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Pharmacy > Y4 IC6 > Flashcards

Y4 IC6 Flashcards

1
Q

morphine excretion

A

active morphine-6-glucuronide is renally eliminated

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2
Q

considerations when changing short to long acting

A

add 50% to 100% of prn usage to ard the clock doses
rescue prn doses = 10%-20% daily opioid requirements

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3
Q

fentanyl pk

A

short half life but patches has longer - 72hrs

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4
Q

ketamine uses

A
  • anesthetic in OT
  • opioid hyperalgesia
  • reverse opioid tolerance(must reduce baseline when initiating by 50% or more) - its supercharges ur opioid
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5
Q

opioid tolerance

A

occurs when a person using opioid begins to experience a reduced response to medication, requiring more opioids to experience the same effect

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6
Q

ketamine ADR

A

hallucinations, insomnia, nightmares

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7
Q

opioid dependence

A

when the body adjusts its normal functioning around the regular opioid use.
unpleasant physical symptoms occur when medication is stopped

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8
Q

DDi of opioids

A

benzodiazepines and other CNS depressants

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9
Q

opioid addiction

A

oud - opioid use disorder
- when attempts to cut down or control use are unsuccessful or when use results in social problems
- generally comes after patient has developed tolerance and dependence, making it physically challenging to stop opioid use and increasing risk of withdrawal.

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10
Q

adjuvants for pain relief

A
  1. gaba acting anticonvulsants (gabapentin, pregabalin)
  2. SNRIs
  3. tramadol
  4. lidocaine patches
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11
Q

early palliative care benefits

A
  1. survival benefit
  2. improve qol, mood, depression score
  3. decrease proportion of aggressive EOL(ICU admission, intubation)
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12
Q

EOL syndromes

A
  1. Dyspnea
  2. secretions
  3. anorexia
  4. n/v
  5. constipation
  6. diarrhea
  7. delirium
  8. bowel obstruction
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13
Q

EOL syndromes: secretion

A

Glycopyrrolate, 0.2-0.4 mg IV or SC every 4 h PRN (less sedating)

Scopolamine, PRN/1.5-mg
patches, 1-2 patches every 72 h

Atropine, 1% ophthalmic solution 1-2 drops SL every 2 h PRN (caution in asthma),

Hyoscyamine, 0.125-0.25 mg PO or SL every 4 h with max dose of 1.5 mg daily

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14
Q

EOL syndromes: Dyspnea

A

Opioids in low doses, with titration as appropriate, can be used to treat dyspnea that is resistant to other therapies.
Base dosing on patient’s opioid requirement. If patient’s opioid requirement is unkhown, start with low doses and titrate up as appropriate.

Fluid overload: Furosemide, PRN dosing as per clinical situation

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15
Q

EOL syndromes: anorexic

A

Counsel family and patients about risks (eg, thrombosis), benefits, and options for cachexia treatment (eg, stopping
therapy if ineffective)

Gastroparesis (early satiety): Metoclopramide 5-10 mg PO QID 30 min before meals and QHS

Low/no appetite (avoid in setting of complete bowel obstruction):
Megestrol acetate, PO

Olanzapine, 2.5-5 mg/d PO

Dexamethasone 3-8 mg/d

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16
Q

EOL syndromes: aggitation/delirium

A

Mild/Moderate Delirium
Haloperidol, 0.5-2 mg PO BID/TID
Alternatives: Risperidone, 0.5-2 mg PO BID;
olanzapine, 5-20 mg PO daily; or
quetiapine fumarate, 25-200 mg PO/SL BID

Severe Delirium (agitation)
Haloperidol, 0.5-2 mg IV every 1-4 h PRN
Alternatives: Olanzapine, 2.5-7.5 mg PO/SL every 2-4 h PRN (maximum = 30 mg/d);

chlorpromazine, 25-100 mg PO/PR/ V every 4 h PRN for-patients who are bedbound.

For direct IV injection, administer diluted solution slow V at a rate not to exceed 1 mg/minute. To reduce the risk of hypotension, patients receiving IV chlorpromazine must remain lying down during and for 30 minutes after the injection.

17
Q

Opioids ADR

A
  1. constipation
  2. nausea
  3. pruritus
  4. delirium
  5. motor and cognitive impairment
  6. respiratory depression
  7. Sedation
18
Q

EOL syndromes: bowel obstructions

A
  • pancreatic enzymes + Sodium bicarbonate

Metoclopramide, 5-10 mg PO QID 30 min before meals an QHS; avoid in the setting of complete obstruction

Dexamethasone, 4-12 mg IV daily, discontinue if no improvement in 3-5 days

Scopolamine (patch or V); hyoscyamine, 0.125 mg PO/ODT/SL every 4 h PRN; glycopyrrolate, 0.2-0.4 mg IV every 4 h PRN

Octreotide, 100-300 mcg SC BID-TID or 10-40 mcg/h continuous SC/IV infusion; if prognosis >8 weeks, consider long acting release (LAR) or depot injection

19
Q

Opioid tolerant

A

more than 1 week of daily use
- at least 25mcg/hr of fentanyl patch
- at least 60mg of morphine
- at least 30mg of oxycodone
- at least 8mg of hydromorphone

20
Q

renally cleared opioids

A
  • morphine
  • codeine
  • hydromorphone
  • oxymorphone
  • hydrocodone
21
Q

transdermal fentanyl

A
  • use only in opioid tolerant
  • use only when well controlled pain
  • 8-12hr prior, may need other opioids, steady state after 2-3d
22
Q

methadone pk

A

long, variable 1/2 life: 15-120 hr
time to steady state: 5-7 days

23
Q

methadone uses

A

hyperalgesia
unrelieved with opioids
heroin detox
cost effective option

24
Q

ketamine MOA

A

noncompetitive NMDA receptor antagonist that block glutamate

Pharmacy (35 decks)

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