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ACP Study > Palliative Care CPGs > Flashcards

Palliative Care CPGs Flashcards

1
Q

The most commonly used route for medication administration in the palliative care setting is:

A

Subcutaneous

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2
Q

A person must have a life expectancy of no more than ___________ to receive benefits under the BC Palliative Care Benefits Program

A

6 months

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3
Q

What should be done with patient Goals of Care documents?

A

Take photos and attach to E-PCR

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4
Q

True or false; terminal delirium is a normal part of the dying process

A

False!

Although delirium often occurs 24 to 48 hours before death, it should not be considered a normal part of the dying process.

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5
Q

The three classes of delirium seen in palliative care patients are:

A

Hyperactive, hypoactive, and mixed

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6
Q

True or False; Physical restraints are a generally appropriate intervention in terminal delirium

A

False!

Avoid the use of physical restraints as they can increase the risk of delirium.

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7
Q

Attention disturbances, restlessness and agitation, and hallucinations are common symptoms of ____________ in palliative care patients

A

hyperactive delirium

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8
Q

Drowsiness, emotional or physical withdrawal, depression, lethargy, and decreased levels of consciousness are symptoms of _____________ in paliiative care patients

A

Hypoactive Delirium

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9
Q

List common causes of delirium in palliative care patients (up to 10)

A
  • Sepsis
  • Metabolic or electrolyte disturbances
  • Hypoxia
  • Organ failure
  • Withdrawal from alcohol or medications
  • Unmanaged or undermanaged pain
  • Sleep deprivation
  • Constipation or urinary retention
  • Dehydration
  • Changes to the patient’s environment or psychosocial situation
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10
Q

Medical management is typically reserved for which form of delirium?

A

hyperactive

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11
Q

The first line pharmaceutical choice for management of delirium in palliative care patients is (give agent, route, and dosage)

A

Benzodiazepines

  • Midazolam
    • Subcutaneous
    • 5-10mg (no more than 30mg total from all sources)
  • Lorazepam (ativan)
    • Sublingual
    • 1mg
    • only if prescribed for patient; ACP must have appropriate Schedule 2 (4(b)) license endorsement
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12
Q

Delirium is a common (but not normal) finding in patients in the last __________ of life

A

24-48hrs

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13
Q

The second line pharmaceutical choice for management of delirium in palliative care patients is (give agent, route, and dosage)

A
  • Ketamine
    • SC/IM
    • 0.1-0.5mg/kg

Patients requiring MIDAZOLam or ketAMINE for management of agitation should have a follow-up from their palliative care team; if care team unable to attend within an acceptable time frame, consider conveyance to hospital for further support

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14
Q

Describe how breakthrough dosing for analgesic medications is determined

A
  • Breakthrough dosing is 10% of the TDD (total daily dose) from the previous days
  • The total daily dose is the 24-hour total of a specific drug that is taken for regular and breakthrough pain.
  • When switching between agents, use equianalgesic dosing conversions
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15
Q

A patient is prescribed 2mg hydromorphone QID (4/day) for analgesia. Yesterday they also self-adminstered 2 x 2mg “breakthrough” doses due to poorly controlled pain. Calculate breakthrough dosing today for them using:

  1. Hydromorphone (HM)
  2. Morphine Sulfate (MS)
  3. Oxycodone (OC)
A

TDD = 4x2mg + 2x2mg = 12mg HM

  1. Breakthrough = TDD x 0.10 = 12mg x 0.10 = 1.2mg SC
  2. MS dosing = 5 x HM dosing = 6mg SC
  3. OC dosing = 3.75 x HM dosing = 4.5mg PO
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16
Q

Describe equianalgesic dosing between hydromorphone, morphine, and oxycodone in palliative care pain management, including differences in route

A
  • Hydromorphone 1mg (subcutaneous)

is equivalent to

  • Morphine 5mg (subcutaneous)

is equivalent to

  • Oxycodone 3.75mg (Oral)
17
Q

Describe equianalgesic dosing for patients who use Fentanyl patches for analgesia

A

Fentanyl 25mcg/hr patch = 60-134mg morphine/day

  • in frail elders and patients with renal failure use upper conversion range.
  • Patients with normal renal function and non-elders use lower conversion range.
  • Breakthrough dose
    • Calculate breakthrough dose based on morphine equivalents of the patch. Lowest dose patch=12mcg/hr
18
Q

A 30yo pt. with intact renal function and end-stage lung Ca is using 2x25mcg/day fentanyl patches for analgesia and has called for a pain crisis.

Calculate equianalgesic and breakthrough dosing using morphine.

A
  • Equianalgesic dosing
    • 25mcg/day fentanyl = 60mg/day morphine (for non-frail pts.)
    • 50mcg/day = 120mg morphine SC TDD
  • Breakthrough
    • TDD x 0.10
    • Breakthrough = 12mg morphine SC
19
Q

A 98yo pt. with end-stage metastatic liver Ca is using 1x12mcg/day fentanyl patches for analgesia and has called for a pain crisis.

Calculate equianalgesic and breakthrough dosing using morphine.

A
  • Equianalgesic dosing
    • 25mcg/day fentanyl = 134mg/day morphine (for frail/elderly pts.)
    • 50mcg/day = 120mg morphine SC TDD
  • Breakthrough
  • TDD x 0.10
  • Breakthrough = 12mg morphine SC

ACP Study (12 decks)

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