HPM Flashcards
1
Q
side effects of megestrol
A
adrenal insufficiency
venous thromboembolism
androgen insufficiency
2
Q
what does MODS predict
A
predictor of mortality among ICU patients.
3
Q
what variables does MODS use
A
physiological variables (PaO2/ FIO2, plt count, bilirubin, (heart rate*CVP)/SBP, GCS, serum creatinine)
4
Q
what is most important parameter affecting mortality in MODS score
A
number of failing organs
5
Q
what is the leading cause of death from blood transfusions
A
TRALI
6
Q
prognosis of patients with HGb<3
A
median survival is 4-5 days
7
Q
familial adenomatous polyposis- what cancers are associated with it
A
papillary thyroid cancer, adrenal carcinomas, central nervous system tumors
8
Q
inherited pancreatic cancer= what also do they have increased risk of
A
2x likely to die of breast cancer
9
Q
chances of developing breast cancer from Peutz-Jeughers
A
54%
10
Q
hereditary conditions associated with increased risk of breast cancer
A
familial pancreatic cancer, cowden syndrome, peutx-jeghers syndrome, hereditary diffuse gastric cancer
11
Q
how to notify patient’s family of death if they are not present
A
over phone if >1 hour away, otherwise wait for in person
12
Q
how quickly should physicians tell family that a patient has died
A
important to get point out quickly- within 30 seconds to 2 mins of starting the conversation
13
Q
how does having an additional child affect grief of parents
A
associated with recovering from grief of losing a child
14
Q
what is best predictor of prognosis
A
functional status
pps 40%-> life expectancy <8 weeks
15
Q
how to calculate intrathecal morphine dose from oral morphine dose
A
Morphine: 10mg IV = 1mg Epidural = 0.1mg Intrathecal (1/10 ratio; very hydrophilic)
16
Q
which group has the lowest rates of hospice enrollment
A
asian and pacific islander
17
Q
what receptors are in the GI tract that are affected by opioids
A
mu receptors
18
Q
what type of opioid receptors are in the chemoreceptor trigger zone
A
mu opioids
19
Q
what causes hypotension, rash, and pruritis with morphine use
A
histamine release
20
Q
besides constipation, what is the other persisting effect of opioid use
A
miosis
21
Q
what drugs can be used with buproprion
A
SSRIS/SNRIS as the bupropion counteracts sex side effects
22
Q
what should you not take with bupropion
A
-MAOIS (wait 14 days or can cause htn)
-clozapine, theophylline, clomipramine because they lower seizure threshold
23
Q
three risk factors most highly associated with decrease in global function in children after death of a parent
A
- lower socioeconomic status
2.pre-exisiing psych factors - presence of a depressed surviving patient
24
Q
three mechanisms of methadone
A
- mu receptor agonist
- NMDA antagonist
- inhibitor of monoamine transmitter reuptake
25
TCA with best side effect profile
nortriptylline (also desipramine- secondary amines)
26
how do opioids affect respiratory depression
agonism of mu-opioid receptors in ventral medulla
27
when can children use number scale or visual analog scale for pain
>8 years old when they can understand abstract concepts
28
when can the faces scale be used in kids
>4 years old
29
how does buprenorphine work
mixed agonist-antagonist opioid receptor modulator with partial agonist at mu opioid receptors and opioid receptorlike receptors; antagonistic at kappa and delta opioid receptors
30
what medication interaction can dextromethorphan have
can cause serotonin syndrome
31
two central acting cough suppressants
opioids, gabapentin
32
what are the most common side effects of celiac plexus blocks
1. diarrhea
2. orthostatic hypotension (due to Inc parasympathatic tone, should volume resuscitate ahead of procedure)
33
can you have passive wishes for death in a normal grief reaction
yes, passive wishes are nomal, but more depression when it becomes SI and persistent
34
do all states have a next of kin rule
no
35
what is the most common cause of malignant cardiac effusion
lung cancer
36
where should intercostal nerve blocks be performed
under the rib to block nerve fibers associated with nociception
37
how to treat serotonin withdrawal
restart medication at prior dose and taper slowly
38
which herbal supplement has been shown to improve fatigue in patients with cancer
american ginseng
39
6-MAM is a unique metabolite of what substance
heroin
40
cisplatin- emetogenic risk
high
41
rituximab emetogenic risk
low
42
which anti-depressants don't interact with tamoxifen
venlafaxine and desvenlafaxine
43
minimum age you can use the FACES scale
age 4
44
what is the prognosis of metastatic osteosarcoma
spread only to lungs- 40% survival rate
spread anywhere else- 5yr survival rate drops from 15-30%
45
what can be used for severe cases of xerostomia
pilocarpine
46
what is oral bioavailability of morphine
10-45%
47
is bereaving loss of loved one to suicide increased risk of causing suicide
yes
48
how does gabapentin work
a2-delta calcium channels and inhibits voltage-dependent sodium channels
-acts peripherally and centrally
49
peak plasma concentrations of gabapentin
2-3 hours
50
difference between opioid and opiate
opiate- from natural opium poppy plant
51
what does prognostic performance index predict
predicts 3 week survival estimates for terminally ill cancer patients receiving palliative care only (not cancer directed therapy)
52
what does the PPI incorporate
PPS + four symptoms (oral intake, dyspnea at rest/severity, edema, delirium)
53
what does HIV neuropathy most commonly involve
the bilateral lower extremities
54
most common cause of death in crest syndrome
pulmonary hypertension or acute renal failure
55
what opioid has no clinically active metabolites
methadone
56
what is hydrocodone's active metabolite
hydromorphone
57
what percentage of people with chronic pain have MDD
15%, higher in pain clinicsw
58
what is the behavioral pain scale
pain scale for ventilated patients
59
what CBC findings are associated with poor prognosis is GBM
hgb<12
thrombocytosis
60
how do neonates metabolize morphine
protein binding is reduced and half life is increased
61
presentations of digoxin toxicity in elderly
nausea, anorexia, confusion
62
Most commonly used screen for complicated grief
inventory of complicated grief
63
cases in which dialysis should not be initiated
cirrhosis without possibility of tranpslant
metastatic cancer
severe CHF or endstage pulm disease
64
REMAP
REFRAME why status quo isn't working
EXPECT emotion
MAP out what's important
ALIGN with the patient's values
PLAN to match values
65
what is the metabolite of cariprosodol
meprobomate
66
what are findings of complex regional pain syndrome
vasomotor (skin color changes)
sudomotor (swelling)
trophic (hair loss)
sensory (allodynia)
67
what type of pain is complex regional pain
sympathetically mediated pain
68
what pain scale can be used in neonates
CRIES
69
what pain scale can be used in2mos to 7yo
FLACC
70
what percentage of patients with chronic conditions have an affective disorder
20-25%
71
what is the youngest age someone can get a PCA
6yo
72
what medications induce metabolism of methadone (CYP450 inducers)
CRAP GPS
Carbemazepines
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
73
CYP540 inhibitors that increase levels of methadone
SICKFACES.COM
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol & Grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
74
lab findings in tumor lysis
hypocalcemia
hyperphosphatemia
75
do more asians or hispanics enroll in hospice
more hispanics than asians
76
what causes overflow incontinence
impaired detrusor contractility or obstruction
77
antidepressant that causes weight loss
bupropion
78
scale used to track complicated grief
clinical global impression scale for complicated grief
79
two mid acting BZDs
lorazepam and temazepam
80
long acting BZDs
clonazepam, diazepam, amd flurazpeam
81
short acting BZD
alprazolam
82
what are phase one and two of metabolism of opioids
1. CYP450
2. glucoronidation
83
what causes respiratory depression from opioids
agonism of mu opioid receptors in brainstem regions
84
most common cause of infant mortality
congenital causes
85
MCC death in babies 1mo to 1 year
SIDS
86
is SIDS more common in boys or girls
boys
87
mormon faith beliefs after death
soul released from physical body and then gets united with a perfect body
88
step 2 WHO ladder
weak opioid like codeine or tramadol
89
step 3 WHO ladder
strong opioid- morphine, methadone, fentanyl
90
step 4 WHO
nerve block, epidural, PCA, spinal stimulator
91
compare loperamide vs diphenoxylate
loperamide crosses BBB much less than diphenoxylate
92
mortality of white vs black vs hispanic men
black men live 8 years less than white men and 6 years less than hispanic men
93
can jehovah parents refuse blood transfusions for their children
not in life threatening situation
94
non-selective NSAID that poses highest CV risk
diclofenac
95
how many patients can be in GIP and respite for a hospice
total inpatient days of GIP and respite cannot exceed 20% of total medicare days
96
when does most recovery after stroke take place
3-6 months after
97
define potency
amount of medication required to produce effect of a given intensity
98
where does superior hypogastric plexus block help with
helps with pain associated with cervical, rectal, bladder, and prostate cancer
99
ecog 0
no performance restrictions
100
ecog 1
moderate physical endurance but no strenous exercise
101
ecog 3
limited self care but spend >50% sitting
102
ecog 2
all self care and <50% sitting
103
ecog 4
bed to chair bound
104
most common psychiatric illness that cancer pateint develops
adjustment disorder
105
chronic cough is most commonly seen in what condition
head and neck cancer
2. lung cancer
106
most common type of incontinence elderly
urge incontinence
107
safest pde5
sildenafil
108
two most common cancers that result in anxiety
lung cancer, melanoma
109
mortality rate for ARDS alone
25%
110
mortality of aki alone +sepsis
35%
111
mortality rate of multi organ failure caused by sepsis
40-75%
112
what is the discriminant function
identifies patients who are likely todie from alcohol hepatitis
113
maddrey discriminant >32 is associated with what
high short term mortality rate
114
most common type of delirium
mixed
115
what is the withdrawal syndrome of tramadol
restlessness, headache, insomnia, diarreha
116
onset of action of tramadol
1 hour
117
what percentage of patients are receiving hospice care at the time of their death
45% in gen populpation (47.5% in medicare)
118
what percentage of patients will die one week into hospice admission
about 1/3
119
what does the meld score predict
3 month mortality in patietns 12+ years old in patients with cirrhosis, acute alcohol hepatitis
120
what does child pugh score predict
mortality in patients with cirrhosis
121
at what age should you get screening ecg for tca
50
122
what should be checked in citalopram doses >40mg/day
ECG
123
requirements for continuous home care
1. >8 hours care (provided by nurse, homemaker, or hospice aide)
2.>50% hours spent by RN, LPN
124
most important prognostic indicator for colon cancer
stage at diagnosis
125
dyspnea- first medication
opioid (unless test says there is wheezing on exam)
126
when would clonazepam withdrawal occur
1-2 weeks after stopping due to half life
127
what is fica screening tool
presence of FAITH
Importance of spirituality
Community
interventions to address spiritual needs
128
drugs most commonly cause extrapyrimidal syndrome
haldol, fluphanezine
129
what muscle relaxant has structure similar to TCA
flexeril
130
how does tizanidine work
central alpha-2 adrenergic receptor agnoist
131
baclofen MOA
GABA agonist
132
mechanism of clonidine
alpha 2 adrenergic receptor agonist
133
most significant risk factor for developing depression in a cancer patient
prior history of depression
134
what is included in childs pugh
albumin, INR, bilirubin, degree of ascites, encephalopathy
135
what is prognosis of stage IV gastric cancer, HCC, colon adenocarcinoma if left untreated
6 months
136
what is prognosis of stage IV small cell lung cancer that is not treated
2 months
137
wwhat has a better prognosis- small cell vs non small cell
non-small cell
138
treatment of choice for pruritis of unknown cause
gabapentin or paroxetine
139
prognosis of malignant hypercalcemia
8 weeks
140
prognosis of malignant pericardial effusion
8 to 12 weeks
141
prognosis of carcinomatous meningitis
8 to 12 weeks
142
prognosis of brain cancer without XRT
4-8 weeks
143
prognosis of brain cancer with XRT
12-24 weeks.
144
how pain is transmitted
transmission
conduction
transduction
perception
modulation
145
what are c fibers
small, unmyelinated, slow-conducting
146
what are a-delta fibers
large, myelinated, fast-conducting
147
where does transmission occur
1. injury site-> spinal cord
2. spinal cord-> brain stem & thalamus
3. thalamus-> cortex
148
age 2-6 understanding of death
death is reversible, death as punishment, wishful thinking
149
age 7-12 understanding of death
death is irreversible
150
normal ped BP
>70/40+ (2xyear)
151
how to dose opioids <6mo age
lower by 25% of usual weight-based childhood dose
152
why is neonatal metabolism slower
-immature liver
-slow kidneys
-inc water to fat ratio
-high perfusion of tissues
-decr albumin
-decr ventilatory response
153
one year mortality rate of pts who start dialysis
41% if greater than 75yo
20% for everyone else
154
what is a clinically significant change on a 0-10 scale
2 points
155
what does gangion impar block treat
pelvicpain
156
most common cause of svc syndrome
nsclc-> small cell-> NHL
157
Ca 19-9
Pancreatic cancer or colon cance
158
Ca-125
Ovarian cancer
159
Cea
GI, cervical, lung, ovarian
160
Cd 117
GI stromal tumor and seminoma
161
Anti depressants for pruritis from ckd
sertraline, amitriptyline, and doxepin
162
What is the best antidepressant to use with tamoxifen
Venlafaxine
163
Antidepressants that inhibit CYP2D6 and prevent tamoxifen from being converted into its active form
fluoxetine, paroxetine, bupropion
164
FEV that can be used for hospice
FEV<30%
165
What serum-ascites albumin <1.1 means
Likely malignant, won’t respond to diuretics
166
Serum to ascites albumin ratio >1.1 suggestive of
Portal hypertension, responds well to diuretics
167
how common are stillbirths
1% of deaths
168
what causes decreased pain control after long-term opioid use
1. increased neuronal activity in the dorsal horn
2. sensitization of primary afferent neurons
3. increased expression of substance P
169
C fibers
Small, unmyelinated, slow
170
What do C fibers conduct
Dull, pooorly localized pain
171
What type of pain do a fibers conduct
Sharp and localized pain
172
What role does lambic system play in pain
Emotional response
173
Reticular system and pain
Manages autonomic responses
