HPM Random Facts Review Flashcards
(48 cards)
What should you always consider for first line pharmacotherapy of delirium?
Consider antipsychotic Haloperidol
For delirium should meds be routine or prn?
PRN!
What other drugs do we consider for escalating delirium, not responding to antipsychotics in patients who are a risk to themselves or others?
Rescue doses of midazolam or lorazepam in addition to antipsychotic
What med do you use in Lewy Body Dementia and Delirium ?
Quetiapine, low dose prn q4hrs
what are imaging signs of pneumonitis?
similar to pna, new focal airspace opacities
how can pneumonitis present clinically?
dry cough, SOB, likely afebrile
If pneumonitis is suspected, what is the work up or plan of care?
work up should be bronchoscopy with bronchoalveolar lavage to rule out infection, then treat with steroids
what symptoms of SVC are emergent requiring immediate surgical/XRT intervention for stent placement or radiation therapy?
AMS from cerebral edema, and stridor from central airway obstruction.
When do you consider a catheter for malignant pleural effusion?
Rapid filling in < 1 week
When are recurrent thoracentesis okay?
Slow fill > 1 month
Life span < 3 months
Low Performance Status
What do you use for relief of dyspnea in patients with advanced terminal disease?
Systemic opioids - optimally long acting with any break through controlled with short acting narcotics
what are risks for aspiration pneumonia
dysphagia, choking, coughing, excessive sedation, OSA with obesity compromising glottis closure or cough reflex during sleep
How does Heliox work?
Decrease turbulent air flow, therefore decreases airway resistance, and makes less work of breath!
Remember it’s temporary!
Name 4 steps to approaching hemoptysis management
- Locate the bleed
- Reverse any coagulopathy
- Bronchoscopy with interventions (ice saline, balloon tamponade, topical vasoconstrictor such as epi)
- if bronch fails, IR embolization/surgery
when can you not use Non invasive positive pressure ventilation?
if the patient is confused or obtunded
When should you use direct thrombolysis for a PE?
If patient is unstable, or has right heart strain
Which anticoagulation is perferred for active cancer and thromboembolism?
LMWH preferred over coumadin
in constipation in the cancer patient with bone mets what is the first step?
look for underlying cause, RULE OUT hypercalcemia prior to assuming OIC or treating.
When do you avoid bulk fiber?
If poor oral intake and or history/risk of fecal impaction
When is methylnaltrexone contraindicated?
If obstruction suspected, or for patients with any compromise of bowel integrity such as prior bowel obx.
what is a bad side effect of methylnaltrexone?
bowel perforation
what is the mechanism of methylnaltrexone?
Opioid antagonist that targets the mu receptors of the GI tract without crossing blood brain barrier or impairing analgesia by opioids.
What type of agents are the following:
- Psyllium
- senna and bisacodyl
- docusate sodium
- Bulk forming agents
- increase intestinal peristalsis and secretions
- soften stool by increasing water penetration
What is the best treatment for hypercalcemia
>14?
- IVF with (0.9% NaCl)
- Calcitonin
- Zoledronic acid
