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26 Cards in this Set
- Front
- Back
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Name 6 end-of-life symptoms:
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Pain
Dyspnea Fatigue Anorexia/cachexia Nausea & vomiting Anxiety / Depression |
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______ _______ is the sum of our strengths minus the sum of our losses.
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Total suffering
"The integrity of the personality breaks down and suffering occurs when our gains in life no longer outweigh our losses" |
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A patient complains of pain, and when you ask him where it hurts, he points to his right 3rd PIP joint.
What kind of pain would this be? |
Somatic pain
Patient can pinpoint the exact location of the pain. |
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A patient complains of pain, and when you ask him where it hurts, he indicates that his abdomen hurts although he can't tell you exactly where.
What kind of pain would this be? |
Visceral pain
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A patient complains of an electric stabbing pain that travels down one of his limbs.
What kind of pain would this be? |
Neuropathic pain
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Valproic acid, neurotin, and cymbaltin treat which type of pain?
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Neuropathic pain
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A 78 year old hospice patient has complaints of severe pain that's lasted for several days, despite large increases in her dosage of pain medication. If you were to examine her brain chemistry, you would note a down-regulation in her opioid receptors and an up-regulation of her NMDA and glutamate receptors.
What kind of pain is this? |
Complex Neuropthic pain
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(T/F) The goal of pain management in hospice patients is to get the patient's pain back down to zero.
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False!
Not every patient wants their pain to be a zero since it may signify they are over-medicated. The goal is to get the pain down to the level that the patient wants. |
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Which of the following would you use for a patient who is complaining of moderate pain (between 4 and 7 on the pain scale)?
A. ASA, Acetaminophen, NSAIDS B. Codeine, Oxycodone, Tramadol C. Morphine, Hydromorphone, Methadone, Levorphanol, Fantanyl |
B
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Which of the following would you use for a patient who is complaining of severe pain (over 7 on the scale)?
A. ASA, Acetaminophen, NSAIDS B. Codeine, Oxycodone, Tramadol C. Morphine, Hydromorphone, Methadone, Levorphanol, Fantanyl |
C.
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This drug is not recommended for pain management in palliative care because of its poor oral absorption, toxic metabolites (which accumulate with renal failure), and psychotomimetic side effects (seizures, myoclonus),
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Meperidine (Demerol)
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This drug is not recommended for pain management in palliative care. It has low efficacy at commercially available doses, toxic at high doses, and shown to be not much better than Placebo.
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Propoxyphene (Darvicet)
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Why are mixed opioid agonist / antagonist not recommended for treating pain in palliative settings?
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They compete with agonists (which could precipitate withdrawal) and have an analgesic ceiling effect.
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This dosage of morphine is equivalent to 1 Vicadin
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5 mg
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What are 3 uses for short-acting opioids / bolus doses in palliative care?
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Rescue doses
Breakthrough Pain Incidence pain |
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List some common side effects of opioids:
(There's a lot) |
Constipation, hallucinations, dry mouth, delirium, nausea, vomiting, seizures, sedation, sweats, respiratory depression, urinary retention
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Are bad dreams a common side effect of opioids?
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No
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What are 2 criteria for switching a patient from short acting bolus opioids to chronic, extended release preparations?
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Drowsiness one half hour to an hour following ingestion
Pain before the next dose is due |
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(T/F) You can flush time-release granules down through feeding tubes
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True
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Which class of drugs are often found to be better at treating bone pain than morphine?
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NSAIDS
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Anticonvulsants and antidepressants help treat which type of pain?
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Neuropathic pain
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Mrs. X is a 84 year old patient with a lung cancer that metastasized to her brain. She has been in palliative care for several weeks. . She has moderate cerebral swelling. She hasn't been eating recently and has a depressed mood. Her medical history is also positive for GI bleeds.
Which of the following drugs would be a good choice for her? A. Naproxen B. Prednisone C. Xanax D. Tegretol |
B.
Steroids are good when NSAIDs are contra-indicated and help with swelling and appetite. |
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Which class of medicine is good for treating hospice patients with agitation, restlessness, dyspnea, COPD, and terminal delirium?
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Antianxiety meds
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Scopolamine is a good choice medicine to treat which symptoms in a palliative setting?
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Terminal secretions, death rattle, colic, spasms
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Which class of meds are good for treating bone pain and hyperkalemia?
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Bisphosphates
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Although it seems counter-intuitive, small doses of opioids (in combo with oxygen) may actually help an end-of-life patient breathe better. Why?
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Although opioids (and benzos) depress the respiratory system, small doses may help by decreasing the sensation of breathlessness so the patient breaths slower, but have higher quality breaths.
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