Term
| common symptoms of End-Stage |
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Definition
| fatigue, anorexia-cachexia, constipations, N/V, delirium, dyspnea, pain |
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Term
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Definition
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Definition
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Term
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Definition
| SSRIs, other antidepressants |
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Term
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Definition
| antihistamines, B blockers, statins, benzos |
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Term
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Definition
| benzos, anti-hypertensives |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| a separate medical benefit |
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Term
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Definition
| patient must have less than 6 months to live |
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Term
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Definition
| pay little/ nothing for med (which are directly provided), med orders based on protocol, allows rapid change in pain meds if needed |
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Term
| hospice covers comfort care |
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Definition
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Term
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Definition
| patients may have terminal illness, focused on comfort care, BUT may have condition with which they could live for years |
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Term
| severe COPD, painful conditions like compression fractures or rheumatoid arthritis |
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Definition
| conditions where patients might live for years, but patient might need end of life care |
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Term
| palliative care is not necessarily terminal |
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Definition
| could still have curative focus even while providing comfort |
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Term
| possible symptom management suggestions |
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Definition
| appropriate meds, dosing and easiest route for patient |
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Term
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Definition
| may be related to difficulty swallowing at end of life, potentially from severe nausea |
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Term
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Definition
| cannot be used if patient is opioid NAIVE |
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Term
| appropriate initiation of fentanyl patch |
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Definition
| patient must be taking at least 60 mg of morphine per day or equivalent for 25 mcg/hr patch |
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Term
| fentanyl patch can still cause nausea |
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Definition
| because nausea caused by opioid is a systemic effect |
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Term
| fentanyl patch may be ineffective in cachectic patients |
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Definition
| because in these patients there is LESS fat leading to less absorption |
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Term
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Definition
| potential issue in cancer patients |
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Term
| concentrated opioid solutions |
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Definition
| small volume, easier to mix with food |
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Term
| concentrated opioid solutions |
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Definition
| can be placed under tongue and allow to be absorbed if patient is not eating at all |
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Term
| concerns when using concentrated opioid solutions |
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Definition
| MUST be careful with dosing, use dropper that comes with bottle, educate caregiver! |
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Term
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Definition
| as needed/ short term basis due to dosing limitations and not easy route |
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Term
| at home with ACUTE need may "make" suppositories |
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Definition
| butter/ vaseline can be used with smaller oral tablets of oxycontin/ MS contin (ONLY do this other options are not available) |
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Term
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Definition
| allow the most flexible dosing (easy adjustment) |
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Term
| SC route preferred over IV rout |
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Definition
| when at home because there is lower risk of infection |
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Term
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Definition
| volume limitations when doses are increased |
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Term
| epidural or intrathecal route |
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Definition
| useful if other methods not effective, more complicated procedure |
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Term
| allow drug delivery to most localized area (trathecal/ epidural) |
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Definition
| may provide better pain relief, reduces CNS side effects |
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Term
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Definition
| patient can take more medication |
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Term
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Definition
| physical symptoms if the med is not taken |
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Term
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Definition
| taking drug becomes more important that the original benefit from it |
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Term
| an addict takes a med to get away from life |
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Definition
| someone seeking pain relief takes med to get on with life |
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Term
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Definition
| does not facilitate the healing of wounds or prevent pressure ulcers in end of life |
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Term
| increased risk of aspiration, diarrhea and other complications |
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Definition
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Term
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Definition
| contribute to wasting syndromes |
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Term
| weight loss is common in end of life |
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Definition
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Term
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Definition
| less appealing, body is slowing down |
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Term
| altered phisiology and body chemistry at end of life |
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Definition
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Term
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Definition
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Term
| eliminate dietary restrictions |
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Definition
| and provide favorite foods, smaller and more frequent |
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Term
| some potentially inappropriate meds for geriatrics |
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Definition
| may become appropriate (anti-nausea); more worried about comfort than side effects |
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Term
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Definition
| sometimes used for severe nausea because it is a very strong dopamine blocker |
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Term
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Definition
| may be the cause of nausea especially as pain meds are increased |
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Term
| promethazine, prochlorperazine |
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Definition
| may make constipation worse especially if it is the cause of nausea |
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Term
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Definition
| may not need to treat hallucinations or behaviors; only an issue if at risk of harming self/ others |
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Term
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Definition
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Term
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Definition
| no need to start dementia meds |
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Term
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Definition
| unnecessary offending medications |
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Term
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Definition
| NMDA receptor antagonist properties, useful for allodynia |
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Term
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Definition
| pain due to a stimulus that doesn't normally cause pain |
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Term
| appropriate for patients with allodynia |
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Definition
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Term
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Definition
| must be dosed cautiously, not first line but might be useful for some cases |
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Term
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Definition
| may also be helpful for allodynia |
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Term
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Definition
| used in anethesia most commonly, also blocks NMDA; might be used for advanced allodynia cases |
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Term
| inflammation can be cause of pain in bone metastases |
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Definition
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Term
| dexamethasone, prednisone |
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Definition
| useful for pain caused by inflammation (bone metastases) |
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Term
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Definition
| might be useful for bone pain (high dose) |
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Term
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Definition
| less effective than glucocorticoids, consider possible adverse reactions |
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Term
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Definition
| subjective symptom of not being able to breath |
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Term
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Definition
| not necessarily associated with decreased O2 in bloodstream, may occur with progressive cancer and other conditions |
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Term
| treatments of "air hunger" |
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Definition
| oxygen, opioids, benzos are most common |
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Term
| in terminal dyspnea, respiratory center |
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Definition
| is like a thermostat that keeps heat pumping out when temp is already too hot |
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Term
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Definition
| may calm respiratory center down |
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Term
| with hyperactivity of respiratory center you have |
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Definition
| DECREASED risk of respiratory suppression, as long as doses are appropriate |
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Term
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Definition
| easiest for opioids/ benzos for respiratory hyperactivity |
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Term
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Definition
| not always effective in trials but often works in practice |
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Term
| benefits of nebulized opioids |
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Definition
| may be related to Mu receptors in lungs |
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Term
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Definition
| may be caused by nebulized opioid |
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Term
| best option for nebulized opioid |
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Definition
| preservative-free intravenous opioid often used to prevent sensitivity |
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Term
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Definition
| lroazepam oral, can be sublingual (can give IV via neb) |
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Term
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Definition
| more predictable half-life |
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Term
| opioids and benzos can be used together |
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Definition
| if added benefit seems to be helpful |
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Term
| suction for oral secretions |
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Definition
| extremely uncomfortable and rarely necessary at end of life |
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Term
| if oral secretions are uncomfortable for the patient |
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Definition
| anticholinergics can help |
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Term
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Definition
| often preferred because a low dose can be used for unwanted oral secretions |
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Term
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Definition
| stimulant that might be helpful for drowsiness/fatigue from opioids or other treatments |
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