Pharmacology: End of Life Care

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Across
  1. 3. Common end of life symptoms: Stress. Common with patient and family. Management: compassion, (blank), counseling, psychotherapy
  2. 6. In terminal patients, always give opioids ‘(three word blank)’
  3. 7. In terminal patients, adverse effects may become (blank) (nausea, sedation, constipation, respiratory depression)
  4. 8. Opioid induced nausea and vomiting experienced by many but tolerance develops within a few days. Treat with antiemetics like (blank)
  5. 10. For breakthrough pain, offer every 1h (orally), every 30min (SC, IM) and every 10-15min (blank)
  6. 11. Common end of life symptoms: (Blank). Causes: infections, GI bleeding, malabsorption, medications, obstruction, overflow incontinence, stress etc.
  7. 16. Simple causes of confusion & agitation should be sought & managed: urinary retention (urinary catheterization), (two word blank), poorly controlled pain, anxiety (benzodiazepines), severe terminal agitation (barbiturates)
  8. 18. Common end of life symptoms: Fluid/Edema. Some patients develop relative hypotension, tachycardia & reduced urine output, At end of life no amount of IV (blankandblank) will return intravascular volume to normal
  9. 19. (Two word blank) help prevent fecal impaction.
  10. 20. Common end of life symptoms: (blank). Frightening & distressing. Prevalence = 12-74%. Causes: anxiety, airway obstruction, bronchospasm, hypoxemia, pulmonary edema, thick secretions etc
  11. 22. Common end of life symptoms: Pressure Ulcers. Associated pain can be significant. Can be soiling & malodorous. Management: hygiene, protection (thin hydrocolloid dressings), supports, avoid iodine-containing products, charcoal-impregnated dressings, superficial infections (topical metronidazole or (two word blank))
  12. 23. Management of (two word blank) which is burning tingling pain, shooting stabbing pain, complex pain:
  13. 26. Treatment of bone pain management: Opioids = (blankofblank)
  14. 28. (Blank) drugs used to treat bone pain: NSAIDs, corticosteroids, calcitonin
  15. 29. A pattern of drug use characterized by a continued craving for an opioid which is manifest as compulsive (three word blank) leading to an overwhelming involvement in the use and procurement of the drug
  16. 31. Treatment of neuropathic shooting stabbing pain use (carbamazepine, blankandblank)
  17. 32. For terminal illness, there is (two word blank) dose of a pure opioid agonist
  18. 33. Knowledge of opioid pharmacology becomes critical during the (two word blank) of life
  19. 34. Opioids that are not recommended include (blankandblank)
  20. 36. For breakthrough pain, ~(blanktoblank)% of 24h dose opioid can be given
  21. 40. Common end of life symptoms: Constipation. Causes: drugs (opioids, (three word blank), anticholinergics), decreased mobility, dehydration, autonomic dysfunction etc. Cause often not carefully assessed
  22. 43. Common end of life symptoms: Nausea/vomitting. Two important organs involved (blank) and GI tract
  23. 49. Relieving or soothing the symptoms of a disease or disorder without (blankablank).
  24. 50. Care does not end until the family have been supported with their (two word blank)
  25. 52. Depending on pain severity, management is started at (two word blank)
  26. 53. Management of diarrhea: establish normal bowel habits, avoid gas-forming foods, increase (blank)
  27. 54. (Two word blank) May further improve pain control. May also be a primary analgesic. Can be added at any step in WHO ladder.
  28. 56. Consider using (two word blank) preparation of same opioid used for routine dosing
  29. 57. WHO 3 Step Ladder: (Two word blank) for mild pain includes: aspirin, acetaminophen, NSAIDs, +/- adjuvants
  30. 58. Detergent (two word blank) not sufficient alone (stimulant also required)
  31. 60. Mixed opioid-antagonists eg, butorphanol, nalbuphine. Should not be used alongside (two word blank) agonist
  32. 61. Common end of life symptoms: Grief. Normal process that usually begins before an anticipated death, denial, fears about loss of control, suffering, an uncertain future, (blankofblank)
Down
  1. 1. Breakthrough pain = (two word blank) of pain
  2. 2. The (blank) conjugates codeine, morphine, oxycodone, and hydromorphone into glucuronides. Some of their metabolites remain active as analgesics
  3. 4. A normal physiological phenomenon in which increasing doses are required to produce the same effect
  4. 5. Common end of life symptoms: Depression. Most dying patients experience some depressive symptoms. Management: psychologic support, antidepressants for persistent, clinically sig. depression, anxiety & insomnia (two word blank); withdrawn, vegetative signs (methylphenidate)
  5. 9. Meperidine: routine dosing leads to accumulation of metabolite (blank) (no analgesic properties but sig. adverse effects)
  6. 12. Treatment of neuropathic complex pain: Combinations may be required (oral [blank,andblank] agonists, NMDA receptor antagonists, corticosteroids etc)
  7. 13. (Blank) are commonly used in advanced illness: acute nerve compression, increased intracranial pressure, bone pain, visceral pain, anorexia, nausea, depressed mood
  8. 14. Common end of life symptoms: Insomnia. Lifestyle management: avoid caffeine, avoid staying in bed when awake, excess (two word blank), avoid overstimulation before sleep
  9. 15. (Blank) should always be expected, tolerance may develop very slowly if at all
  10. 17. Significance of (blank): 90-95% excreted renally
  11. 21. Pharmacological interventions for insomnia include: antihistamines (eg, diphenhydramine), benzodiazepines (eg, lorazepam), neuroleptics (eg, blank)
  12. 24. Prophylactic laxatives help prevent fecal impaction and detergent stool softeners (blank) not sufficient alone (stimulant also required)
  13. 25. Management of nausea/vomiting: dopamine antagonists (eg, metoclopramide), histamine antagonists (eg, meclizine, diphenhydramine), anticholinergics (eg, scopolamine), serotonin antagonists (eg, ondansetron, granisetron), antacids, (two word blank)
  14. 27. Opioid induced (blank) should always be expected. Tolerance is slow to develop if at all.
  15. 30. Persistent diarrhea can lead to dehydration, malabsorption, fatigue, hemorrhoids, perianal (two word blank)
  16. 35. A (two word blank) phenomenon in which a withdrawal syndrome occurs when an opioid is abruptly discontinued or an opioid antagonist is administered
  17. 37. (Blank) and weakness. Most frequent distressing symptom at end of life. Management: discontinue medications that are no longer appropriate and may make (blank) worse (eg, antihypertensives, diuretics); optimize fluid & electrolyte intake; not easy to treat pharmacologically but some options are: corticosteroids (eg, dexamethasone); psychostimulants (eg, methylphenidate)
  18. 38. Common end of life symptoms: Constipation. Management. stimulant laxatives (eg, casanthranol, senna), osmotic laxatives (eg, lactulose, sorbitol), detergent laxatives (stool softeners eg, docusate), prokinetic agents, (two word blank), large-volume enemas
  19. 39. Common end of life symptoms: Constipation. If left unmanaged can lead to considerable patient distress eg, abdominal pain, bloating, nausea, vomiting, (two word blank)
  20. 41. Common end of life symptoms: (blank/blank) occur in many illnesses. Management: non-pharmacological; corticosteroids (eg, dexamethasone); cannabinoids (eg, dronabinol); conditions that cause poor nutrition intake like oral candidiasis, gastritis should be treated
  21. 42. Effective treatment requires clear understanding of pharmacology, potential impact, and (two word blank)
  22. 44. WHO 3 Step Ladder: (Two word blank) for severe pain includes: Morphine, hydromorphone, methadone, levorphanol, fentanyl, oxymorphone, +/- Nonopioid analgesics, +/- adjuvants
  23. 45. Diarrhea management: Transient/mild (bismuth salts); persistent/bothersome, slow peristalsis (loperamide, diphenoxylate/atropine, tincture of opium; persistent, severe secretory (blank, parenteral fluid)
  24. 46. Common end of life symptoms: Confusion is distressing for patients and family. Causes include: drugs, hypoxia, intrinsic (two word blank)
  25. 47. Treatment of neuropathic burning tingling pain (blank) (amitriptyline, imipramine), gabapentin
  26. 48. Management of dyspnea: oxygen, opioids (DOC = blank), anxiolytics
  27. 51. Opioid induced nausea/vomiting: Experienced by many patients, Tolerance develops within few days, Treat with (blank) (eg, metoclopramide)
  28. 55. WHO 3 Step Ladder: (Two word blank) for moderate pain includes: aspirin or acetaminophen, codeine, hydrocodone, oxycodone, dihydrocodeine, tramadol, +/- adjuvants
  29. 59. (Blank) administration is preferred in terminal disorders