronic N/V from radiation/ chemo

A

metoclopramide, ondansetron, dex

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15
Q

how to correct chronic N/V from brain mets

A

radiation + corticosteroids

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16
Q

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

A

3-5 days

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17
Q

how to combat opioid induced nausea

A

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

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18
Q

what is cachexia

A

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

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19
Q

what is the key feature of cachexia

A

depetion of skeletal muscle

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20
Q

treatments for cachexia/ anemia

A

progsetins
corticosteroids
cannabinoids
mirtazapine

21
Q

megestrol efficacy for cachexia/ anemia

A

improved weight gain and appetite
simillar efficacy to corticosteroids

22
Q

which is better for appetite: megestrol or medroxyprogesterone

A

megestrol

23
Q

what is the overall efficacy of progestins and cachexia/ anorexia

A

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

24
Q

what corticosteroids are used in cachexia/ anorexia

A

dexamethasone
methylprednisolone
prednisolone

25
Q

overall efficacy of CS in cachexia/ anorexia

A

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

26
Q

dronabinol efficacy in C/A

A

no improvement, inferior to megestrol

27
Q

nabilone efficacy in C/A

A

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

28
Q

mirtazapine effect on C/A

A

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

29
Q

dyspnea is more common in _____ pts

A

lung cancer pts or those with lung metastasis

30
Q

tx for pleural effusion/ ascites

A

drainage

31
Q

tx for airway obstruction

A

RT, corticosteroids

32
Q

tx for lymphangitic carcinomas

A

CS

33
Q

if a dyspnenic pt is hypoxic, O2 should be kept

A

> 90%

34
Q

what is first line tx for dyspnea

A

opioids to decrease perception of breathlessnses
- use morphine or hydromorphone

35
Q

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

A

bronchodilators

36
Q

what can be used for dyspnea with pulmonary congestion

A

diuretics

37
Q

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

A

85%

38
Q

T or F: some episodes of delirium are reversible

A

T

39
Q

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

A

1

40
Q

what delirium subtype would an agitated and confused patient fall under

A

hyperactive

41
Q

what delirium subtype would a confused and withdrawn patient fall under

A

hypoactive

42
Q

what is mixed delirium

A

pt with features of both hyper and hypoactive delirium

43
Q

what psyc med to give for agitation/ hallucinations

A

haloperidol

44
Q

what combo to give for delirious + combative/ agitated pts

A

haloperidol + lorazepam

45
Q

methotrimeprazine is used in cancer delirium for

A

persistent symptoms

46
Q

what is palliative sedation

A

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

47
Q

why is timing of palliative sedation critical

A

cause tachyphylaxis can occur

48
Q

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

A

principle of double effect

49
Q

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

A

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

444-Oncology and Neurology (22 decks)

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