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PHM 704: gremlins and wizards > Witches and Wizards: Palliative Care > Flashcards

Witches and Wizards: Palliative Care Flashcards

1
Q

hospice qualifiaton

A
  • Medicare benefit: termina illness with a prognosis of 6 mo or less as certified by the attending md and the hospice medical director
  • hospice is provided under
    • medicare part a
    • private/public/gov health ins
    • edicai
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2
Q

hospice vs palliative care

A
  • palliative: improving qol of those with serious illness
    • does not require terminal dx
    • does not forgo curative therapy
  • hospice: focuses primarily on comfort care
    • may be life sustaining but NOT curative
    • pt prognosis < 6 months
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3
Q

desirable proeprites in medications used in end of lfe care

portmantaeu drugs

A
  1. multiple tpx effects
  2. minimal adr
  3. multiple roa
  4. wide tpx window
  5. cost effective
  6. conienent dosing
  7. dose response and favorable ceiling effect
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4
Q

portmanteau drugs examples

A
  • morphine liqd
    • metahdoe liqd
    • hydromorphone liqd
    • oxy liqd
  • lorazepam concentrate
  • alprazolam liqd (lil expensive tho)
  • haloperidol
  • atropine gtts
  • dexamethasone liqd
  • ondansetron odt (lil expensive tho)
  • metoclopramide ODT (lil expensive tho)
  • metoclopramide liqd
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5
Q

intensol

A

concentrated liqd (like morphine liqd, lorazepam concentrate)

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6
Q

gut wall n/v end of lfie causes and treatment

A

gastrtis, chemo, intestinal distention
1. H2RA or PPI
2. metoclopramide
3. zofran

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7
Q

med induced N/V (area postrema) end of life treatment

A
  1. haloperidol or metoclopramide
  2. || + dexamethasone
  3. zofran + dexamethasone
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8
Q

cerebral cortex (fear/anx, hyponatremia) N/V end of life treatment

A
  1. dexamethasone
  2. amitriptyline or haloperidol or lorazepam
  3. limit free water +/- 3% saline +/- haloperidol
    - esp if hyponatremia
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9
Q

vertigo end of life treatment

A
  1. diphenhydramine or dimenhydrinate
  2. meclizine or cyclizine
  3. glycopyrrolate or scopolamine
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10
Q

dyspnea end of life treatment

A
  1. targeted therapy
  2. duoneb +/- dexamethasone
  3. morphine (or any opioid) +/- dexamethasone
  4. morphine + (chlorpromazine or diazepam or midazolam)
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11
Q

dyspnea: targeted treatment - tumor

A

radiotherapy

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12
Q

dyspnea: targeted treatment - carcinomatous lymmphangitis

A

steroids

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13
Q

dyspnea: targeted treatment - bronchospasm

A

bronchodilators

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14
Q

dyspnea: targeted treatment - cardiac falure

A

diuretcis

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15
Q

dyspnea: targeted treatment - chest infection

A

abx +/- physoitherapy

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16
Q

dyspnea: targeted treatment - pleural effusions

A

aspiration

17
Q

dyspnea: targeted treatment - ascites

A

paracenteiss and maybe diuretcs

18
Q

dyspnea: targeted treatment - anemia

A

transfusion

19
Q

s/s of bowel obstruction

A
  • early satiety
  • constpation
  • bloating
  • ileus with n/v (intractable)
20
Q

cough end of life treatment

A
  1. treat underlying cause
  2. prmote production (neb saline and/or mucinex)
  3. supress cough (morphine, hydrocodone, dextromethorphan)
  4. dexamethasone or glycopyrroltae/atropine; NAC
  5. nebulized lidocaine, gabapentin, others

if using neb NAC, give bronchodilator prior (duoneb)

21
Q

anx end of life treatment

A
  1. non-pharm
  2. short term (lorazepam, alprazolam, amitriptyline)
  3. longterm (buspar, ssri, mirtazepine)

end of life = bad organ -> increased half life and [ ] -> short actiing better (lorazepam)

22
Q

delirium end of life treatmet

A
  1. haloperidol
  2. haloperidol + lorazepam (sedaton)
  3. haloparidol + (midazolam or chlorporamie) for agitatio in terminal stages
23
Q

depresson end of lfie treatment

A
  • > 4 weeks survival: (lexapro or zoloft) +/- methylphendiate (until SSRI effective)
  • > 4 weeks survival with other s/s: (amitriptyline or nortriptyline) +/- methylphenidate
  • < 4 weeks: methylphendiate (maybe ketamine)
24
Q

constipatio prevention end of life treatment

A
  1. if opioid: senna or bisacodyl +/- docusate +/- metoclopramide
    1. if aging or disease induced: fiber, fluids, docsate
  2. sorbitol, lactulose, PEG
  3. MOM, mag citrate, bisacodyl supp
25
Q

acute constipation end of lfie treamtnet

A
  1. stimulant laxative (bisacodyl or senna)
  2. double dose
  3. osmotic laxtive (sorbitol)
  4. MOM
  5. bisacodyl suppository then enema in 2H (repeat QD for 3 day)
  6. pheripheral acting mu opoid reeptor antag, naloxegol, methylnaltrexone
  7. nuclear enema
26
Q

underlying causes of anorexia-cachexia

A
  • anx
  • depression
  • n/v
  • stomatitis
  • constiaptin
  • dysphagia
  • pain
27
Q

bowel obstruction end of life treatment

A
  1. metoclopramide +/- dexamethasone IF it is NOT a complete obstrution because it will try to push poo through
  2. glycopyrrolate +/- morphine +/- haloperidol
  3. octreotide +/- above
  4. PEG tube or stent

bowel obstruction: too much secretion into bowels that cant excrete -> vomit it up (octreotide reduces these secretios)

28
Q

anorexia-cachexia end of life treatment

A
  1. treat underlying cause
  2. early saity, dysmotility, gastroparesis: metoclopramide
  3. appetite loss, wt loss
    • survival < 3 months: dexamethasone
    • surivival > 3 months: mirtazepine or megestrol
  4. dronabinol
29
Q

insomnia end of lfie treatment

A
  1. ftreat underlying cause
  2. cause dependent
    • difficult iniating sleep
      • trazadone or melatonin (esp in sundowning or dementia)
      • temazepam or zolpidem (bed ound)
    • difficulty staying asleep (disturbing dreams): haloperidol
    • conmitat depression: mirtazapine or amitriptyline
  3. increase doses, try combos
    • substitue midazolam or high dose lorazepam (NOT to exceed 7 days)
30
Q

xerostomia end of life treatment

A
  1. ice chips, gum, lemon drops
  2. saliva substitite
  3. pilocarpine
31
Q

terminal secretions treatment

A

atrpine 2-3 sl gtts q2h prn (used for death rattle - normal saliva production but not draining)
- scopolomine patch
- glycopyrrolate

32
Q

palliative sedation agents

A
  • opioids
  • benzos
  • neuroletptic
  • barbitutes
  • anesthetics

or combo of above

PHM 704: gremlins and wizards (16 decks)

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