palliative pharm

Question 1

trade name dexamethasone

Answer 1

Decadron

Question 2

dosage range dexamethasone

Answer 2

2-8 mg daily to BID

Question 3

should you give PO dexamethasone with food?

Answer 3

yes, always!

Question 4

indications for dexamethasone?

Answer 4

decrease inflammation, tx spinal cord compression, co-analgesic, decrease nausea, increase energy, increase appetite

Question 5

major side effects of dexamethasone

Answer 5

sleep disturbance
increase energy & appetite
fluid retention
increase blood glucose

Question 6

peak serum levels dexamethasone

Answer 6

1-2 hours

Question 7

what should also be ordered with dexamethasone

Answer 7

PPI e.g. lansaprazole

Question 8

2 trade names for hydropmorphone

Answer 8

dilaudid, hydromorph contin

Question 9

dosage range hydropmorphone

Answer 9

0.25 mg to no max - limited by side effects experienced

Question 10

renal impairment & hydropmorphone

Answer 10

has been used safely in pts with renal failure but use with caution as 3-glucuronide metabolite is neuroexcitatory and can accumulate

Question 11

other than pain, what is an indication of hydropmorphone

Answer 11

dyspnea

Question 12

what levels of pain is hydropmorphone indicated for?

Answer 12

moderate to severe

Question 13

major side effects hydropmorphone

Answer 13

constipation, nausea & vomiting, delerium, dry mouth, hallucinations, myoclonus, unsteadiness, sweating, pruritus, drowsiness

Question 14

onset of action unsteadiness PO & SC hydropmorphone

Answer 14

PO - 15 to 30 min

SC - 15 min

Question 15

duration of action immediate & controlled release hydropmorphone

Answer 15

IR PO & SC - 4-5 hrs

CR - 12 hrs

Question 16

is it appropriate to open the CR capsule and sprinkle it onto soft, cold food?

Answer 16

yes, but should should not be chewed, crushed, or dissolved d/t to potential for rapid release & absorption of fatal dose

Question 17

what type of drug is Lorazepam

Answer 17

benzodiazepine

Question 18

dosage range Lorazepam

Answer 18

0. 5 to 2 mg q2 to 12 h PRN

* will also see scheduled doses

Question 19

other than anxiety, what is Lorazepam indicated for?

Answer 19

antiemetic adjunct, initial tx of seizure, insomnia, agitation (acute and terminal)

Question 20

major side effects of Lorazepam

Answer 20

sedation
Respiratory depression
Hypotension
Confusion
Dizziness
Akathisia 
Headache
Disorientation
Amnesia

Question 21

what is a more common route for lorazepam?

Answer 21

sublingual

Question 22

onset of action for SL vs. PO lorazepam

Answer 22

SL 5 min

PO 10-15 min

Question 23

duration of action lorazepam

Answer 23

duration of action of 6 to 72 hours

Question 24

what is the generic name of Haldol?

Answer 24

haloperidol

Question 25

what type of drug is haldol?

Answer 25

antipsychotic, D2-receptor antagonist ("D" for dopamine)

Question 26

what are the indications for haldol?

Answer 26

Tx and prevention of N and V associated with opioids, hypercalcemia, renal failure, inoperable bowel obstruction tx of agitation (delirium)

Question 27

major side effects haldol

Answer 27

Extrapyramidal side effects Sedation Hypotension

Question 28

Onset of action haldol

Answer 28

10 to 15 min SC or >1 hr PO

Question 29

duration of action haldol

Answer 29

up to 24 hrs

Question 30

what other medication can haldol be used with to tx agitation/restlessness?

Answer 30

midazolam

Question 31

at what doses are extrapyramidal side effects more likely?

Answer 31

>5 mg/day

Question 32

what is the generic name for nozinan?

Answer 32

Methotrimeprazine

Question 33

what type of med is nozinan?

Answer 33

antipsychotic

Question 34

dosage range nozinan

Answer 34

5 to 25 mg q4, 6, or 8 h PRN | *may see scheduled

Question 35

what is the max dosage per day of nozinan?

Answer 35

300 mg

Question 36

indications of nozinan

Answer 36

Antiemetic, tx of terminal agitation and delirium, tx of palliative sedation, tx of nausea due to bowel obstruction, analgesic properties

Question 37

major side effects nozinan

Answer 37

Sedation, Postural hypotension, Tachycardia, Palpitations, Blurred vision, Dry mouth, Heartburn, Constipation, Hesitancy & retention of urine, Palpitations, Reduced sweating, Flushing

Question 38

Onset of action nozinan

Answer 38

30 min

Question 39

peak plasma concentration nozinan

Answer 39

PO is 1-3 h | SC is 30-90 min

Question 40

duration of action nozinan

Answer 40

12-24 hrs

Question 41

how is nozinan useful in relation to uncontrolled pain?

Answer 41

useful co-analgesic in very distressed pt with severe pain unresponsive to other measures

Question 42

what is nozinan indicated for in low doses?

Answer 42

antiemetic