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Palliative care
Special Populations Exam 1
80
Pharmacology
Professional
02/18/2014

Additional Pharmacology Flashcards

 


 

Cards

Term
common symptoms of End-Stage
Definition
fatigue, anorexia-cachexia, constipations, N/V, delirium, dyspnea, pain
Term
confusion
Definition
anticholinergics, benzos
Term
depression
Definition
benzos, ETOH
Term
lack of appetite
Definition
SSRIs, other antidepressants
Term
weakness
Definition
antihistamines, B blockers, statins, benzos
Term
ataxia
Definition
benzos, anti-hypertensives
Term
constipation
Definition
anticholinergics
Term
urinary retention
Definition
anticholinergics
Term
hospice
Definition
a separate medical benefit
Term
to qualify for hospice
Definition
patient must have less than 6 months to live
Term
benefits of hospice
Definition
pay little/ nothing for med (which are directly provided), med orders based on protocol, allows rapid change in pain meds if needed
Term
hospice covers comfort care
Definition
not curative
Term
palliative care
Definition
patients may have terminal illness, focused on comfort care, BUT may have condition with which they could live for years
Term
severe COPD, painful conditions like compression fractures or rheumatoid arthritis
Definition
conditions where patients might live for years, but patient might need end of life care
Term
palliative care is not necessarily terminal
Definition
could still have curative focus even while providing comfort
Term
possible symptom management suggestions
Definition
appropriate meds, dosing and easiest route for patient
Term
loss of oral route
Definition
may be related to difficulty swallowing at end of life, potentially from severe nausea
Term
fentanyl
Definition
cannot be used if patient is opioid NAIVE
Term
appropriate initiation of fentanyl patch
Definition
patient must be taking at least 60 mg of morphine per day or equivalent for 25 mcg/hr patch
Term
fentanyl patch can still cause nausea
Definition
because nausea caused by opioid is a systemic effect
Term
fentanyl patch may be ineffective in cachectic patients
Definition
because in these patients there is LESS fat leading to less absorption
Term
cachexia
Definition
potential issue in cancer patients
Term
concentrated opioid solutions
Definition
small volume, easier to mix with food
Term
concentrated opioid solutions
Definition
can be placed under tongue and allow to be absorbed if patient is not eating at all
Term
concerns when using concentrated opioid solutions
Definition
MUST be careful with dosing, use dropper that comes with bottle, educate caregiver!
Term
suppositories
Definition
as needed/ short term basis due to dosing limitations and not easy route
Term
at home with ACUTE need may "make" suppositories
Definition
butter/ vaseline can be used with smaller oral tablets of oxycontin/ MS contin (ONLY do this other options are not available)
Term
IV/ SC parenteral routes
Definition
allow the most flexible dosing (easy adjustment)
Term
SC route preferred over IV rout
Definition
when at home because there is lower risk of infection
Term
disadvantage of SC route
Definition
volume limitations when doses are increased
Term
epidural or intrathecal route
Definition
useful if other methods not effective, more complicated procedure
Term
allow drug delivery to most localized area (trathecal/ epidural)
Definition
may provide better pain relief, reduces CNS side effects
Term
tolerance
Definition
patient can take more medication
Term
dependence
Definition
physical symptoms if the med is not taken
Term
addiction
Definition
taking drug becomes more important that the original benefit from it
Term
an addict takes a med to get away from life
Definition
someone seeking pain relief takes med to get on with life
Term
tube feeding
Definition
does not facilitate the healing of wounds or prevent pressure ulcers in end of life
Term
increased risk of aspiration, diarrhea and other complications
Definition
tube feeding
Term
TNF and other cytokines
Definition
contribute to wasting syndromes
Term
weight loss is common in end of life
Definition
and is to be expected
Term
food at end of life
Definition
less appealing, body is slowing down
Term
altered phisiology and body chemistry at end of life
Definition
mild sense of euphoria
Term
neither hungry
Definition
or thirsty
Term
eliminate dietary restrictions
Definition
and provide favorite foods, smaller and more frequent
Term
some potentially inappropriate meds for geriatrics
Definition
may become appropriate (anti-nausea); more worried about comfort than side effects
Term
haloperidol
Definition
sometimes used for severe nausea because it is a very strong dopamine blocker
Term
constipations
Definition
may be the cause of nausea especially as pain meds are increased
Term
promethazine, prochlorperazine
Definition
may make constipation worse especially if it is the cause of nausea
Term
delirium at end of life
Definition
may not need to treat hallucinations or behaviors; only an issue if at risk of harming self/ others
Term
no need to treat
Definition
pleasant hallucination
Term
confusion is normal
Definition
no need to start dementia meds
Term
can review for
Definition
unnecessary offending medications
Term
methadone
Definition
NMDA receptor antagonist properties, useful for allodynia
Term
allodynia
Definition
pain due to a stimulus that doesn't normally cause pain
Term
appropriate for patients with allodynia
Definition
methadone
Term
methadone can accumulate
Definition
must be dosed cautiously, not first line but might be useful for some cases
Term
meds for neuropathy
Definition
may also be helpful for allodynia
Term
ketamine
Definition
used in anethesia most commonly, also blocks NMDA; might be used for advanced allodynia cases
Term
inflammation can be cause of pain in bone metastases
Definition
glucocorticoids
Term
dexamethasone, prednisone
Definition
useful for pain caused by inflammation (bone metastases)
Term
bisphosphonates
Definition
might be useful for bone pain (high dose)
Term
NSAIDs
Definition
less effective than glucocorticoids, consider possible adverse reactions
Term
"air hunger"
Definition
subjective symptom of not being able to breath
Term
dyspnea in end of life
Definition
not necessarily associated with decreased O2 in bloodstream, may occur with progressive cancer and other conditions
Term
treatments of "air hunger"
Definition
oxygen, opioids, benzos are most common
Term
in terminal dyspnea, respiratory center
Definition
is like a thermostat that keeps heat pumping out when temp is already too hot
Term
opioids and benzos
Definition
may calm respiratory center down
Term
with hyperactivity of respiratory center you have
Definition
DECREASED risk of respiratory suppression, as long as doses are appropriate
Term
oral rout
Definition
easiest for opioids/ benzos for respiratory hyperactivity
Term
nebulized opioids
Definition
not always effective in trials but often works in practice
Term
benefits of nebulized opioids
Definition
may be related to Mu receptors in lungs
Term
bronchospasm
Definition
may be caused by nebulized opioid
Term
best option for nebulized opioid
Definition
preservative-free intravenous opioid often used to prevent sensitivity
Term
benzo of choice
Definition
lroazepam oral, can be sublingual (can give IV via neb)
Term
lorazepam
Definition
more predictable half-life
Term
opioids and benzos can be used together
Definition
if added benefit seems to be helpful
Term
suction for oral secretions
Definition
extremely uncomfortable and rarely necessary at end of life
Term
if oral secretions are uncomfortable for the patient
Definition
anticholinergics can help
Term
atropine eye drops
Definition
often preferred because a low dose can be used for unwanted oral secretions
Term
methylphenidate
Definition
stimulant that might be helpful for drowsiness/fatigue from opioids or other treatments
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