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PHAR 557 > Palliative Care > Flashcards

Palliative Care Flashcards

1
Q

What’s the goal of palliative care?

A

Relieve suffering (pain and other physical, psychological, spiritual problems)

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2
Q

T or F: Palliative care aims to hasten death.

A

F

It doesn’t intend to hasten nor postpone death

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3
Q

Who is palliative care for?

A

ANY pt w/ a chronic, life-limiting illness or tx

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4
Q

Who will most likely receive palliative care?

A

pts w/ advanced terminal illnesses

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5
Q

T or F: Palliative care is only for cancer pts

A

F

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6
Q

T or F: Palliative care is only for pts who are imminently dying

A

F

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7
Q

What’s the main diff b/w palliative care units and hospices?

A

Hospices are for palliative pts w/ STABLE probs

Palliative care units are for palliative care pts w/ acute or difficult-to-tx problems

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8
Q

What type of pts are most likely to receive palliative care?

A

Cancer pts

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9
Q

What kind of drug coverage is available for palliative pts?

A

Palliative Care Drug Coverage > covers 100% of Rx’ed drugs

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10
Q

Main drug used by those on palliative drug plans?

A

Opioids

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11
Q

What’re the three main trajectories of decline at the end of life?

A

Cancer, organ failure, and physical/cognitive frailty

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12
Q

Describe the functional trajectory of cancer patients

A

These pts have a high level of functioning throughout their lives until they near their death, where they have a sudden decline in functionality

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13
Q

Most common sx in cancer pts

A

Pain

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14
Q

T or F: Most cancer pts do not have satisfactory relief of their pain.

A

F

90% DO get relief from their pain

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15
Q

Goal of palliative pain mgmt?

A

Comfort

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16
Q

Palliative pain mgmt is managed mainly by…

A

opioids

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17
Q

What parenteral route is used for palliative pain mgmt?

A

subcutaneous butterfly route

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18
Q

T or F: Multiple drugs can be injected into the same butterfly subcut lne.

A

F (one line per medication)

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19
Q

What assessment algorithm is used to initially assess pain?

A

OPQRST

onset
palliation/provocation (what makes it better/worse?)
quality (nociceptive vs neuropathic)
radiation/region (does it travel? where is it located?)
severity
temporal (how long does it last? any particular time it gets worse/better? how long does med cause relief for?)

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20
Q

What is the analgesic ladder?

A

The medications recommended for persistent/increasing amts of pain

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21
Q

List the meds recommended on the analgesic ladder, starting with the lowest potency ones

A
  1. non-opioids (tylenol, NSAIDs +/- adjuvant)
  2. Opioids for mild-moderate pain (codeine, oxycodone, tramadol +/- adjuvant)
  3. Opioids for mod-severe pain (morphine, oxycodone, hydromorphone, fentanyl, methadone +/- adjuvant)
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22
Q

What’s an adjuvant wrt analgesic tx for palliative pts?

A

Agents used for neuropathic pain

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23
Q

What additional medication should be taken with opioids?

A

constipation meds

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24
Q

T or F: Opioid-induced constipation eventually goes away

A

F

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25
Q

T or F: Opioid-induced sedation eventually goes away

A

T (after 2-4d)

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26
Q

Opioid AEs:

A

N/V, constipation, sedation, delirium/confusion/hallucinations, pruritus, dry mouth, urinary retention, resp dep, myoclonus, hyperalgesia and allodynia

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27
Q

Opioid-induced pruritus is caused by…

A

histamine release

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28
Q

T or F: N/V are not common in advanced stages of cancer

A

F

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29
Q

What is used for: opioid-induced N/V that stimulates DA receptors in the CTZ?

A

D2 antagonist

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30
Q

What is used for: opioid-induced N/V that is the result of slow GI transit?

A

prokinetic agents (domperidone or metoclopramide)

31
Q

What is used for: opioid-induced N/V that is the result of increased sensitivity of the vestibular apparatus?

A

antiH’s, antichols

32
Q

N/V mediated by the chemoreceptors and mechanoreceptors of the GIT - what’re the NTs and receptors involved?

A

5-HT3, D2, and opioid receptors

33
Q

N/V mediated by the CTZ - what’re the NTs and receptors invovled?

A

D2, 5-HT3, H1, ACh

34
Q

N/V mediated by the cerebral cortex - what’re the NTs and receptors involved?

A

GABA

35
Q

N/V mediated by the vestibular apparatus - what’re the NTs and receptors involved?

A

H1 and ACh

36
Q

List D2 antagonists used for N/V.

A

metoclopramide, domperidone, haloperidol, methotrimprazine, prochlorperazine

37
Q

List 5-HT3 antagonists for N/V.

A

ondansetron, granisetron

38
Q

List histamine blockers for N/V (antihistamine).

A

dimenhydrinate

39
Q

What steroid is used for tx’ing N/V?

A

dexamethasone

40
Q

First line for opioid-induced N/V?

A

Metoclopramide > both a D2 antagonist and prokinetic

41
Q

CI of metoclopramide?

A

Complete bowel obstruction

42
Q

Why does domperidone have less risk of EPS relative to metoclopramide?

A

Bc it does NOT cross the BBB

43
Q

If you want a broader spectrum D2 antagonists and prokinetic, would you use domperidone or metoclopramide? Why?

A

Metoclopramide since it crosses the BBB

44
Q

1st line for N due to malignant bowel obstruction?

A

Haloperidol

45
Q

This medication is good for most types of N

A

Methotrimeprazine

46
Q

Why is methotrimeprazine good for most types of N?

A

It is an antagonist for D2, 5-HT2, H1, and ACh

47
Q

1st line for chemotx/radiotx-induced N.

A

Ondansetron/Granistron

48
Q

MOA of ondansetron/granistron?

A

5-HT3 antagonist

49
Q

1st line for anticipatory or anxiety-related N?

A

BZDs

50
Q

1st line for motion-induced nausea?

A

dimenhydrinate (Gravol)

51
Q

MOA of dimenhydrinate?

A

H1 antagonist

52
Q

T or F: dimenhydrinate is useful for opioid-induced nausea

A

F

53
Q

Dimenhydrinate: AEs

A

drowsiness, dry mouth, confusion in older adults

54
Q

2nd line for motion-induced N?

A

scopolamine

55
Q

MOA of scopolamine?

A

anticholinergic

56
Q

Scopolamine: AEs

A

dry mouth, urinary retention, palpitations

57
Q

Constipation: What is the goal of tx’ing constipation in palliative pts on opioids?

A

Bowel movement at least q3 days

58
Q

T or F: Nonpharm approaches to preventing/tx’ing constipation in palliative pts are usually the best.

A

F (risk of obstruction if not enough fluids are consumed)

59
Q

T or F: Tolerance does NOT develop to opioid-induced constipation.

A

T

60
Q

What should be used as prophylaxis for opioid-induced constipation?

A

Stimulant and/or osmotic laxative +/- stool softener

61
Q

How to tx opioid-induced constipation?

A

Suppository or enema

62
Q

What is used if stimulant/osmotic laxatives and stool softeners have failed?

A

Methylnaltrexone

63
Q

MOA of methylnaltrexone?

A

Peripheral (intestinal) acting selective µ-opioid antagonist

64
Q

When should methylnaltrexone be d/c’ed?

A

if it’s not effective after 4 doses

65
Q

One of the most feared aspects of dying?

A

Dyspnea

66
Q

First line for dyspnea?

A

Opioids

67
Q

List why opioids are preferred in pts suffering from dyspnea?

A
  • reduce resp effort
  • central sedative effect > lowers ventilatory response
  • lower sensitivity to hypercapnia and hypoxemia
  • reduce O2 consumption
  • reduce perception of dyspnea and anxiety
68
Q

In pts suffering from dyspnea, what should be used if there’re respiratory panic attacks?

A

BZD

69
Q

When does dyspnea increase dramatically in terms of occurrence and severity?

A

in the last 48h of life

70
Q

What can develop in pts who’re undergoing cancer tx or chronic CS tx?

A

Oral and esophageal candidiasis

71
Q

Tx for oral and esophageal candidiasis

A

Nystatin (local) or fluconazole (systemic)

72
Q

What’s an important counseling point for antifungal meds?

A

to continue for 7d after lesions have healed

73
Q

What’re some end-of-life symptoms/experiences experienced by the pt?

A
  1. Nearing-death awareness
  2. terminal restlessness
  3. respiratory congestion
74
Q

T or F: MAiD is part of palliative care.

A

F

PHAR 557 (36 decks)

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