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End of Life
Overview
47
Bartending
5th Grade
02/16/2014

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Cards

Term
Common Manifestations: Confusion
Definition
anticholinergics, benzodiazepines
Term
Common Manifestations: Depression
Definition
benzoz, ETOH
Term
Common Manifestations: Lack of Appetite
Definition
SSRIs and other antidepressants
Term
Common Manifestations: Weakness
Definition
antihistamines/BBs/statins/benzos
Term
Common Manifestations: ataxia
Definition
benzos, anti-hypertensives
Term
Common Manifestations: constipation
Definition
anticholinergics
Term
Common Manifestations: urinary retention
Definition
anticholinergics
Term
< 6 months to live; separate medication benefit; covers comfort care, not curative
Definition
hospice
Term
may have terminal illness, could be condition in which they live for years; pay for meds w/ standard pharmacy benefit; can receive broader scope of txt
Definition
palliative
Term
can be used if patient is not opioid-naive
Definition
Fentanyl patch
Term
Fentanyl patch be ineffective
Definition
cachetic patients
Term
concentrated solutions (small volume, easier to mix with food) MUST be careful with dosing!!!
Definition
morphine 20 mg/mL; oxycodone 5 mg/mL; methadone 10 mg/mL
Term
may be useful on as-needed basis or short-term; could be difficult for long term management
Definition
Suppositories
Term
Allow most flexible dosing; SC may be preferable at home with lower infection risk, SC has volume limitations as the dose increases
Definition
Parenteral Routes
Term
Useful if other methods not effective; more complicated procedure; allow drug delivery to most localized area
Definition
Epidural or Intrathecal Route
Term
Patient can take more medication
Definition
Tolerance
Term
Physical symptoms if don't get med
Definition
Dependence
Term
taking drug becomes more important than the original benefit from it
Definition
Addiction
Term
increases the risk of aspiration, diarrhea, and other complications; does not lead to better quality of life or longer life
Definition
Tube feeding at end of life
Term
sometimes used for severe nausea because it is a very strong dopamine blocker
Definition
Haloperidol
Term
May make constipation worse
Definition
Promethazine, Prochlorperazine
Term
Has NMDA receptor antagonist properties; makes it useful for allodynia in some cases
Definition
Methadone
Term
pain that can be caused from simple touch (sheets, pressure from clothing, etc)
Definition
allodynia
Term
Methadone
Definition
can accumulate; dose cautiously; not a first line agent but may be useful in some cases
Term
some MDS will use for advanced allodynia cases; used in anesthesia most common, also bloks NMDA receptors
Definition
Ketamine
Term
Given for inflammation that can be the cause of pain
Definition
Glucocorticoids; Bisphosphonates; NSAIDs
Term
Glucocorticoids
Definition
Dexamethasone 12-20 mg/day; Prednisone 10-50mg/day
Term
Bisphosphonates
Definition
High dose; Zoledronic acid common
Term
NSAIDs
Definition
less effective than glucocorticoids; consider possible adverse reactions
Term
Terminal Dyspnea
Definition
"Air hunger"; subjective symptoms of not being able to breathe; may occur with progressive cancer and other conditions
Term
Target for terminal dyspnea
Definition
respiratory center in brain
Term
Respiratory center in brain
Definition
in terminal dyspnea it is like a thermostat that keeps heat pumping out when temp is already too hot
Term
may calm respiratory center down
Definition
opiods and benzos
Term
Routes for opioids
Definition
oral may be easiest to use; nebulized may be effective but may cause bronchospasm
Term
for nebulized route, most common; can be given every 4 hours initially; based on patient need
Definition
morphine
Term
possible nebulized alternatives
Definition
hydromorphone, fentanyl
Term
calm respiratory center, help with anxiousness
Definition
Benzodiazepines (lorazepam often used)
Term
can be used for excessive oral secretions
Definition
anticholinergics may hel
Term
excessive secretions: often preferred because a low dose can be used
Definition
atropine eye drops
Term
may need for drowsiness/fatigue from opioids or other treatments; sometimes cannot cut down the dose for treatmnts; even caffeine can be helpful in more mild cases
Definition
Stimulants
Term
much more lipophilic as compared to morphine and has a more rapid onset of action
Definition
fentanyl
Term
I-isomer responsible for drug's analgesic effects; drug accumulation secondary to a long half life is a potential risk as well as potential for arrhythmias
Definition
methadone
Term
potent mu-opiate receptor agonist
Definition
morphine
Term
high-potency antipsychotic structurally related to droperidol; boxed warning regarding an increased risk of death in elderly patients with dementia receiving these drugs for behavioral problems
Definition
Haloperidol
Term
Haloperidol
Definition
blocks postsynaptic dopamine receptors
Term
enhances GI motility and is an effective anti-nauseant; also blocks D2 dopaminergic receptors in the chemoreceptor trigger zone
Definition
Metoclopramide
Term
prototype antimuscarinic; competitive inhibitor at autonomic postganglionic cholinergic receptors
Definition
Atropine
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