Palliative Care

Question 1

What are the beneficial associations of palliative care (4), other than symptom management?

Answer 1

1. Improved QOL
2. Improved mood
3. Fewer aggressive interventions at the end of life.
4. Improved overall survival (11.6 versus 8.9 months)

Question 2

What is the ECOG scale, from 0-4?

Answer 2

0 - Asymptomatic
1 - Symptomatic, completely ambulatory and able to do light housework
2 - < or = 50% day spent in bed/chair, capable of ALL self care, not capable of work
3 - > or = 50% of day spent in bed/chair, only limited self-care
4 - Bedbound

Question 3

What percentage of total daily dose should be ordered for breakthrough pain management?

Answer 3

10%

Question 4

Which opioids (listed below) should and should not be used in renal dysfunction?

Methadone, morphine, fentanyl, codeine, Tramadol, Demerol

Answer 4

OK - hydromorphone, methadone, fentanyl

NOT OK - morphine, codeine, tamadol, demerol

Question 5

What opioids (listed below) should and should not be used in hepatic dysfunction?

Hydromorphone, methadone, fentanyl, codeine, morphine

Answer 5

OK - hydromorphone, morphine, fentanyl

NOT OK - codeine, methadone

Question 6

How do you convert oxycodone to oral morphine?

Answer 6

Multiply by 1.5

Question 7

How do you convert oral hydromorphone to oral morphine?

Answer 7

Multiple by 5

Question 8

How would you convert oral morphine into a fentanyl patch?

Answer 8

~ 100 mg morphine = 25 mcg/hr fentanyl

60-130 mg -> 25 mcg/hr
135-179 mg -> 37.5 mcg/hr
180-224 mg -> 50 mcg/hr
225-269 mg -> 75 mcg/hr

Question 9

What is the evidence for treating delirium with anti-psychotics at the end of life?

Answer 9

Risperidone and haloperidol DO NOT alleviate distress at the end of life and tend towards harms, with potentially worse delirium symptoms and possibly worse EPS side effects.

Question 10

What is the opioid antagonist used to treat severe opioid induced constipation?

Answer 10

Methylnaltrexone

Question 11

What are the eligibility criteria for MAiD? (5)

Answer 11

1. Need to be eligible for health services funded by the government (health card)
2. 18 or older and mentally competent
3. Grevious us & irremediable medical condition
4. Make voluntary request for MAiD, free from outside pressure or influence
5. Provide informed consent

Question 12

How long do you have to wait to perform MAiD?

Answer 12

Must wait full 10 days from date patient signed written request before MAiD can be provided, except in certain circumstances where death is fast approaching and patient may lose capacity - then can be expedited.

Question 13

What is the prognosis required to get MAiD?

Answer 13

There is no specific prognosis.

Natural death must be REASONABLY FORESEEABLE.

Question 14

What is the rough conversion of PO morphine to transdermal fentanyl?

Answer 14

~ 100 mg PO morphine = 25 mcg/hr fentanyl

Question 15

What is the definition of “grievous and irremediable” in the eligibility criteria for MAiD (4)?

Answer 15

(1) DOES NOT need to be a fatal or terminal condition.
(2) Must be a serious illness, disease, disability in an advanced, irreversible state.
(3) Must result in unbearable physician/mental suffering that cannot be relieved.
(4) Must be to a point where a natural death is REASONABLY FORESEEABLE, but does not have any requirements on a specific prognosis.