palliative care and end of life Flashcards
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
