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Palliative Care Jeopardy!
         A Highly Interactive Game

   Mary Lynn McPherson, Pharm.D., BCPS
                                 Professor
University of Maryland School of Pharmacy
Palliative Care Jeopardy – The Rules

Game board contain 25 squares with 5 categories
   and 5 “answers” of increasing difficulty and point
   values
In sequential order, teams get to select the square
   at the beginning of each round
If the designated team member is able to answer
   the question, the team earns full point value. If
   more than one team member works together to
   supply the correct answer, half the points are
   awarded to the team.
Palliative Care Jeopardy – The Rules

The correctness of your team’s “answer” will
 be determined by me.
The correct “answers” and my decisions are
 final. They, admittedly, may be arbitrary.
The team with the most points at the end of
 50 rounds plus Final Jeopardy WINS!!
Let’s Play
The
The
  categories
   categories
           are …
            are …
Nausea, Vomiting
and Constipation:
    Oh My!
PQRST
Pain
Pathogenesis
Opioid Facts
Neuropsychiatric
  Symptoms
NVC   PQRST    Pain   Opioid    Neuro-
              Patho   Facts    Psych Sx

100    100    100      100       100

200    200    200      200       200

300    300    300      300       300

400    400    400      400       400

500    500    500      500       500
NVC for 100
The answer is …
Defined as forceful contracture of the abdominal
muscles.

The question is …
What is retching?




               Return to Game Board
               Return to Game Board
NVC for 200
The answer is …
An antipsychotic agent also used to treat chemical-
induced nausea.

The question is …
What is haloperidol (Haldol)?




               Return to Game Board
               Return to Game Board
NVC for 300
The answer is …
The area of the brain that detects toxins and lacks a
blood brain barrier.

The question is …
What is the chemoreceptor trigger zone?




                Return to Game Board
                Return to Game Board
NVC for 400
The answer is …
Epigastric pain, early satiety, and regurgitation are
symptoms of this cause of nausea.

The question is …
What is gastric stasis?




                Return to Game Board
                Return to Game Board
NVC for 500
The answer is …
A sugar-coated treatment option for the
management of high bowel impaction.

The question is …
What are frozen vaseline balls?




               Return to Game Board
               Return to Game Board
PQRST for 100
The answer is …
“It’s a lot worse when I roll over, but if I lie perfectly
still, it’s not too bad.”

The question is …
What is “what precipitates or worsens your pain?”




                  Return to Game Board
                  Return to Game Board
PQRST for 200
The answer is …
“It feels like a lightning bolt at first, but ends up
numb and tingling.”

The question is …
What is “describe the quality of your pain?”




                 Return to Game Board
                 Return to Game Board
PQRST for 300
The answer is …
“I can’t eat, I can’t sleep, I can’t get out of bed, and I
cry all of the time.”

The question is …
What is “what symptoms accompany your pain?”




                 Return to Game Board
                 Return to Game Board
PQRST for 400
The answer is …
“Right here in the center of my left rib cage, and it
moves around to my back.”

The question is …
What is “where is your pain located?”




                Return to Game Board
                Return to Game Board
PQRST for 500
The answer is …
“That long acting morphine generally controls it, but
I have to take the short acting when the pain is 5 or
higher, and the heating pad didn’t help at all.”

The question is …
What is “what have you tried to relieve the pain and
how well did it work?”


                Return to Game Board
                Return to Game Board
Pain Pathogenesis for 100
The answer is …
A myelinated, large diameter fiber that transmits
sharp, well localized pain.

The question is …
What is an A-delta fiber?




                Return to Game Board
                Return to Game Board
Pain Pathogenesis for 200
The answer is …
The step during which a noxious stimulus is
changed by the body into an action potential.

The question is …
What is transduction?




               Return to Game Board
               Return to Game Board
Pain Pathogenesis for 300
The answer is …
Enkephalins, dynorphins and beta endorphins.

The question is …
What are endogenous opioids?




              Return to Game Board
              Return to Game Board
Pain Pathogenesis for 400
The answer is …
Free nerve endings that are activated by noxious
stimuli.

The question is …
What are nociceptors?




               Return to Game Board
               Return to Game Board
Pain Pathogenesis for 500
The answer is …
A relay station for reception and processing of
nociceptive information.

The question is …
What is the thalmus?




                Return to Game Board
                Return to Game Board
Opioid Facts for 100
The answer is …
This opioid is used as a cough suppressant and has
the highest incidence of nausea and constipation.

The question is …
What is codeine?




               Return to Game Board
               Return to Game Board
Opioid Facts for 200
The answer is …
This long-acting opioid is dosed every 12 hours, has
minimal active metabolites, and is available as 10, 15,
20, 30, 40, 60 and 80 mg.

The question is …
What is oxycodone (OxyContin)?



                Return to Game Board
                Return to Game Board
Opioid Facts for 300
The answer is …
This short-acting opioid has poor oral bioavailability
and is available parenterally, transdermally, and as
an oral transmucosal lozenge, an effervescent
tablet, a transmucosal film, a sublingual tablet and
intranasal spray.

The question is …
What is fentanyl?

                Return to Game Board
                Return to Game Board
Opioid Facts for 400
The answer is …
This opioid used to be commonly used for acute
pain, and has an active metabolite that can
accumulate and cause CNS excitation including
seizures.

The question is …
What is meperidine?


               Return to Game Board
               Return to Game Board
Opioid Facts for 500
The answer is …
This combination analgesic is no more effective than
plain acetaminophen and its active metabolite
causes sedation and confusion, particularly in the
elderly, and most importantly IS OFF THE MARKET!

The question is …
What is Darvocet N-100?


               Return to Game Board
               Return to Game Board
Neuropsychiatric Symptoms for 100

The answer is …
A patient with opioid-induced daytime sedation is
best treated with this agent, which may also be used
to treat depression.

The question is …
What is methylphenidate?



               Return to Game Board
               Return to Game Board
Neuropsychiatric Symptoms for 200

The answer is …
A patient with acute agitated, confused behavior and
a history of Parkinson’s disease is best treated with
this behavior.

The question is …
What is quetiapine (or another atypical antipsychotic
agent)


               Return to Game Board
               Return to Game Board
Neuropsychiatric Symptoms for 300

The answer is …
Neuropathic pain AND depression are best treated
with this type of antidepressant.

The question is …
What is a TCA (e.g., nortriptyline or desipramine) or
SNRI (e.g., duloxetine or venlafaxine)?



                Return to Game Board
                Return to Game Board
Neuropsychiatric Symptoms for 400

The answer is …
This medication, used adjunctively to treat
metastases to the brain, to reduce intracerebral
edema, and to treat metastatic bone pain may
cause anxiety or delirium.

The question is …
What is dexamethasone (or other CCS)?


               Return to Game Board
               Return to Game Board
Neuropsychiatric Symptoms for 500

The answer is …
The number of anxiety-induced dyspnea attacks
may be reduced by this agent.

The question is …
What is lorazepam (or other BZD)?




              Return to Game Board
              Return to Game Board

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Palliative care jeopardy i fall 2011

  • 1. Palliative Care Jeopardy! A Highly Interactive Game Mary Lynn McPherson, Pharm.D., BCPS Professor University of Maryland School of Pharmacy
  • 2. Palliative Care Jeopardy – The Rules Game board contain 25 squares with 5 categories and 5 “answers” of increasing difficulty and point values In sequential order, teams get to select the square at the beginning of each round If the designated team member is able to answer the question, the team earns full point value. If more than one team member works together to supply the correct answer, half the points are awarded to the team.
  • 3. Palliative Care Jeopardy – The Rules The correctness of your team’s “answer” will be determined by me. The correct “answers” and my decisions are final. They, admittedly, may be arbitrary. The team with the most points at the end of 50 rounds plus Final Jeopardy WINS!!
  • 5. The The categories categories are … are …
  • 11. NVC PQRST Pain Opioid Neuro- Patho Facts Psych Sx 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500
  • 12. NVC for 100 The answer is … Defined as forceful contracture of the abdominal muscles. The question is … What is retching? Return to Game Board Return to Game Board
  • 13. NVC for 200 The answer is … An antipsychotic agent also used to treat chemical- induced nausea. The question is … What is haloperidol (Haldol)? Return to Game Board Return to Game Board
  • 14. NVC for 300 The answer is … The area of the brain that detects toxins and lacks a blood brain barrier. The question is … What is the chemoreceptor trigger zone? Return to Game Board Return to Game Board
  • 15. NVC for 400 The answer is … Epigastric pain, early satiety, and regurgitation are symptoms of this cause of nausea. The question is … What is gastric stasis? Return to Game Board Return to Game Board
  • 16. NVC for 500 The answer is … A sugar-coated treatment option for the management of high bowel impaction. The question is … What are frozen vaseline balls? Return to Game Board Return to Game Board
  • 17. PQRST for 100 The answer is … “It’s a lot worse when I roll over, but if I lie perfectly still, it’s not too bad.” The question is … What is “what precipitates or worsens your pain?” Return to Game Board Return to Game Board
  • 18. PQRST for 200 The answer is … “It feels like a lightning bolt at first, but ends up numb and tingling.” The question is … What is “describe the quality of your pain?” Return to Game Board Return to Game Board
  • 19. PQRST for 300 The answer is … “I can’t eat, I can’t sleep, I can’t get out of bed, and I cry all of the time.” The question is … What is “what symptoms accompany your pain?” Return to Game Board Return to Game Board
  • 20. PQRST for 400 The answer is … “Right here in the center of my left rib cage, and it moves around to my back.” The question is … What is “where is your pain located?” Return to Game Board Return to Game Board
  • 21. PQRST for 500 The answer is … “That long acting morphine generally controls it, but I have to take the short acting when the pain is 5 or higher, and the heating pad didn’t help at all.” The question is … What is “what have you tried to relieve the pain and how well did it work?” Return to Game Board Return to Game Board
  • 22. Pain Pathogenesis for 100 The answer is … A myelinated, large diameter fiber that transmits sharp, well localized pain. The question is … What is an A-delta fiber? Return to Game Board Return to Game Board
  • 23. Pain Pathogenesis for 200 The answer is … The step during which a noxious stimulus is changed by the body into an action potential. The question is … What is transduction? Return to Game Board Return to Game Board
  • 24. Pain Pathogenesis for 300 The answer is … Enkephalins, dynorphins and beta endorphins. The question is … What are endogenous opioids? Return to Game Board Return to Game Board
  • 25. Pain Pathogenesis for 400 The answer is … Free nerve endings that are activated by noxious stimuli. The question is … What are nociceptors? Return to Game Board Return to Game Board
  • 26. Pain Pathogenesis for 500 The answer is … A relay station for reception and processing of nociceptive information. The question is … What is the thalmus? Return to Game Board Return to Game Board
  • 27. Opioid Facts for 100 The answer is … This opioid is used as a cough suppressant and has the highest incidence of nausea and constipation. The question is … What is codeine? Return to Game Board Return to Game Board
  • 28. Opioid Facts for 200 The answer is … This long-acting opioid is dosed every 12 hours, has minimal active metabolites, and is available as 10, 15, 20, 30, 40, 60 and 80 mg. The question is … What is oxycodone (OxyContin)? Return to Game Board Return to Game Board
  • 29. Opioid Facts for 300 The answer is … This short-acting opioid has poor oral bioavailability and is available parenterally, transdermally, and as an oral transmucosal lozenge, an effervescent tablet, a transmucosal film, a sublingual tablet and intranasal spray. The question is … What is fentanyl? Return to Game Board Return to Game Board
  • 30. Opioid Facts for 400 The answer is … This opioid used to be commonly used for acute pain, and has an active metabolite that can accumulate and cause CNS excitation including seizures. The question is … What is meperidine? Return to Game Board Return to Game Board
  • 31. Opioid Facts for 500 The answer is … This combination analgesic is no more effective than plain acetaminophen and its active metabolite causes sedation and confusion, particularly in the elderly, and most importantly IS OFF THE MARKET! The question is … What is Darvocet N-100? Return to Game Board Return to Game Board
  • 32. Neuropsychiatric Symptoms for 100 The answer is … A patient with opioid-induced daytime sedation is best treated with this agent, which may also be used to treat depression. The question is … What is methylphenidate? Return to Game Board Return to Game Board
  • 33. Neuropsychiatric Symptoms for 200 The answer is … A patient with acute agitated, confused behavior and a history of Parkinson’s disease is best treated with this behavior. The question is … What is quetiapine (or another atypical antipsychotic agent) Return to Game Board Return to Game Board
  • 34. Neuropsychiatric Symptoms for 300 The answer is … Neuropathic pain AND depression are best treated with this type of antidepressant. The question is … What is a TCA (e.g., nortriptyline or desipramine) or SNRI (e.g., duloxetine or venlafaxine)? Return to Game Board Return to Game Board
  • 35. Neuropsychiatric Symptoms for 400 The answer is … This medication, used adjunctively to treat metastases to the brain, to reduce intracerebral edema, and to treat metastatic bone pain may cause anxiety or delirium. The question is … What is dexamethasone (or other CCS)? Return to Game Board Return to Game Board
  • 36. Neuropsychiatric Symptoms for 500 The answer is … The number of anxiety-induced dyspnea attacks may be reduced by this agent. The question is … What is lorazepam (or other BZD)? Return to Game Board Return to Game Board