ABIM Palliative Care flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Equianalgesic oral-to-parenteral morphine

Oral morphine 30 mg is approximately equianalgesic to parenteral morphine 10 mg, a 3:1 ratio; use this to convert routes and avoid overdose when switching.

Opioid breakthrough dose

For a patient on scheduled opioids, a breakthrough dose is typically 10–20% of the total daily opioid dose, given every one hour as needed.

Neuropathic pain first-line adjuncts

Gabapentin, pregabalin, duloxetine, and tricyclic antidepressants are first-line adjuvants for neuropathic pain; titrate to effect and monitor renal function and anticholinergic effects.

Opioid-induced constipation prophylaxis

Constipation does not reliably resolve with tolerance, so start a stimulant laxative with or without an osmotic laxative when scheduled opioids begin, especially in older adults.

Renal failure opioid selection

Morphine is avoided in renal failure because active metabolites accumulate; fentanyl is preferred, and hydromorphone or methadone require cautious reduced dosing and monitoring.

Dyspnea first-line opioid

Systemic opioids reduce refractory dyspnea by lowering respiratory drive and anxiety; oxygen is indicated only for hypoxemia, not for normoxemic dyspnea.

Nausea mechanism-based antiemetic

Match antiemetic to pathway: haloperidol for metabolic, ondansetron for serotonin, scopolamine for vestibular, metoclopramide for gastric stasis, olanzapine for mixed mechanisms.

Malignant bowel obstruction

Octreotide and dexamethasone reduce secretions and edema; antiemetics control nausea; avoid prokinetics with complete obstruction; surgery is considered in selected patients.

Terminal delirium management

Search for reversible causes; use haloperidol or quetiapine for agitation or hallucinations; avoid benzodiazepines unless withdrawal or seizures are present; nonpharmacologic measures remain first-line.

Anorexia-cachexia appetite stimulants

Megestrol, dexamethasone, and olanzapine may improve appetite but have limited effect on weight; megestrol increases thrombosis and adrenal suppression risk.

SPIKES communication protocol

SPIKES stands for Setting, Perception, Invitation, Knowledge, Empathy, and Strategy/Summary; it structures bad-news conversations and invites the patient's information preferences.

Decision-making capacity

Capacity requires understanding, appreciation, reasoning, and expressing a choice; it is decision-specific and does not require a formal psychiatric diagnosis or global competence.

Surrogate decision standard

Surrogates use substituted judgment, choosing what the patient would have wanted; if wishes are unknown, they act in the patient's best interest.

Advance directive versus POLST

Advance directives guide future care but are not portable orders; POLST becomes actionable medical orders for seriously ill patients and travels across settings.

Spiritual history FICA

FICA asks about Faith, Importance, Community, and Address in care; it is a brief screening tool, not a substitute for chaplain referral.

Depression versus grief

Major depression causes persistent anhedonia, guilt, worthlessness, and functional impairment; normal grief waves center on yearning and can coexist with positive memories.

Double effect conditions

The doctrine of double effect permits a good-intentioned act with a foreseen bad effect when the bad effect is not the means and is proportionate.

Cultural humility in care

Cultural humility means asking about the patient's values, rituals, family roles, and truth-telling preferences rather than assuming beliefs from ethnicity alone.

Malignant hypercalcemia treatment

Malignancy-associated hypercalcemia is treated with IV isotonic fluids and a bisphosphonate or denosumab; calcitonin acts rapidly but briefly and is used for severe cases.

Spinal cord compression

New back pain with weakness, sensory loss, or bowel or bladder dysfunction in cancer requires urgent MRI and dexamethasone; do not wait for imaging to give steroids.

Heart failure palliative triggers

Palliative care is appropriate in advanced heart failure with recurrent hospitalizations, refractory symptoms, or device decisions; ICD deactivation is discussed separately from stopping other treatments.

Dialysis withdrawal

In dialysis withdrawal, conservative management treats uremic symptoms with opioids, antiemetics, and anxiolytics; death usually occurs within days to weeks after stopping.

Signs of imminent dying

Mottling, Cheyne-Stokes breathing, decreased urine output, terminal secretions, and drowsiness often signal death within days; they guide comfort-focused care.

Terminal secretions management

Reposition and suction gently; glycopyrrolate or scopolamine may reduce secretions, but evidence is limited and benefit is mainly for observers.

Hospice eligibility prognosis

Medicare hospice requires a prognosis of six months or less if the illness follows its expected course, certified by two physicians.

Prolonged grief disorder

Prolonged grief disorder is persistent disabling yearning or preoccupation lasting at least 12 months in adults, with functional impairment and identity disruption.

Pediatric palliative consent

Parents or guardians provide consent for minors, while children provide assent according to developmental ability; palliative care can begin at diagnosis alongside curative treatment.

Beers criteria in elders

Beers criteria identify potentially inappropriate medications in older adults, including benzodiazepines, anticholinergics, and long-term NSAIDs, prompting deprescribing review.

Limited English proficiency communication

Use qualified professional interpreters, not family members, for goals-of-care and consent discussions; document interpretation and confirm understanding with teach-back.

Hospice levels of care

Medicare hospice has routine home care, continuous home care, general inpatient care, and inpatient respite care; level depends on symptom intensity and caregiver needs.

Interdisciplinary team meeting

The hospice interdisciplinary group meets at least every 15 days to update the plan of care; members include physician, nurse, social worker, chaplain, and other disciplines.

Advance care planning billing

CPT 99497 covers the first 30 minutes of advance care planning; 99498 covers each additional 30 minutes, with time documented in the record.