Palliative Care

Question 1

Management of breathlessness

Answer 1

Morphine 1mg PO PRN/sustained release 5mg BD

Short acting Benzos- lorazepam 0.5mg

Question 2

Types of laxatives and their uses

Answer 2

Bulking agents- fybogel- fibre- not used in poor intake or poor bowel

Stimulant- Senna- not used in obstruction or colonostomy

Osmotic-pull water in- lactulose, movicol

Question 3

When to give ondansetron

Answer 3

Chemo
Abdo Radio
Abdo surgery

Question 4

When to give cyclizine

Answer 4

Central vomiting
CNS lesion
Labrythnitis

Question 5

When to give Metoclopramide

Answer 5

Delayed GIT transit
Bowel obstruction

Question 6

When to give Haloperidol

Answer 6

Chemical causes
Renal failure
Drug causes

Question 7

SE of ondansetron

Answer 7

Constipating
QT prolongation

Question 8

Haloperiol SE

Answer 8

Parkinsons
Lower seizure threshold

Question 9

Metoclopramide SE

Answer 9

Parkinsons
Cardiac
young women- movement disorders

Question 10

Conversion of tramadol to morphine oral

Answer 10

/10
Any step 2 to Morphine

Question 11

Oral morphine to SC morphine (SYRINGE)

Answer 11

/2

Question 12

Oral morphine to oral oxycodone

Answer 12

/2

Question 13

Immediate to Modified release for morphine

Answer 13

Convert to BD
Same for oxycodone

Question 14

Calculating PRN doses

Answer 14

Calculate daily dose
PRN =daily/6

Question 15

What to usually co prescribe with opioid

Answer 15

Anti emetic
Laxative

Question 16

Which opioids are safe in renal failure

Answer 16

Fentanyl
Alfentanil
Buprenorphine

Question 17

Common symptoms in patients in last hours/days to live

Answer 17

Pain and breathlessness
N+V
Agitation anxiety
Respiratory secretions

Question 18

Prescription for symptoms for last hours to live

Answer 18

Morphine- 2.5-5 SC 1-2hrs PRN - pain
Midazolam- “- agitation
Glycopyrronium- 0.2-0.4 SC QDS PRN- secretions
Haloperidol 0.5-1.5 SC BD PRN - N+V

Question 19

Preferred opioid in palliative care

Answer 19

Diamorphine

Question 20

Increasing pain treatment

Answer 20

Increase by 1/3rd if pain not 90% received

Question 21

Mx of hiccups

Answer 21

Chlorpromazine

Question 22

Tx of secretions

Answer 22

Hyoscrine 1st
Glycopyyronium

Question 23

Tx of agitation and confusion

Answer 23

Haloperidol
Chlopromazine

Terminal restlessness- midazolam

Question 24

What should you increase morhpine by if not controlled

Answer 24

30-50%

Question 25

If mild renal impairment and SOB and pain what should you give

Answer 25

Oxycodone

Question 26

If on high doses of pain killer with metastatic disease pain not controlled what can you do next

Answer 26

If spinal cord involvement- dex

If no- radio, bisphosphonates

Question 27

Morphine to diamorphine SC

Answer 27

Divide by 3

Question 28

Treatment of bowel colic

Answer 28

Hyoscrine

Question 29

Tx of mouth pain in end of life

Answer 29

Benzydamine Hydrochloride