symptom mngmnt in end of life

Question 1

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

Answer 1

IM

Question 2

management in terms of life sustaining interventions

Answer 2

these are considered futile in end of life treatment

Question 3

how to manage in cases of accumulation of oropharyngeal secretions ?

Answer 3

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

Question 4

mngmnt in loss of ability to close eyes ?

Answer 4

maintain moisture with artificial tears

Question 5

management in terminal bleeding for end of life patients ?

Answer 5

provide anxiolytics
dark bed sheeting

Question 6

what is the maximum dose of acetaminophen in adults ?

Answer 6

3-4 g in 24 hours

Question 7

recommended dose of acetaminophen ?

Answer 7

<2.6 g

Question 8

most potent analgesic effect in bone pain, myofascial pain ?

Answer 8

NSAIDS

Question 9

what must be evaluated before the administration of NSAIDS?

Answer 9

CVDD, GIT and renal adverse effecst

Question 10

how to reduce the risk of GI bleeding with NSAIDS ?

Answer 10

using a combination of COX-2 inhibitors and PPI

Question 11

in what conditions should codeine be avoided ?

Answer 11

renal failure

Question 12

dose of codeine ?

Answer 12

15-30 mg every 4 to 6 hours

Question 13

what is the dose for dihydrocodeine ?

Answer 13

60-120 mg every 12 hours

Question 14

drug to help the adverse effects of opioid induced constipation ?

Answer 14

oxycodone and naloxone mixed together

Question 15

dos for oxycodone ?

Answer 15

5 mg every 4 hours

Question 16

what type of patients cannot take tramadol ?

Answer 16

patieents with history of seizures

Question 17

what is the mechanism of action of tramadol ?

Answer 17

serotonin and acetylcholine blocker

Question 18

what syndrome is associated with tramadol ?

Answer 18

serotonin syndrome

Question 19

where is morphine metabolized ?

Answer 19

in the kidneys , meetabolized into more potent form

Question 20

dose for morphine ?

Answer 20

5-10 mg every 4 hours

Question 21

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

Answer 21

hydromorphone
buprenorphine is also safe in renal failure
fentanyl

Question 22

what type of drug is buprenorphine ?

Answer 22

synthetic opioid analogue (partial agonist)

Question 23

what must be immediately done upon the administration of buprenorphine ?

Answer 23

all routine dosing of alternative opioids should be stopped

Question 24

what drug is reserved for opioid resistant patients ?

Answer 24

fentanyl andd methadone

Question 25

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

Answer 25

up to 1 day

Question 26

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

Answer 26

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

Question 27

what type of patients use methadone ?

Answer 27

end stage renal disease

Question 28

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

Answer 28

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

Question 29

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

Answer 29

prokinetic antiemetics (metoclopramide) or dopamine antagonists (haloperidol)

Question 30

what are thecontraindications to metoclopramide use ?

Answer 30

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

Question 31

most frequent adverse effect of opioids ?

Answer 31

constipation

Question 32

what other medications are required for opioid induced constipation ?

Answer 32

senna lactulose

Question 33

which opioids have minimally active metabolites ?

Answer 33

hydromorphone fentanyl buprenorphine

Question 34

what does opioid induced hyperalgesia commonly develop with ?

Answer 34

neurotoxicity

Question 35

how should opioid induced hyperalgesia bee managed ?

Answer 35

by reducing opioid dose by third or half

Question 36

how is neurotoxicity managed ?

Answer 36

by adequate hydration and reduction of opioid dose

Question 37

management of severe opioid overdose ?

Answer 37

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

Question 38

examples of co analgesics ?

Answer 38

antiepileptics tricyclic antidepressant biphosphonates

Question 39

examples of antiepileptic ?

Answer 39

gabapentin pregabalin carbamazepine

Question 40

when should gabapentin be used ?

Answer 40

neuropathic pain

Question 41

what is the most common adverse effect of gabapentin ?

Answer 41

somnolesence

Question 42

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

Answer 42

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

Question 43

first line therapy for the management of trigeminal neuralgia ?

Answer 43

carbamazepine

Question 44

doses for TCA :

Answer 44

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