Palliative Care Flashcards
opioid induced constipation management
increasing fluid and dietary fiber intake and physical activity. Then can try daily senna-docusate or osmotic laxative (polyethylene glycol or lactulose)
what do you give for someone who has refractory opioid induced constipation?
Give subcutaneous methylnaltrexone - doesn’t cross blood brain parrier and doesn’t cause opioid withdrawal symptoms, acts on peripherally only.
any considerations with methylnatrexone and GI lesions?
it can cause severe abdominal pain and bowel perforaiton if there’s a malignancy or PUD or diverticular dx present. give cautiously but stop if abdominal pain worsens
Cancer pain management
treatment of major depression in terminally ill pts should be
identified and treated.
Ppl may assume that depression is normal part of grieving but should be identified.
should pharmacological tx for goal of alleviating pt and family distress and facilitating a connection in last weeks of life.
major depression in terminally ill patients management
Make sure that there’s adequate pain control and provided support, and should have low threshold for starting medications based on anticipated life expectancy.
1st line is SSRI but can take weeks to start and appropriate for peopel who months to live
psychostimulants (methylphenidate dextroamphetamine, modafinil) are meant for people who have 2-4 weeks because of faster onset of action for antidepression.
pyschostimulants like methylphenidate, dextroamphetamine, modafinil) are preferred
because they are well tolerated work in 2-4 weeks and improvement in mood can be seen in 1-2 days.
They can also counteract fatigue and opioid related sedation.
Determining prognosis of cancer is based on:
physician’s predictions (based on prior clinical experience), clinical symptoms, and pts performance status.
dyspnea, dysphagia, confusion are associated with
average survival time <30-38 days
survival time based on anorexia and xerostomia is associated with
<50-60 days
