palliative care and end of life Flashcards
(19 cards)
what is palliative care, goal and when to consider
the active total care of patients who disease is not responsive to curative treatment
- Goal: improving quality of life for those with serious illness
- used in combo with curative care at time of diagnosis of a potentially terminal illness
- used alone when attempts at cure is futile
what is hospice
philosophy and program that delivers palliative care, interdisciplinary
- end of life care
can be home, hospital, etc.
how does pt quality for hospice
medicare benefit
- prognosis of six months or less of life
what agents are in palliative care toolkit
- morphine liquid
- lorazepam or alprazolam (ODT)
- haloperidol
- Atropine
- Dexamethasone
- ondansterone ODT and metoclopramide
examples of gut wall n/v and treatment options 1st,2nd,3rd
- cytotoxic chem, intestinal distention, radiotherapy
- 1st: h2 antag or PPI
- 2nd: Metoclopramide
- 3rd: ondansetron
examples of postrema n/v and treatment options
- clonidine, chemo, morphine
- 1st: haloperidol, metoclopramide
- 2nd: add on dexamethasone
- 3rd: ondasetron + dexamethasone
examples of cerebal cortex n/v and treatment options
- fear/anxiety, intracranial pressure, hyponatremia
- 1st: dexamethasone
- 2nd: amitriptyline, haloperidol, lorazepam
- 3rd: free water, saline, haloperidol
vertigo n/v treatment options
1st: diphenydramine
2nd: meclizine
3rd: scopolamine
dyspnea treatment
1st: ipratropium/albuterol +/- dexa
2nd: morphine +/- dexa
3rd: morphine +/- chlorpromazine, diazepam or midazolam
opioids - start slow and go slow
*morphine mainstay
cough treatment
1st: treat underlying
2nd: promote production w/ nebulizer
3rd: suppress cough- morphine hydrocodone, dext
4th: nac
5th: nebulized lido
mixed anxiety and delirium
can use benzos for anxiety and haloperidol for delirium at the same time
constipation therapy
1st: stimulant (senna or bisacodyl) +/- docusate, fibers
2nd: sorbitol, lactulose, peg 3350
3rd: milk of mag
depression therapy
> 4 weeks of survival: escitalopram or sertraline
4 weeks of survival with pain : TCAs +/- methylphenidate
<4 weeks; step 3: methylphenidate, ketamine
insomnia treatment difficulty falling asleep
- trazodone or melatonin (sundowning/dementia)
- temazepam or zolpidem (bed bound)
insomnia difficulty staying asleep treatment
haloperidol
insomnia w/ depression treatment
mirtazepine or amitriptyline
xerostomia (dry mouth) treatment
- ice chips, gum, lemon drops
- saliva substitute
- pilocarpine
terminal secretions treatment
“death rattle”
atropine 1% PRN
scopolamine patch , glycopyrrolate
why dexa used so often ?
Multi therapeutic effects
minimal AEs
Multi routes of admin
wide therapeutic window
cost effective
convenient drug
dose response and favorable ceiling effect
