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Palliative Care > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Highest risk of TdP in antipsychotic

A

IV haldol

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2
Q

Antipsychotics with relatively low risk of torsades

A

Quetiapine, ariprazole, olanzapine

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3
Q

Antidepressants with lowest risk of torsades

A

Bupropion, duloxetine,

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4
Q

Risks of megestrol

A

Increase weight, mostly edema, and risk of VTE

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5
Q

Best options for insomnia when non-pharm doesn’t work

A

Quetiapine, olanzapine (good for appetite and mood)

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6
Q

Which antidepressants should be used for tolerability

A

Sertraline, escitalopram

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7
Q

Antidepressant for melancholic presentation

A

Bupropion, duloxetine, nortriptyline

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8
Q

Only FDA drug for hiccups

A

Chlorpromazine

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9
Q

SSRI with longest half life

A

prozac

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10
Q

pro/con of zoloft

A

few side effects, can take longer than others to see results

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11
Q

substitutions for determining depression in pall care

A
  1. depressed appearance
  2. social withdrawal, decreased talkativeness
  3. brooding, self-pity, pessimism
  4. lack of reactivity, can’t be cheered up
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12
Q

SSRIs with lowest risk of drug interactions

A

escitalopram

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13
Q

SSRI good for patients primarily with anxiety

A

escitalopram

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14
Q

SNRI best for chemo-associated neuropathy

A

duloxetine

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15
Q

how much venlafaxine do you need to get pain benefits

A

225mg

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16
Q

dose range for cymbalta (duloxetine)

A

20-120mg (minimal benefit >60mg)

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17
Q

best SSRI for a patient on multiple meds

A

escitalopram (lexapro)

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18
Q

brand name for citalopram

A

celexa

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19
Q

brand name for lexapro

A

escitalopram

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20
Q

brand name for fluoxetine

A

prozac

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21
Q

brand name for venlafaxine

A

effexor

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22
Q

brand name for duloxetine

A

cymbalta

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23
Q

combination of medications for poor energy

A

SSRI+ wellbutrin OR stimulant

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24
Q

combination of medications for poor sleep

A

SSRI + Remeron, SSRI + SGA (sedating), or SSRI + trazodone

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25
Q

combination of medications for nausea

A

Remeron + Zyprexa

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26
Q

antidepressant that can worsen anxiety

A

wellbutrin

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27
Q

benefit of cholinesterase inhibitors

A

small benefit in regards to cognition, behaviors, and function for mild to late Alzheimer’s type dementia

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28
Q

side effects of cholinesterase inhibitors

A

gastrointestinal and include nausea, diarrhea, weight loss, and bradycardia

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29
Q

most common side effect of memantine

A

dizziness; followed by confusion, constipation, headache

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30
Q

Lowest dose long acting morphine available

A

Kadian 10mg

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31
Q

Rapid dose escalation for acute pain IV morphine

A

1mg q1m x10mins, 5 minute respite, repeat if needed

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32
Q

Goal for pain control in rapid dose escalation

A

Reduction in 2-4 points of pain control or RR<10

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33
Q

Rapid dose escalation using IV dilaudid

A

0.2mg IV hydromorphone q1min x10, rest for 5, repeat

34
Q

How to convert patient from methadone for SUD to pain control

A

Divide daily methadone dose for SUD into 3 separate doses

35
Q

What are the fastest acting immediate release medications for pain control

A

Fentanyl, methadone (more lipid soluble)

36
Q

Rapid dose escalation using po morphine

A

5mg oral morphine x30min until pain decrease 2-4 points

37
Q

Converting IV methadone to po methadone

A

1:1.3 conversion (IV:po)

38
Q

How long to wait before changes in methadone dosing

A

5-7 days

39
Q

Conversion from opiate to methadone <60mg OME

A

2-7.5mg methadone per day, increase q5-7days

40
Q

Conversion from opiate to methadone daily OME 60-199 and pt <65yo

A

10:1 ratio (opiate to methadone)

41
Q

Conversion from opiate to methadone daily OME >200 or patient greater than 65

A

20:1 conversion (opiate to methadone)

42
Q

Adjustments to methadone based on liver disease

A

Consider decrease in dose and increase time between dose chagnes

43
Q

At what Qtc to avoid methadone

A

> 500msec

44
Q

What to consider if patient smokes and is taking methadone

A

Smoking increases CYP2B6-> increases clearance of methadone, so stopping smoking causes increase in methadone in system

45
Q

How to counsel patient about taking immediate acting opiate prior to volitional pain activity

A

30-45mins prior to activity

46
Q

What is duration of effectiveness of methadone for pain

A

6-12 hour duration

47
Q

What is the duration of effectiveness of methadone for SUD

A

24-36 hours (hence daily dosing)

48
Q

With what increases do patients not feel change in pain control

A

Don’t feel pain control with increases <25%

49
Q

How to adjust opiate dosing when a patient has good control but adverse effects

A

Decrease ATC by 30%, keep immediate the same

50
Q

How to adjust opiate dosing when a patient has continued pain and adverse side effects

A

Decrease ATC by 30-50% or switch opiate

51
Q

Open ended question to get better idea of how they’re taking opiate

A

Tell me how you take your opioid medication

52
Q

How to adjust dose when converting to fentanyl patch

A

Don’t need to decrease for cross tolerance because that has already been accounted for when you multiply by 2

53
Q

What are three types of drugs that interact with methadone

A

Three As- amiodarone

  • anti-invectives
  • anti-depressants
54
Q

How to manage someone on methadone enzyme inhibitor

A

Decrease dose methadone by 25%

55
Q

How rapidly can enzyme inducers/inhibitors work on methadone

A

Inducers- take 1-2 weeks to notice difference, so make prns readily available
Inhibitors-take a few hours-days to work, so methadone overdose can occur quickly.

56
Q

Starting dose of methadone in opioid naive

A

2.5mg BID or TID, can be as low as once daily in older/frail

57
Q

What to look for in first five days of methadone initiation

A

Counsel partner to look for signs of somnolence- patient not able to woken up by voice or firm shake or doze off during a conversation. Look for euphoria, loud snoring, slurred speech, ataxia. Ask them to check twice a day.

58
Q

How to titrate methadone

A

Increase by no more than 5mg q5-7days, after reaching 30-40mg/day, you can consider increasing by 10mg/5-7 days

59
Q

Oral methadone:oral morphine to convert methadone back to morphine

A

1:3

60
Q

PCA demand dose

A

50-150% of continuous infusion

61
Q

When to titrate continuous PCA infusion

A

Should wait at least 8 hours but ideally 12-24 hours increase

62
Q

PCA to TDF transition

A

Keep continuous for 6 hours, 50% at 6 hours, and then off at 12 hours

63
Q

PCA to oral meds

A

Give long acting 2-3 hours before discontinuing PCA

64
Q

How often can the PCA bolus dose be adjusted

A

Can be increased every two hours

65
Q

Fundoscopic exam of CRVO

A

Dilated veins, diffuse retinal hemorrhages, retinal and macular edema, possible afferent pupillary defect

66
Q

Painful vision loss differential

A

Acute glaucoma, optic neuritis, GCA, uveitis, migraine

67
Q

Painless vision loss differential

A

central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), ischemic optic neuropathy, cataract, vitreous hemorrhage, amaurosis fugax, TIA, cortical blindness, retinal detachment, macular degeneration, diabetic retinopathy, CMV retinitis, methanol intoxication, and functional visual loss.

68
Q

deep, boring eye pain and nausea/vomiting

A

Acute glaucoma

69
Q

Describe ophthalmology exam

A

Visual fields, visual acuity, pressure, pupils, fundoscopy, EOM, fluorescein, slit lamp, US

70
Q

Ophthalmology follow up for acute central retinal artery occlusion, acute glaucoma, and giant cell arteritis

A

Immediate

71
Q

Management of open globe

A

NPO, avoiding FB removal, avoiding eye manipulation, eye shield placement, head of bed elevation to at least 30 degrees, aggressive nausea treatment, analgesia, and IV antibiotics including vancomycin plus fluoroquinolone or ceftazidime, tetanus

72
Q

Labs to assess GCA

A

ESR/CRP

73
Q

Magnesium dose In children

A

20 to 25mg/kg bolus if pulseless, infusion over 15 to 30 mins for asthma

74
Q

Treatment of torsades in child

A

Magnesium, defibrillation, lidocaine

75
Q

Who usually gets retropharyngeal abscess

A

<6yo

76
Q

Treatment of RPA

A

Abx-unasyn or zosyn (vancomycin as well in severe cases), ?intubation, ENT consult, ICU

77
Q

Sore throat what to always think of in a child

A

Foreign body

78
Q

Recurrent croup, think

A

Bacterial tracheitis

79
Q

Imaging of bacterial tracheitis

A

Lateral neck, CXR (pneumonia would make tracheitis more likely), endoscopy

80
Q

Child with concerning neck pathology

A

Call ENT right away

Palliative Care (4 decks)

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