Amy's Palliative Nursing

Front 1

What category are these drugs?
Citalopram, Paroxetine, Fluoxetine, Sertraline

Back 1

Selective Serotonin Reuptake Inhibitors (anti-depressants)

Front 2

What are the trade names of these drugs?
Citalopram,Paroxetine, Fluoxetine, Sertraline

Back 2

Celexa, Paxil, Prozac/Serafem, Zoloft

Front 3

What is the starting dose for citalopram?

Back 3

10 to 20 mg daily to start

Front 4

What is the maximum daily does of citalopram?

Back 4

Maximum daily dose is 60 mg, although doses above 40 mg are not ordinarily recommended

Front 5

What can the sudden cessation of SSRI therapy when a patient is unable to swallow produce?

Back 5

withdrawyl syndrome

Front 6

DEAD SWAMP (mnemonic)

Back 6

(depressed mood, energy, anhedonia, death (thoughts of ), sleep, worthlessness/guilt, appetite, mentation, psychomotor).(17)

Front 7

What drug category is Venlafaxine?

Back 7

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Front 8

What is a trade name for venlafaxine?

Back 8

Effexor

Front 9

What is the initial does for venlafaxine?

Back 9

75mg per day

Front 10

What is the maintenance dose for venlafaxine?

Back 10

150-375mg/day

Front 11

What drug category is buprpion?

Back 11

Atypical Anti-depressant

Front 12

What is a trade name for bupropion?

Back 12

wellbutrin

Front 13

What patients is bupropion contraindicated for?

Back 13

Those with hx of seizure, or with seizure disorder, or on drugs that lower seizure threshold due to initial activating dose-related seizure inducing potential.

Front 14

What line of treatment is buproprion?

Back 14

3rd line

Front 15

What is the initial dose of buproprion?

Back 15

Initial: 100 mg per day

Front 16

What is the maintenance dose of buproprion?

Back 16

200 mg per day not to exceed 150 mg per dose

Front 17

What drug category is trazodone?

Back 17

Atypical Anti-depressant

Front 18

What patients should trazadone be given cautiously to?

Back 18

Those with orthostatic hypotension and those on antihypertensives as it may cause OH and syncope.

Front 19

What levels might be increased with concurrent trazodone use?

Back 19

Increased serum digoxin and phenytoin levels have been reported with concurrent trazodone use.(1,10)

Front 20

What is the initial dose for trazodone?

Back 20

25 to 50 mg daily in divided doses or in an evening single dose.

Front 21

What is the maintenance dose for trazodone?

Back 21

The dose may be increased slowly to a maximum of 300 mg daily in ambulatory patients and to 600 mg daily in hospitalized patients.

Front 22

What is a trade name for trazodone?

Back 22

Desyrel, Oleptro, Beneficat

Front 23

What is a trade name for mirtazapine?

Back 23

Remeron, Avanza, Zispin

Front 24

What drug category is mirtazapine?

Back 24

tetracyclic antidepressant

Front 25

Concurrent use of these ____+_____ opioids and SSRIs ____+_____ can therefore result in decreased pain control?

Back 25

oxycodone + codeine, paroxetine + fluoxetine

Front 26

Mirtazapine elimination is decreased in..........?

Back 26

elderly persons

Front 27

What is the initial dose of mirtazapine?

Back 27

Initial dose: 7.5 to 15 mg daily,

Front 28

What is the maintenance dose for mirtazapine?

Back 28

15 to 45 mg daily.

Front 29

What drug class is Methylphenidate?

Back 29

Psychostimulants

Front 30

What drug class is Dextroamphetamine?

Back 30

Psychostimulants

Front 31

What is a trade name for methylphenidate?

Back 31

Ritalin, Concerta, Metadate, or Methylin

Front 32

What is a trade name for Dextroamphetamine?

Back 32

Dexedrine and Dextrostat.

Front 33

When would psychostimulants be considered for palliative patients?

Back 33

when life expectancy may be short,(1, 5, 6, 8, 15) as these
drugs work within hours to days.

Front 34

What drug class often enhance opioid analgesia, reduce opioid sedation and improve appetite?

Back 34

psychostimulants

Front 35

What drug class can improve attention, concentration and overall performance?

Back 35

psychostimulants

Front 36

What are some side effects of psychostimulants?

Back 36

Side effects include agitation, confusion, insomnia, anxiety and paranoia

Front 37

What patients should psychostimulants be use in caution for?

Back 37

Use cautiously in the elderly, avoid in delirious patients(1) and underlying medical conditions that may be compromised by increases in blood pressure or heart rate such as pre-existing hypertension, heart failure, recent myocardial infarction,
or hyperthyroidism.(21)

Front 38

What is the initial dosing for methylphenidate?

Back 38

5 mg PO at 8 AM and noon or
2.5 mg b.i.d. in very frail patients

Front 39

What is the maintenance dose for methylphenidate?

Back 39

Increase 2.5 to 5 mg every 1 or 2 days until desired effect is reached, or to a maximum daily dose of 30 mg per day.(

Front 40

Why is methylphenidate not given after noon?

Back 40

Afternoon dosing can affect nighttime sleep and is generally not recommended

Front 41

What drug category is nortriptyline?

Back 41

tricyclic antidepressants

Front 42

What drug category is amitriptyline?

Back 42

tricyclic antidepressants

Front 43

What drug category is imipramine?

Back 43

tricyclic antidepressants

Front 44

What drug category is doxepin?

Back 44

tricyclic antidepressants

Front 45

What are some side effects of TCA's?

Back 45

Effects include sedation and anticholinergic effects; dry mouth, blurred vision, urinary hesitancy, or retention, constipation.

Front 46

What groups should TCA's be avoided for?

Back 46

patients with cardiac conduction delays, coronary artery disease, or history of myocardial infarction in past six months.

Front 47

When do the Adverse effects of TCA's usually decrease?

Back 47

3 to 4 days after initiation of a TCA or after increasing the dosage.

Front 48

What is the initial dosing for TCA's?

Back 48

Start at low doses (10 to 25 mg PO at bedtime)

Front 49

Onset of _____ effect may take 2 to 4 weeks.

Back 49

TCA

Front 50

______ may provide additional neuropathic pain benefits.

Back 50

tca's

Front 51

Terminal restlessness occurs in approximately what % of dying patients.

Back 51

42% to 62%

Front 52

Delirium occurs in approximately ____% of palliative care patients and ____% of advanced cancer patients.

Back 52

30% + 40%

Front 53

Terminal delirium reported in ___% of deaths.

Back 53

88%

Front 54

What are the 3 types of delirium?

Back 54

Hypoalert – hypoactive, often misdiagnosed as depression in the elderly
Hyperalert – hyperactive
Mixed type – with fluctuations
from hypoalert to hyperalert

Front 55

_________ isagitated delirium in a dying patient, frequently associated with impaired consciousness” and non-purposeful movement.

Back 55

Terminal restlessness

Front 56

Has an acute onset and can fluctuate and be preceded by subtle changes.

Back 56

delirium

Front 57

Delirium is reversible in approximately ____% of patients with advanced disease.

Back 57

50%

Front 58

T/F Delirium may not be reversible in the last 24 to 48 hours of life.(

Back 58

True

Front 59

Hallucinations often visual or tactile but not auditory (this is more common with schizophrenia) in a _________

Back 59

delirium

Front 60

T/F Patients may have comforting hallucinations – common in hypoactive delirium

Back 60

True

Front 61

T/F It is important to explain to the family that the symptoms are caused by the illness, are not within the patient’s control, will fluctuate and the patient is not going ‘insane’.

Back 61

True

Front 62

Tips for families caring for a delirious patient

Back 62

don't argue, give repeated assurance, be gentle and calming, provide well lit environment, limit visitors

Front 63

Watch for the_____effect (nocturnal confusion)(as it is often the ______symptom of early delirium.

Back 63

sun downing, 1st

Front 64

___________may paradoxically excite some patients and should be avoided unless the source of delirium is alcohol or sedative drug withdrawal, or when severe agitation is not controlled by the neuroleptic.Examples of neuroleptic drugs include haloperidol and methotrimeprazine.

Back 64

Benzodiazepines

Front 65

Examples of neuroleptic drugs include_______ and ________

Back 65

haloperidol +methotrimeprazine.

Front 66

Dexamethasone 16 to 36 mg PO daily in the morning may be given for__________

Back 66

suspected brain metastases in treated delirium (corticosteroid)

Front 67

Medication Used for Mild Restlessness

Back 67

Haloperidol 0.5 to 1.5 mg PO t.i.d.(3) The parenteral dose should be 50% of the oral dose.

Front 68

____________should be used as an adjunct only on a p.r.n basis only until the neuroleptic provides control.

Back 68

Lorazepam 1 to 2 mg S.C.

Front 69

Medication Used for Delirium and Agitation In Terminal Illness:Restless & Confused but Cooperative

Back 69

Haloperidol 1.5 to 5 mg PO or S.C. q4h to q8h. or
Methotrimeprazine 10 to 15 mg for mild and up to 50 mg for severe delirium q4h to q6h.

Front 70

Medication used for Delirium with Paranoia, Confusion and/or Aggression

Back 70

Haloperidol 10 mg S.C. or I.V. q30 to 60 min until relief then maintenance dose is 50% of amount to achieve control (usually between 1.5 to 20 mg per day divided into one to three doses).

Front 71

Medication used for Delirium with Paranoia, Confusion and/or Aggression

Back 71

Methotrimeprazine 10 to 50 mg S.C. q30min until relief then 10 to 50 mg PO or SL or S.C. q4h to q8h.

Front 72

Methotrimeprazine 10 to 50 mg S.C. q30min until relief then 10 to 50 mg PO or SL or S.C. q4h to q8h.

Back 72

Chlorpromazine 50 to 100 mg I.M. or rectally or I.V. q1h until relief then 12.5 to 50 mg PO or I.V. q4h to q12h

Front 73

Haloperidol 1.5 to 5 mg PO or S.C. q4h to q8h is given to a ___________patient

Back 73

Restless & Confused but Cooperative

Front 74

Methotrimeprazine 10 to 15 mg for mild and up to 50 mg for severe delirium q4h to q6h is given to a ___________patient

Back 74

Restless & Confused but Cooperative

Front 75

Haloperidol 10 mg S.C. or I.V. q30 to 60 min until relief then maintenance dose is 50% of amount to achieve control (usually between 1.5 to 20 mg per day divided into one to three doses) is given to a patient with a ____________

Back 75

delirium with paranoia, confusion and/or agression

Front 76

Methotrimeprazine 10 to 50 mg S.C. q30min until relief then 10 to 50 mg PO or SL or S.C. q4h to q8h

Back 76

delirium with paranoia, confusion and/or agression

Front 77

Chlorpromazine 50 to 100 mg I.M. or rectally or I.V. q1h until relief then 12.5 to 50 mg PO or I.V. q4h to q12h.(4)

Back 77

delirium with paranoia, confusion and/or agression

Front 78

What is the dose of haloperidol for a restless and confused but cooperative patient?

Back 78

1.5mg-5mg PO or SC q4-8h

Front 79

What is the dose of methotrimeprazine for a restless and confused but cooperative patient?

Back 79

10 to 15 mg for mild and up to 50 mg for severe delirium q4h to q6h.(3)

Front 80

What is a trade name for haloperidol?

Back 80

haldol

Front 81

What is a trade name for methotrimeprazine?

Back 81

Nosinan Nozinan, Levoprome

Front 82

What is the dose of haloperidol for a patient with a delirium with paranoia, confusion and/or aggresion?

Back 82

10 mg S.C. or I.V. q30 to 60 min until relief then maintenance dose is 50% of amount to achieve control (usually between 1.5 to 20 mg per day divided into one to three doses).

Front 83

What is the dose of methotrimeprazine for a patient with a delirium with paranoia, confusion and/or aggresion?

Back 83

10 to 50 mg S.C. q30min until relief then 10 to 50 mg PO or SL or S.C. q4h to q8h.(3)

Front 84

What is the dose of chlorpromazine for a patient with a delirium with paranoia, confusion and/or aggresion?

Back 84

50 to 100 mg I.M. or rectally or I.V. q1h until relief then 12.5 to 50 mg PO or I.V. q4h to q12h.

Front 85

What is a trade name for chlorpromazine?

Back 85

Largactil, thorazine