NSAIDs - <<<<ANSWERS>>>anti-inflammatory & antipyretuc
1st defense for inflammatory conditions
A/E: GI bleed, ulcers, dec. renal, impaired platelets, short term memory
in elderly
cant use beyond 6-12 months
*allergy to sulfa may be contraindicated *
myoclonus - <<<<ANSWERS>>>the sudden, involuntary jerking of a
muscle or group of muscles.
occurs opiods in high doses w/ renal failure, seizures can occur
others include brain surgery, intrathecal placement, AIDs dementia,
hypoxia.
nocturnal is common
Adjuvent - <<<<ANSWERS>>>additional treatment after primary
treatment.
generally w/ opiod
antidepressants, anticonvulsant, corticosteroids
Ketamine- pain crisis - <<<<ANSWERS>>>0.1 mg/kg IV if no
response follow up in 5 minutes & repeat PRN
decrease opiod by 50%
1 mg/min for 70 kg person
,subcutaneous is possible 0.3-0.5 mg/kg
consider benzo w/ to prevent hallucinations/bad dreams.
if ^ secretions use glycopyrrolate, scopalamine or atropine
outcome indicators for palliative care - <<<<ANSWERS>>>Bring pain
not managed within pt comfort level in first 48 hrs
pain control should be maintained
not controlled needs active intervention
A/E should be anticipated & prevented or tx.
EOL meds - <<<<ANSWERS>>>controlling pain with meds does not
shorten or expand life span. cant hasten or cause death when used
responsibly
methadone: common, safe, and inexpensive
addiction/respiratory depression is only a concern when the pt is 1st
introduced to opiod
Morphine - <<<<ANSWERS>>>No ceiling dose (often used for pt w/
CA)
Different forms: IV, IM, IR, SR, Long-acting, liquid, suppositories
s/e: sedation, respiratory depression, itching, nausea, chronic spasms,
twitching, constipation
after a few days pts overcome itching, nausea, Resp depression, sedation
Meperidine (Demerol) - <<<<ANSWERS>>>discourage use
no long term effect, only lasts 2-3 hrs.
repeated doses can lead to CNS toxicity r/t ineffective netabolite
clearance. especially renal pt
lead to muscle twitching, new onset seizure, increased pain/sensitivity
not easily reversed & doesn't respond to narcan
oral fentanyl - <<<<ANSWERS>>>on an oral applicator, pt applies
dose (typically 200 mcg) to buccal mucosa between cheek/gum for rapid
absorption.
, useful for breakthrough pain, relief begins in 5 min. wait 15 min before
repeating
swallowing effects timing=
peak occurs 20- 40 min. & lasts 2-3 hrs
s/e: somnolence, nausea, dizziness.
coffee, tea, and juice can effect pH and absorption
Oxycodone - <<<<ANSWERS>>>moderate to severe pain
S/E similar to morphine w/ N/V
cannot be crushed or cut due to ER
can be hestiation from pt due to poor perception from public
use cautiously in pt w/ hypothyroidism, addisons disease, urethral
stricture, prostatic hypertrophy, or Lung/liver disease
Lymphoma types - <<<<ANSWERS>>>Hodgkins and Non-Hodgkins
Hodgkin's disease - <<<<ANSWERS>>>painless lymph node swelling,
generally in upper body, general fatigue, weight loss, fever, nifht sweats,
back pain
Non-Hodgkin's Lymphoma - <<<<ANSWERS>>>same symptoms
except itching & night sweats
Parkinson's disease - <<<<ANSWERS>>>Slow progression of motor
skills, resting tremors, slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - <<<<ANSWERS>>>pill rolling
movements in bands, loss of facial expression, difficulty initiating
movement, gait changes
Renal Cancer/symptoms - <<<<ANSWERS>>>asymptomatic early.
Gross hematuria, dull, aching pain, palpable abdomen mass.
polycythemia- HA, dizzy, vein inflammation, itchy. hypercalcemia-
tired, poor appetite, freq. urine, thirst, n/v, confusion, constipation, poor
concentration
1st defense for inflammatory conditions
A/E: GI bleed, ulcers, dec. renal, impaired platelets, short term memory
in elderly
cant use beyond 6-12 months
*allergy to sulfa may be contraindicated *
myoclonus - <<<<ANSWERS>>>the sudden, involuntary jerking of a
muscle or group of muscles.
occurs opiods in high doses w/ renal failure, seizures can occur
others include brain surgery, intrathecal placement, AIDs dementia,
hypoxia.
nocturnal is common
Adjuvent - <<<<ANSWERS>>>additional treatment after primary
treatment.
generally w/ opiod
antidepressants, anticonvulsant, corticosteroids
Ketamine- pain crisis - <<<<ANSWERS>>>0.1 mg/kg IV if no
response follow up in 5 minutes & repeat PRN
decrease opiod by 50%
1 mg/min for 70 kg person
,subcutaneous is possible 0.3-0.5 mg/kg
consider benzo w/ to prevent hallucinations/bad dreams.
if ^ secretions use glycopyrrolate, scopalamine or atropine
outcome indicators for palliative care - <<<<ANSWERS>>>Bring pain
not managed within pt comfort level in first 48 hrs
pain control should be maintained
not controlled needs active intervention
A/E should be anticipated & prevented or tx.
EOL meds - <<<<ANSWERS>>>controlling pain with meds does not
shorten or expand life span. cant hasten or cause death when used
responsibly
methadone: common, safe, and inexpensive
addiction/respiratory depression is only a concern when the pt is 1st
introduced to opiod
Morphine - <<<<ANSWERS>>>No ceiling dose (often used for pt w/
CA)
Different forms: IV, IM, IR, SR, Long-acting, liquid, suppositories
s/e: sedation, respiratory depression, itching, nausea, chronic spasms,
twitching, constipation
after a few days pts overcome itching, nausea, Resp depression, sedation
Meperidine (Demerol) - <<<<ANSWERS>>>discourage use
no long term effect, only lasts 2-3 hrs.
repeated doses can lead to CNS toxicity r/t ineffective netabolite
clearance. especially renal pt
lead to muscle twitching, new onset seizure, increased pain/sensitivity
not easily reversed & doesn't respond to narcan
oral fentanyl - <<<<ANSWERS>>>on an oral applicator, pt applies
dose (typically 200 mcg) to buccal mucosa between cheek/gum for rapid
absorption.
, useful for breakthrough pain, relief begins in 5 min. wait 15 min before
repeating
swallowing effects timing=
peak occurs 20- 40 min. & lasts 2-3 hrs
s/e: somnolence, nausea, dizziness.
coffee, tea, and juice can effect pH and absorption
Oxycodone - <<<<ANSWERS>>>moderate to severe pain
S/E similar to morphine w/ N/V
cannot be crushed or cut due to ER
can be hestiation from pt due to poor perception from public
use cautiously in pt w/ hypothyroidism, addisons disease, urethral
stricture, prostatic hypertrophy, or Lung/liver disease
Lymphoma types - <<<<ANSWERS>>>Hodgkins and Non-Hodgkins
Hodgkin's disease - <<<<ANSWERS>>>painless lymph node swelling,
generally in upper body, general fatigue, weight loss, fever, nifht sweats,
back pain
Non-Hodgkin's Lymphoma - <<<<ANSWERS>>>same symptoms
except itching & night sweats
Parkinson's disease - <<<<ANSWERS>>>Slow progression of motor
skills, resting tremors, slowness, rigidity. typically in people >65
Parkinson Signs/Symptoms - <<<<ANSWERS>>>pill rolling
movements in bands, loss of facial expression, difficulty initiating
movement, gait changes
Renal Cancer/symptoms - <<<<ANSWERS>>>asymptomatic early.
Gross hematuria, dull, aching pain, palpable abdomen mass.
polycythemia- HA, dizzy, vein inflammation, itchy. hypercalcemia-
tired, poor appetite, freq. urine, thirst, n/v, confusion, constipation, poor
concentration
