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HPM Board Review > Symptoms > Flashcards

Symptoms Flashcards

1
Q

D2 antagonists, cat. 1A

A

more potent and longer acting: haloperidol* (though IV formulations maybe less likely to prolong QTc than orals), olanzapine, chlorpromazine (thorazine, not first-line agent due to risk of sedation).

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2
Q

D2 antagonists, cat. 1B

A

weaker/shorter acting: examples include prochlorperazine (compazine)

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3
Q

D2 antagonists, cat. 1C

A

Promotility: metoclopramide* is a promotility agent for gastroparesis. Use for 3 months or more is associated with a risk for tardive dyskinesia, particularly in patients with renal/hepatic impairment, diabetes, or who are older than 70.

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4
Q

Meds besides opioids that constipate

A

anticholinergics (tricyclic antidepressants, scopolamine, oxybutinin, promethazine, diphenhydramine), lithium, verapamil, bismuth, iron, aluminum, calcium salts.

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5
Q

When patients have multi-organ failure, some paralytics may not be cleared for

A

2-18 hours. If in doubt, utilize a peripheral nerve stimulator, ok to extubate when you see muscle twitches with 4 consecutive nerve stimulations.

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6
Q

itch is mediated by

A

unmylenated C fibers

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7
Q

drugs that cause pruritis

A

opioids, aspirin, drug reactions

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8
Q

More direct cooling agent than calamine or methol

A

EMLA cream, a mixture of lidocaine and prilocaine

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9
Q

Best medications for itch

A

combined H1 (classics, first and second gen)/H2 (lower stomach acid, like famotidine)
TCA like doxepin if refractory

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10
Q

Antidepressants for itch, paraneoplastic pruritis

A

paroxetine, mirtazapine

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11
Q

Antidepressants for itch, CKD pruritis

A

sertraline, amitriptyline, doxepin (another TCA)

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12
Q

Antidepressants for itch, cholestatic pruritis

A

sertraline

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13
Q

Ondanstreon and other 5HT3 antagonists treat pruritis caused by

A

opioids, cholestatis and renal disease

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14
Q

peristent versus intractable hiccups

A

peristent, longer than 48 hours; intractable, longer than 1 month

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15
Q

hiccup etiologies (10)

A

gastric or esophageal distention, corticosteroids, idiopathic, post-surgical, chemotherapy, cancer, myocardial infarction, liver disease, uremia, and CNS lesions

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16
Q

Hiccups non-pharm treatments

A

SSMI (deep deep breathing), HiccAway, breath-holing, hyperventilation, vagal stimulation, carotid massage, rubbing C5 to disrupt phrenic nerve

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17
Q

The only FDA approved drug for hiccups

A

Chlorpromazine (thorazine) 25mg-50mg PO TID or QID

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18
Q

Anticonvulsants for hiccups (4)

A

Gabapentin 300-400mg TID
Phenytoin (central hiccups), VAL, CARB

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19
Q

Baclofen for hiccups

A

the only drug RTC’d, 5mg Q8H, symptomatic relief despite continued hiccuping

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20
Q

Hiccups from stomach distention treatment

A

metacloprmide 10 q6h

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21
Q

Interventions for refractory hiccups (3)

A

acupuncture, diaphragmatic pacing electrodes, surgical ablation of the reflex arc

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22
Q

Kaolin and Pectin (Kaopectate) indication and time to effect

A

diarhhea, 48h, may impair absorbtion of meds

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23
Q

diphenoxylate

A

Lomotil, opioid that treats diarrhea, more BBB crossing so more side effects than Loperimide (Immodium)

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23
Q

Lopermide (imodium) class and mechanism

A

opioid, reduces peristalsis, increases water reabsorbtion, only weakly crosses BBB, max dose of 16mg per day, (54mg have been used)

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24
Q

Aspirin and Cholestyramine can reduce the diarrhea in

A

radiation enteritis. pysllium may also help

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25
Q

Mesalamine treats diarrhea in

A

IBD

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26
Q

Octreotide treats diarrhea in

A

HIV, chemo induced, high stoma volume (expensive and IV/SC infusion)

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27
Q

duration of “primary insomnia”

A

1 month

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28
Q

Benzos for insomnia

A

short term, improve sleep quality, total sleep time and fewer awakenings; high incidence of amnesia and rebound insomnia

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29
Q

Mechanism of Zolpidem and Zaleplon

A

Benzodiazepine receptor agonists. These are rapidly absorbed, metabolized by the liver, do not have active metabolites, have low abuse potential and do not cause rebound insomnia

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30
Q

atypical antipsychotics (quetiapine, olanzapine and ziprasidone) in insomnia

A

Most of the atypical antipsychotics (quetiapine, olanzapine and ziprasidone), except for risperidone, improve total sleep time and/or sleep efficiency in healthy subjects and schizophrenic patients. These may be beneficial in patients with insomnia who do not respond to front-line treatment or insomnia in medically ill patients with delirium.

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31
Q

Melatonin efficacy

A

not proven! but ramelteon has a short half life, reduces sleep latency and increases total sleep time in older adults with chronic insmonia

32
Q

Herbal remedies for insomnia

A

valerian, as effective as mild hypnotics. The major side effects are hepatotoxicity, cardiotoxicity and delirium. Evidence is lacking for other medications like kava kava, L-tryptophan, chamomile, St. John’s wort and Jamaican dogwood.

33
Q

deathe rattle prognosis

A

one study indicated the median time from onset of symptoms to death was 16 hours.

34
Q

meds that worsen death rattle

A

Medications which increase saliva production (e.g., pilocarpine, clozapine), mucosal irritation (e.g., doxycycline), or dose-dependent drooling as a medication side effect (e.g., clobazam).

35
Q

scopalomine time to onset

A

about 12h, 24h to steady state, lasts 72h

36
Q

glycopyrrolate PO time to onset

A

30min, lasts 2-4hours

37
Q

glycoprrolate IV time to onset

A

1 minute, lasts 7 hours

38
Q

atropine SL time to onset

A

30 min, lasts 2 hours

39
Q

Aerosolized N-acetylcysteine

A

reduce sputum viscosity to treat death rattle

40
Q

associated with myoclonus (7)

A

opioids, anticonvulsants (gabapentin, phenytoin, valproate, lamotrigine, and phenobarbitol), tricyclic antidepressants and selective serotonin reuptake inhibitors, contrast dye, anesthetics, antibiotics (penicillins, cephalosporins, imipenem, and quinolones), cannabinoids and the chemotherapeutic agent ifosfamide

41
Q

AEDs to treat myoclonus

A

benzos, LEV, valproate (note, valproate also causes myoclonus!)

42
Q

Dantrolene

A

is a msucle relaxant? may treat myoclonus

43
Q

5-fluoruracil, doxorubicin and methotrexate commonly cause

A

mucositis (vincristine does not)

44
Q

Timing of mucositis

A

1-2 weeks after RT, as soon as 3d after chemo

45
Q

prevention of RT-indcued mucositis in H/N cancers (4)

A

povidone iodine rinses; honey swish and spits administered before each radiation dose, daily zinc supplementation, and 5-15 grams of oral glutamine 2-3 times a day may help prevent mucositis.

46
Q

Shown in RTCs to reduce ucler rate and need for opioids in mucocitis

A

benzydamine (NSAID)

47
Q

diagnostic features of panic attack in a dying person

A

presence of derealization, depersonalization and fear of loss of control are more useful in making the diagnosis of panic disorder in the terminally ill.

48
Q

Panic attacks, prognosis of several weeks or more

A

Selective serotonin reuptake inhibitors (SSRI) either as monotherapy or augmented with low dose benzodiazepines for a period of 3 to 4 weeks (taper off benzodiazepines after 3 weeks)

49
Q

First line for thrush in PC setting

A

Clotrimazole

50
Q

Nystatin suspension in immunocompromised patients

A

much less effective than azoles!

51
Q

Guaifenesin mechanism

A

Expectorant! Guaifenesin acts by stimulating gastric mucosa and the gastric nerve to stimulate the cough reflex, and also induces a vagally mediated increase in airway secretion.

52
Q

Nebulizers for increased secretions

A

Hypertonic saline, elevated pH of secretions, weakening the saccharide bonds of the mucus. Additive with N-acetylcysteine (Mucomyst, severes glycoproteins); NOT GOOD in COPD (can trigger bronchospasm)

53
Q

Beta-adrenergic agonists and drugs containing aminophylline improve mucus clearance by

A

increasing ciliary activity

54
Q

most prevalent and disabling symptom of cancer

A

fatigue

55
Q

Exercise for cancer related fatgieu

A

Aerobic (low to mod) is ideal, resistance may help, 20-30min 3 days a week

56
Q

Methylphenyldate for cancer related fatigue

A

First line? improves fatigue for up to 5 hours as needed. avoid dosing after noon

57
Q

Modafinil for fatigue

A

pilots suggest efficacy in depression, MS, ALS, HIV

58
Q

Antidepressants for fatigue

A

Bupropion (4 weeks to benefit), Paroxetine (superior to methyphenidate, modafinil, works in weeks to months)

59
Q

Herbal/other remedies for fatigue

A

2000mg of genseng qd, acupunture

60
Q

meds causing dry mouth

A

antiemetics, antihistamines, antipsychotics, antispasmodics, antidepressants (especially the tricyclics), and bronchodilators, alpha-blockers (e.g. terazosin), alpha-2 agonists (e.g. clonidine), beta-blockers (e.g. metoprolol). Opioids and benzodiazepines cause dry mouth, although the mechanisms are not known.

61
Q

meds to treat dry mouth

A

candy with xylitol, vitamin c; cholinergic agonists like pilocarpine, cevimeline (contraindicated in asthma, narrow angle glaucoma; caution in COPD, cardiac dz)

62
Q

Non-opioid antitussives

A

don’t work! same as placebo. use expectorants (guaifenesin) and mucomyst/hypertonic saline

63
Q

opioids for cough

A

only effective central anti-tussive. suppress the brainstem cough center through mu and kappa opioid receptor agonism; codeine, dextromethorphan, hydrocodone; often compounded with guaf or antihistamines

64
Q

Tx complicated grief

A

CBT, group therapy , maybe SSRIs

65
Q

Prophylactic AEDs for seizure in brain tumor

A

Don’t work, can dc unless patient has had seziures.

66
Q

AEDs that can be given rectally

A

Phenobarbital, pentobarbital, carbamazepine, valproic acid, and lamotrigine (no dose adjustment needed)

67
Q

Aborting seizures at home

A

IN midazolam 0.2mg/kg. Rectal diazepam less preferred.

68
Q

SSRIs and P450 “2D6”

A

INHIBITORS! Paroxetine and fluoxetine are the strongest CYP2D6 inhibitors, followed, in order of decreasing potency of inhibition, by sertraline, citalopram, and venlafaxine

69
Q

Best D2 drugs to avoid EPS

A

Thorazine (chlorpromazine) has a lower risk than other older antipsychotics; quetiapine has lowest D2 receptor affinity; olanzapine is better than risperidone, aripiprazole.

70
Q

meds to treat EPS if you can’t rotate

A

mirtazapine, propranolol, clonidine, benadryl, benzos and benztropine

71
Q

Pain in post-herpetic neuralgia

A

gabapentin/pregabalin and TCAs, topical lidocaine. Opioids (short course) and magnesium are are second line

72
Q

drugs that cause urinary retention

A

antipsychotics, antihistamines, anti-emetics and antidepressants, opioids and anesthetics, alpha-agonists, benzodiazepines, NSAIDs, detrusor relaxants (e.g., oxybutynin), and calcium channel antagonists.

73
Q

Will naloxone and methylnaltrexone treat urinary retnetion?

A

Maybe

74
Q

methylnaltrexone cost, efficacy, contraindications and side effects

A

$55/dose, 50% within 4 hours, bowel obstrction, nausea, diarrhea and cramping

75
Q

Cancer patients most at risk for dysguesia (3)

A

Patients with head and neck cancer and those exposed to tyrosine kinase inhibitors or taxane based regimens

76
Q

medication for dysguesia

A

zinc 100-150mg daily, dronabinol 2.5mg BID or alpha lipoic acid

77
Q
A

HPM Board Review (5 decks)

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