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OPEC > symptom mngmnt in end of life > Flashcards

symptom mngmnt in end of life Flashcards

1
Q

what method of administration of drugs should be avoided in end of life patients ?

A

IM

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2
Q

management in terms of life sustaining interventions

A

these are considered futile in end of life treatment

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3
Q

how to manage in cases of accumulation of oropharyngeal secretions ?

A

occurs due to lack of gag reflex
first try postural drainage and repositioning
no response ? hyoscine butylbromide

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4
Q

mngmnt in loss of ability to close eyes ?

A

maintain moisture with artificial tears

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5
Q

management in terminal bleeding for end of life patients ?

A

provide anxiolytics
dark bed sheeting

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6
Q

what is the maximum dose of acetaminophen in adults ?

A

3-4 g in 24 hours

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7
Q

recommended dose of acetaminophen ?

A

<2.6 g

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8
Q

most potent analgesic effect in bone pain, myofascial pain ?

A

NSAIDS

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9
Q

what must be evaluated before the administration of NSAIDS?

A

CVDD, GIT and renal adverse effecst

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10
Q

how to reduce the risk of GI bleeding with NSAIDS ?

A

using a combination of COX-2 inhibitors and PPI

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11
Q

in what conditions should codeine be avoided ?

A

renal failure

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12
Q

dose of codeine ?

A

15-30 mg every 4 to 6 hours

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13
Q

what is the dose for dihydrocodeine ?

A

60-120 mg every 12 hours

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14
Q

drug to help the adverse effects of opioid induced constipation ?

A

oxycodone and naloxone mixed together

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15
Q

dos for oxycodone ?

A

5 mg every 4 hours

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16
Q

what type of patients cannot take tramadol ?

A

patieents with history of seizures

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17
Q

what is the mechanism of action of tramadol ?

A

serotonin and acetylcholine blocker

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18
Q

what syndrome is associated with tramadol ?

A

serotonin syndrome

19
Q

where is morphine metabolized ?

A

in the kidneys , meetabolized into more potent form

20
Q

dose for morphine ?

A

5-10 mg every 4 hours

21
Q

patients who cant use morphine due to renal insufficiency , what can be used instead ?

A

hydromorphone
buprenorphine is also safe in renal failure
fentanyl

22
Q

what type of drug is buprenorphine ?

A

synthetic opioid analogue (partial agonist)

23
Q

what must be immediately done upon the administration of buprenorphine ?

A

all routine dosing of alternative opioids should be stopped

24
Q

what drug is reserved for opioid resistant patients ?

A

fentanyl andd methadone

25
Q

how long does fentanyl stay in the blood after removal of the patch ?

A

up to 1 day

26
Q

what must be done in regards to fentanyl use in critically ill patients ?

A

transdermal patches to be converted directly to IV i a 1:1 ratio

27
Q

what type of patients use methadone ?

A

end stage renal disease

28
Q

what is thee management in cases of worsening or increased somnolence ?

A

decrease opioid dose to the lowest pain control level
may also be an indication to switch the type of opioid

29
Q

what is the best management for opioid induced nausea and vomiting ?

A

prokinetic antiemetics (metoclopramide) or dopamine antagonists (haloperidol)

30
Q

what are thecontraindications to metoclopramide use ?

A

it should not be used with anticholinergics or in patients with colic or complete bowel obstruction

31
Q

most frequent adverse effect of opioids ?

A

constipation

32
Q

what other medications are required for opioid induced constipation ?

A

senna
lactulose

33
Q

which opioids have minimally active metabolites ?

A

hydromorphone
fentanyl
buprenorphine

34
Q

what does opioid induced hyperalgesia commonly develop with ?

A

neurotoxicity

35
Q

how should opioid induced hyperalgesia bee managed ?

A

by reducing opioid dose by third or half

36
Q

how is neurotoxicity managed ?

A

by adequate hydration and reduction of opioid dose

37
Q

management of severe opioid overdose ?

A

0.4 to 1 mg of naloxone , usually need a continuous infusion

38
Q

examples of co analgesics ?

A

antiepileptics
tricyclic antidepressant
biphosphonates

39
Q

examples of antiepileptic ?

A

gabapentin
pregabalin
carbamazepine

40
Q

when should gabapentin be used ?

A

neuropathic pain

41
Q

what is the most common adverse effect of gabapentin ?

A

somnolesence

42
Q

what is the mechanism of action of pregabalin and what is the most common adverse effect ?

A

works the same as gabapentin and is associated with confusion and volume overload

43
Q

first line therapy for the management of trigeminal neuralgia ?

A

carbamazepine

44
Q

doses for TCA :

A

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

OPEC (24 decks)

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