symptom mngmnt in end of life Flashcards
what method of administration of drugs should be avoided in end of life patients ?
IM
management in terms of life sustaining interventions
these are considered futile in end of life treatment
how to manage in cases of accumulation of oropharyngeal secretions ?
occurs due to lack of gag reflex
first try postural drainage and repositioning
no response ? hyoscine butylbromide
mngmnt in loss of ability to close eyes ?
maintain moisture with artificial tears
management in terminal bleeding for end of life patients ?
provide anxiolytics
dark bed sheeting
what is the maximum dose of acetaminophen in adults ?
3-4 g in 24 hours
recommended dose of acetaminophen ?
<2.6 g
most potent analgesic effect in bone pain, myofascial pain ?
NSAIDS
what must be evaluated before the administration of NSAIDS?
CVDD, GIT and renal adverse effecst
how to reduce the risk of GI bleeding with NSAIDS ?
using a combination of COX-2 inhibitors and PPI
in what conditions should codeine be avoided ?
renal failure
dose of codeine ?
15-30 mg every 4 to 6 hours
what is the dose for dihydrocodeine ?
60-120 mg every 12 hours
drug to help the adverse effects of opioid induced constipation ?
oxycodone and naloxone mixed together
dos for oxycodone ?
5 mg every 4 hours
what type of patients cannot take tramadol ?
patieents with history of seizures
what is the mechanism of action of tramadol ?
serotonin and acetylcholine blocker
what syndrome is associated with tramadol ?
serotonin syndrome
where is morphine metabolized ?
in the kidneys , meetabolized into more potent form
dose for morphine ?
5-10 mg every 4 hours
patients who cant use morphine due to renal insufficiency , what can be used instead ?
hydromorphone
buprenorphine is also safe in renal failure
fentanyl
what type of drug is buprenorphine ?
synthetic opioid analogue (partial agonist)
what must be immediately done upon the administration of buprenorphine ?
all routine dosing of alternative opioids should be stopped
what drug is reserved for opioid resistant patients ?
fentanyl andd methadone
how long does fentanyl stay in the blood after removal of the patch ?
up to 1 day
what must be done in regards to fentanyl use in critically ill patients ?
transdermal patches to be converted directly to IV i a 1:1 ratio
what type of patients use methadone ?
end stage renal disease
what is thee management in cases of worsening or increased somnolence ?
decrease opioid dose to the lowest pain control level
may also be an indication to switch the type of opioid
what is the best management for opioid induced nausea and vomiting ?
prokinetic antiemetics (metoclopramide) or dopamine antagonists (haloperidol)
what are thecontraindications to metoclopramide use ?
it should not be used with anticholinergics or in patients with colic or complete bowel obstruction
most frequent adverse effect of opioids ?
constipation
what other medications are required for opioid induced constipation ?
senna
lactulose
which opioids have minimally active metabolites ?
hydromorphone
fentanyl
buprenorphine
what does opioid induced hyperalgesia commonly develop with ?
neurotoxicity
how should opioid induced hyperalgesia bee managed ?
by reducing opioid dose by third or half
how is neurotoxicity managed ?
by adequate hydration and reduction of opioid dose
management of severe opioid overdose ?
0.4 to 1 mg of naloxone , usually need a continuous infusion
examples of co analgesics ?
antiepileptics
tricyclic antidepressant
biphosphonates
examples of antiepileptic ?
gabapentin
pregabalin
carbamazepine
when should gabapentin be used ?
neuropathic pain
what is the most common adverse effect of gabapentin ?
somnolesence
what is the mechanism of action of pregabalin and what is the most common adverse effect ?
works the same as gabapentin and is associated with confusion and volume overload
first line therapy for the management of trigeminal neuralgia ?
carbamazepine
doses for TCA :
such as amitriptyline
starting dose at 10 mg at bedtime
increased to 25 mg after 3 to 7 days
then increased by 25 mg every 1 to 2 weeks
