Hospice and Palliative Medicine Flashcards
(112 cards)
1
Q
Constant, dull, aching, localized, changing with movement pain
A
Somatic
2
Q
Deep, aching, cramping, poorly localized pain
A
Visceral
3
Q
Burning, shooting, tingling, or shock-like pain
A
Neuropathic
4
Q
Pain levels expected to interfere with function and sleep
A
Moderate (4-6/10) or greater
5
Q
Pain levels expected to interfere with concentration
A
Severe (7-10)
6
Q
Opioid selection in renal insufficiency?
A
Fentanyl and methadone
7
Q
Opioid selection in hepatic insufficiency?
A
Fentanyl, hydromorphone, oxycodone, and methadone with caution
8
Q
Methadone receptor profile
A
Mu and delta receptor agonist, NMDA receptor antagonist
9
Q
Methadone re: serotonin
A
Inhibits reuptake
10
Q
Methadone re: norepinephrine
A
Inhibits reuptake
11
Q
Methadone Absorption
A
Lipophilic, Through the stomach, No transdermal application
12
Q
Methadone Metabolism
A
Hepatic, with no known active metabolites
13
Q
Methadone Elimination
A
Fecal
14
Q
Methadone EKG effects
A
QT prolongation
15
Q
Nociceptive Pain Mechanism
A
stimulation of intact pain receptors and transmission along normal nerves
16
Q
Nociceptive Pain Prevalence
A
Most common type of pain
17
Q
Nociceptive Pain Quality
A
aching, throbbing, sharp
18
Q
Nociceptive Pain Examples
A
arthritis, myofascial pain
19
Q
Neuropathic Pain Mechanism
A
injury to or disease of peripheral or central nerves
20
Q
Neuropathic Pain Prevalence
A
Less common and often more difficult to treat
21
Q
Neuropathic Pain Quality
A
tingling, burning, electrical, lancinating
22
Q
Neuropathic Pain Examples
A
postherpetic neuralgia, diabetic neuropathy, complex regional syndromes
23
Q
The only valid measure of pain is…
A
Self-report
24
Q
% elderly with chronic pain?
A
70-80%
25
% elderly with constant pain?
30%
26
% of elderly with constant pain with regular pain medication available?
less than 1/3 (33%)
27
Verbal Agitation
High association with pain or other physical symptoms
28
PQRST of Pain History "P"
Palliative or Precipitating factors
29
PQRST of Pain History "Q"
Quality of life impact
30
PQRST of Pain History "R"
Radiation/distribution
31
PQRST of Pain History "S"
Severity
32
PQRST of Pain History "T"
Temporal patterns
33
piper methysticum (Kava Extract)
Effective in treating anxiety, causes Hepatotoxicity
34
Cognitive Behavioral Therapy
Best risk/benefit ratio for insomnia. Better than relaxation techniques.
35
Opioid Induced Neuroexcitability Symptoms
Increased Agitation, Hyperalgesia, Agitation
36
Aspiration pneumonia
Most common mechanism of death in dementia
37
Opioid Related Nausea
Try antiemetics, then rotate opioids
38
Complication from Transjugular Intrahepatic Portosystemic Shunt
Encephalopathy
39
Absence of pupillary or corneal response
High predictor of mortality in comatose patients
40
Malignant Spinal Cord Compression Diagnosis
MRI for patient with worsening back pain
41
Malignant Spinal Cord Compression Treatment
Surgery followed by radiation
42
Have opioids or benzos been shown to hasten death?
No
43
Management of Hiccups
Gabapentin
44
Accupuncture
Effective in Pain Management
45
Antihypertensive associated with constipation
Verapamil
46
Fee for service Medicare
Less likely to be referred to hospice
47
Prevents burnout
Activities that enhance mindfulness
48
Continue antibiotics
May be compatible with comfort only care
49
Agitated Delirium Treatment
Chlorpromazine
50
Status Epilepticus treatment without IV access
Midazolam
51
Treatment of myoclonus and seizures related to uremia
benzodiazepines
52
Manage secretions and minimize delirium
glycopyrrolate
53
Does not improve survival after elective extubation
BiPAP
54
Immediate intervention for SVC syndrome
Endovascular stent
55
Metabolic abnormalities cause nausea by stimulating this
Chemoreceptor Trigger Zone
56
Sensory input, anxiety, meningeal irritation, and increased ICP cause nausea by stimulating this
Cerebral Cortex
57
Helpful pain assessment dimension
Temporal pattern-pain fluctuations
58
Prognosis after electively stopping dialysis
7 to 9 days
59
Mortality after intracerebral hemorrhage
50%
60
Meaningful recovery after intracerebral hemorrhage survival
20%
61
Noninvasive treatment of pruritis in end stage liver disease
Naltrexone
62
Prognosis for independent functional recovery in myoclonus status epilepticus after circulatory arrest
1%
63
"Wind-up" pain is mediated by
NMDA receptors in the dorsal horn of the spinal cord
64
Most distressing symptoms to parents of dying children
low energy and decreased consciousness
65
Olanzapine method of action
Blocking dopamine receptors in the CTZ
66
Olanzapine trade name
Zyprexa
67
Useful complementary therapy for pain, anxiety, and fatigue and may improve quality of life
Massage Therapy
68
Common side effect of Ketamine
Psychomimetic symptoms
69
Acute fluctuating pattern and inattention
Delirium
70
Useful in treatment of odor in wounds with superficial anaerobic infection
Metronidazole
71
Cause of early satiety in cancer patients
Neuroendocrine alterations
72
Symptoms of systemic seratonin syndrome
Mental status changes, autonomic dysfunction, neuromuscular hyperactivity
73
Relative potency - Morphine (IV) : Morphine (PO)
3:01
74
Relative potency - Morphine (PO) : Oxycodone (PO)
3:02
75
Relative potency - Morphine (PO) : Hydrocodone (PO)
1:01
76
Relative potency - Morphine (PO) : Hydromorphone
4:01
77
Oral daily Morphine dose 60 to 134 mg
Transdermal Fentanyl 25 mcg/hour
78
Oral daily Morphine dose 135 to 224 mg
Transdermal Fentanyl 50 mcg/hour
79
Oral daily Morphine dose 225 to 314 mg
Transdermal Fentanyl 75 mcg/hour
80
Hopelessness
Frequently associated with requests for hastened death
81
Faster onset than typical oral opioids
Fentanyl buccal lozenge
82
Act at the NMDA receptor
Methadone, ketamine
83
Three major classes of opioid receptors
Mu, kappa, and delta
84
Mechanism of opioid action
Bind to receptors that inhibit calcium channels and prevent or induce the release of neurotransmitters
85
Preferred bowel regimen for opioid naive patient
Senna and docusate
86
The four components of total pain
Physical, emotional, social, spiritual
87
Unreliable markers for chronic and subacute pain
Physiologic signs of acute pain such as pulse and blood pressure
88
Meaningful pain relief with intolerable side effects from oral opioid therapy
Indication for neuraxial opioid infusion
89
Symptoms of opioid induced hypogonadism
Fatigue, erectile dysfunction, and depressed mood
90
Confer higher risk for future aberrant drug use
Psychiatric illness, personal or FHx of alcohol or drug abuse
91
causes of cortical nausea
CNS tumors, increased ICP, anxiety, uncontrolled pain
92
Have best evidence for use in delayed chemotherapy-induced nausea and vomiting
Ondansetron and aprepitant
93
Antineurokinin antiemetic
Aprepitant
94
Helpful in management of hypoactive delirium or apathy
Methylphenidate
95
First line treatment of nonspecific dyspnea in patients with advanced disease
Opioids
96
Always associated with opioid induced respiratory depression
Sedation
97
Frequently found in men with cancer cachexia
Hypogonadism
98
Effective short-term treatment of malignant colorectal obstruction
Self expanding metal stents
99
Opioid Induced Neuroexcitability Treatment
Rotate Opioids, add benzos
100
Changes prognosis in pts with advanced dementia with aspiration pneumonia
Nothing
101
Generic Percocet
Oxycodone/Acetominophen brand name
102
Generic Dilaudid
Hydromorphone brand name
103
Generic Vicodin
Hydrocodone/Acetominophen brand name
104
Generic Oxyfast, Oxycontin, Oxy IR
Oxycodone brand name
105
Generic MS Contin, MS IR
Morphine Sulfate brand name
106
ACC/AHA Stage C Heart Failure
Prior or current symptoms of heart failure
107
ACC/AHA Stage D Heart Failure
Refractory heart failure requiring specialized interventions
108
Lung volume reduction surgery outcome
Improved lung function, exercise capacity, and QOL
109
"B" in the BODE index
Body Mass Index
110
"O" in the BODE index
airway Obstruction (FEV1)
111
"D" in the BODE index
Dyspnea (MMRC dyspnea index)
112
"E" in the BODE index
Exercise tolerance measured by 6 minute walk
