PHARMOCOLOGY Flashcards
(19 cards)
In most palliative care settings drug administration is preferred via what route? How should these drug be administered (strategy)? How is breakthrough pain managed?
oral
continuous dose not “as needed”
Provide 10-20% of Total dose as a supply of rapidly acting medication for breakthrough pain
As tolerance increases so should both the sustained release maintenance dose and the rapidly acting breakthrough dose. Use same med for both if possible.
How are opioids unlike NSAIDs in terms of maximum dose?
NSAIDs have a ceiling effects (max doses) whereas opioids can be used to relieve pain at whatever dose is helpful to the patient.
Your patient has not felt relief from the opioid prescribed what’s your next step? If you decide to switch medications how can you do so safely?
If they have little effect or if side effects are to great switch out the medicine using the equianalgesic chart and start them off at 50-75% the recommended dose.
What are some contraindicated drugs for cancer patients in pain and why?
merperidine-neurotoxic
mixed agonist/antagonist: nalbuphine and butorphanol (Kappa- no constipation or respiratory effects, but weak opioids with a celing).
A absent minded resident forgets to give prophylactic senna to a patient receiving high dose opioids, and the patient now has severe opioid induced constipation. What subcutaneous injection Rx do you need to correct the problem?
Methynaltrexone
You have a senior patient with FTT as a result of his new opioid medication. He must take this medication for his current illness. How can you use pharmacology to help stimulate his appetite?
High dose megestrol (progestin)
Oral dexamethasone
What can scopolamine be used for in a dying patient? What else can you use with a similar effect?
death rattle due to failure to clear respiratory secretions.
atropine eye drops sublingual
glycopyrrolate
What’s the purpose of adjuvant therapy; examples?
What Rx should you consider as adjuvant therapy for bone pain or neuropathic pain?
Provide relief to the patient in addition to the analgesic, like a sleeping pill or an anti-depressant.
bone pain-NSAID, corticosteroids, radiotherapy
neuropathic pain- antidepressants: amitriptyline, anticonvulsants: gabapentin.
Describe the WHO ladder for pain relief?
Ibuprofin Vicodin (acetomenophine + hydrocodone) Morphine, hydromorphone, oxycodone, fentanyl
NW is a 77 y/o man recovering from surgery and complications resulting from surgery. He took his last dose of pain medication (opioids) about 6-8 hrs ago and seems to be going through withdrawal symptoms. Is this man an addict?
No these are physical symptoms associated with withdrawal and not addiction; his body is just used to the drugs in his system. In fact seriously ill patients rarely get addicted to their pain medication.
What is benzodiazepine good for in pain management?
aniexty, dyspnea, but BAD for delirium
What is the best treatment for depression related to pain management?
Psychostimulants rapid days
SSRI weeks
TCA relative contraindication b/c side effects
How does the STOPP criteria help ID PIMS? what does it include?
STOPP is screening tool of older persons potentially inappropriate prescriptions/meds (PIMS)
Neuroleptics drugs, opiates, anti-cholenergics
Other than the normal affects of certain beer criteria drugs which increase fall risk, why are these drugs contraindicated in the elderly?
decreased renal function is likely to increase the effect of the drugs
CrCl is normally used to estimate GFR, why is this inaccurate in the elderly?
both numbers decrease giving the illusion of a normal value. the first Cr production is lower b/c decreased lean body mass (sarcopenia) so serum Cr is not accurate.
explain the use of eGFR and eCrCl in clinical practice
eGFR- used to stage renal failure use the CDK-EPI equation ml/min/1.73m2
eCrCl is used for dosing changes related to decreased renal function CG equation ml/min
what are the 7 steps of medication reconciliation?
list of meds accuracy reconcile and resolve discrepancies decision about meds optimizing care patient understanding documenting
What is shared accountability between health care professionals during med reconciliation?
Partnership in management, encourage patient to keep accurate med list that’s up to date, to use it as a reference and update with the provider as needed whether it be their primary or another.
How can you asses patient understanding concerning their medication list?
Use plain language, slow down, break up info into short statements, chunk and check, 5th grade reading level, communication aids, ask them to teach it back to you.
88% of elderly patients in the ER due to taking their meds improperly could have been reduced by patient education.
