Palliative Care: Principles & Symptom Management

What is the primary difference in timing between the initiation of palliative care and hospice care?

Palliative care can be initiated at any stage of a serious illness, whereas hospice care is specifically for patients with a prognosis of 6 months or less.

According to the WHO Analgesic Ladder, what class of medication is recommended for Step 1 (mild pain)?

Non-opioid analgesics such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).

Why do opioids almost universally cause constipation in patients without a prophylactic bowel regimen?

Opioids bind to mu-receptors in the gastrointestinal tract, decreasing motility and increasing water absorption.

What is the primary purpose of a Durable Power of Attorney for Healthcare (DPOA-H)?

To designate a surrogate decision-maker to make medical decisions if the patient loses capacity.

What is the first-line pharmacological treatment for dyspnea in a terminal patient?

Low-dose systemic opioids, such as oral or intravenous morphine.

What requirement must be met regarding curative treatment for a patient to enroll in Medicare-funded hospice?

The patient must agree to forgo curative-intent treatments for their terminal diagnosis.

What does the Palliative Performance Scale (PPS) primarily measure to assist in prognostication?

Functional status based on ambulation, activity level, evidence of disease, self-care, intake, and level of consciousness.

In the SPIKES protocol for delivering bad news, what does the 'S' at the end represent?

Strategy and Summary (discussing the next steps and summarizing the conversation).

When switching from oral Morphine to oral Oxycodone, what is the standard potency ratio used for calculation?

Oral Oxycodone is approximately 1.5 to 2 times more potent than oral Morphine.

What is the preferred pharmacological management for 'death rattle' or terminal respiratory secretions?

Anticholinergic medications such as glycopyrrolate, hyoscyamine, or scopolamine.