Palliative Care

Question 1

Mx. - Agitation and confusion

Answer 1

Look for specific cause and treat - failing that:

1) Haloperidol
2) other options = chlorpromazine, levopromazine
* In terminal phase of illness agitation is best treated with MIDAZOLAM

Question 2

Mx. - Hiccups

Answer 2

Chlorpromazine

Haloperidol, gabapentin

Question 3

Mx. Nausea and vomiting
Chemically related: 
Visceral/serosal causes = 
Raised ICP =  
Vestibular = 
Cortical =

Answer 3

Based on cause:
Chemically related: Ondansetron, haloperidol, levopromazine

Visceral/serosal causes = Cyclizine

Raised ICP = Cyclizine, Dexamethasone

Vestibular = Cyclizine -> olanzapine, risperidone

Cortical = Lorazepam -> ondansetron and metoclopramide may also be trialled

Question 4

Mx. Nausea and vomiting - Routes of administration

Answer 4

Oral preferred. unless pt. is vomiting -> parenteral route preferred.

Question 5

Mx. Secretions

Answer 5

hyoscine hydrombromide/butylbromide

-> glycopyronium bromide

Question 6

Mx. PAIN starting tx.

Answer 6

Oral Morphine (20-30mg/day with 5mg BREAKTHROUGH)
Oral used in preference to patches.

Question 7

What to co-prescribe with opiods?

Answer 7

Laxatives

Question 8

Breakthrough dose of morphine (fraction)?

Answer 8

1/6th of daily dose (30mg = 5mg bt)

Question 9

Preferred opioid in renal disease?

Severe renal disease

Answer 9

Oxycodone
Buprenorphine
Fentanyl

Question 10

What may be used in addition to strong opioids, bisphosphonates and RT in metastatic bone pain

Answer 10

Denosumab

Question 11

Opioid side-effects

Answer 11

Transient - nausea, drowsiness

Persistent - Constipation

Question 12

Oral codeine to oral morphine conversion

Oral tramadol to oral morphine conversion

Answer 12

DIVIDE BY 10

DIVIDE BY 10

Question 13

Oral morphine to oral oxycodone

Answer 13

DIVIDE by 1.5-2

Question 14

Oral morphine to SC morphine

Answer 14

DIVIDE BY 2

Question 15

Oral morphine to SC diamorphine

Answer 15

DIVIDE by 3

Question 16

Oral oxycodone to SC diamorphine

Answer 16

DIVIDE by 1.5

Question 17

What drugs require sodium-chloride 0.9% for syringe driver.

Answer 17

Granisetron
Ketamine
Octreotide
Ondansetron

Question 18

Commonly used drugs
N&V:
Resp secretions:
Agitation/retlessness

Answer 18

Cyclizine, levopromazine, haloperidol, metoclopramide Hyoscine
Midazolam, haloperidol levopromazine
Pain: DIAMORPHINE preferred

Question 19

Purpose for syringe drivers

Answer 19

When patients unable to take oral medication due to nausea , dysphagia, intestinal obstruction, weakness

Question 20

Cyclizine is incompatible with

Answer 20

clonidine, dexamethasone, hyoscine, ketamine, metoclopramide, midazolam, octreotide

Question 21

Mx. pain (acute)

Answer 21

Diamorphine