Canada PCOC flashcards

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

PAINAD tool

A 5-item observational scale (breathing, negative vocalization, facial expression, body language, consolability) scored 0–10 to assess pain in advanced dementia when self-report is not possible.

Breakthrough pain

A transient flare of pain occurring despite otherwise controlled baseline pain; classified as incident, idiopathic, or end-of-dose failure; treated with short-acting opioid at 10–20% of daily dose.

Equianalgesic dose

The dose of one opioid that produces analgesia equivalent to another; used for opioid rotation; reduce calculated dose by 25–50% for incomplete cross-tolerance.

Opioid-induced constipation

Constipation caused by mu-opioid receptor agonism in the gut; prophylaxis with stimulant plus osmotic laxative is recommended at opioid initiation, not after symptoms develop.

CAM delirium screen

Confusion Assessment Method: positive if acute onset and fluctuating course plus inattention, and either disorganized thinking or altered consciousness; used for delirium screening.

Dyspnea first-line opioid

Low-dose morphine (e.g., 2.5–5 mg PO q4h) is first-line for refractory dyspnea in palliative care; titrate to effect; oxygen only if hypoxemic.

Hydromorphone starting dose

For opioid-naïve adults: 1–2 mg PO q4h or 0.5–1 mg SC/IV q4h; titrate to effect; preferred over morphine in renal impairment.

Methadone rotation

Methadone has nonlinear equianalgesic conversion; when switching from high-dose morphine, start at ≤10% of morphine daily dose, divided q8h–q12h; only by experienced prescribers.

Fentanyl patch indication

Transdermal fentanyl is for persistent severe pain requiring continuous opioid therapy; not for acute or postoperative pain; conversion: oral morphine 100 mg/24h ≈ 25 mcg/h patch.

Acetaminophen maximum dose

3–4 g/day in healthy adults; reduce to ≤2 g/day in hepatic impairment, chronic alcohol use, or low body weight; check combination products for hidden acetaminophen.

NSAID contraindications

Avoid in peptic ulcer disease, eGFR <30, heart failure, and anticoagulation; use lowest effective dose for shortest duration; monitor GI, renal, and cardiovascular effects.

Dexamethasone palliative uses

Corticosteroid used for appetite stimulation, bone pain, and cerebral edema; monitor hyperglycemia, GI irritation, and myopathy; taper if used >2 weeks.

First-pass metabolism

Hepatic metabolism of orally administered drug before systemic circulation; explains lower oral bioavailability of morphine (~30%) and hydromorphone (~24%) versus parenteral.

Codeine CYP2D6

Codeine is a prodrug requiring CYP2D6 for conversion to morphine; inhibitors (fluoxetine, paroxetine, bupropion) reduce analgesia; ultrarapid metabolizers risk toxicity.

Naloxone half-life

Opioid antagonist with half-life ~30–90 minutes; may require repeat dosing or infusion for long-acting opioids; titrate to restore breathing, not full consciousness.

Buprenorphine receptor activity

Partial mu-opioid agonist with high affinity; can precipitate withdrawal and reduce efficacy of full agonists; used for opioid use disorder and pain.

Steady state

Achieved after ~4–5 half-lives of a drug; methadone half-life is highly variable (8–59 hours), requiring slow titration and monitoring for accumulation.

Renal impairment opioid choice

Avoid morphine (active metabolites) and meperidine (normeperidine neurotoxicity); prefer hydromorphone, fentanyl, or methadone with dose adjustment.

Informed consent

Obtain consent for treatment after discussing risks, benefits, and alternatives; in palliative care may be verbal; document the discussion in the health record.

Decision-making capacity

Assess ability to understand, appreciate, reason, and express a choice; if absent, follow provincial substitute decision-maker hierarchy and best interests standard.

MAiD eligibility

Medical Assistance in Dying: legal in Canada for competent adults with grievous and irremediable condition, informed consent, and two independent assessments; pharmacists may conscientious object.

Opioid prescription requirements

Under Canada's Controlled Drugs and Substances Act, prescriptions must include patient name, drug, dose, quantity, directions, and prescriber information; some provinces require triplicate forms.

Confidentiality limits

Disclose personal health information only with consent or as required by law (mandatory reporting of abuse, court order); use minimum necessary information.

Advance care planning

Document goals of care and substitute decision-maker; legally binding in some provinces (e.g., Ontario advance directives), while others rely on substitute decision-makers.

SBAR handover

Situation, Background, Assessment, Recommendation: structured communication tool for urgent patient information; reduces errors and improves interprofessional handover.

Teach-back method

Ask patient to repeat instructions in their own words to confirm understanding; use for new medications and complex regimens; improves health literacy and adherence.

Health literacy strategies

Use plain language, avoid jargon, limit to 3–5 key points per session, and supplement with written or visual aids; confirm understanding with teach-back.

Cultural safety

Recognize power imbalances and historical trauma; ask about preferences for family involvement, traditional healing, and language needs; adapt communication accordingly.

Medication reconciliation

Obtain best possible medication history (BPMH) at admission and discharge; compare with orders and resolve discrepancies; reduces adverse drug events.

Opioid stewardship

Implement take-back programs, prescribe naloxone kits with opioids, and monitor for aberrant behaviors using prescription monitoring programs (PMPs).

PDSA cycle

Plan-Do-Study-Act: quality improvement method to test changes on a small scale; measure outcomes such as pain scores, constipation rates, and medication errors.

Drug shortage plan

Maintain emergency preparedness for drug shortages; identify therapeutic alternatives and communicate with prescribers; document substitutions and monitor outcomes.