Palliative care

Question 1

what benefits could early palliative care provide a patient with metastatic NSCLC?

Answer 1

early pall care can provide significant improvements in QOL and mood
it improved survival!
less aggressive care at end of life

Question 2

what is the recommended therapy for opioid associated itch?

Answer 2

the best thing would be to rotate to another opioid or to trial some antihistamine

Question 3

what occurs downstream after activation of the mu receptor?

Answer 3

there are pre and post synaptic opioid receptors

the result: presynaptic inhibition of the neurotansmitter release
AND
post-synaptic inhibition of evoked activity
there is also an effect on C-fibre terminals via inhibition of adenyl cyclase and calcium channels and activation of potassium channels

Question 4

what is the oral morphine to hydromorphone conversion?

Answer 4

5mg of morphine is equal to 1mg of hydromorphone

Question 5

what is the P450 interaction associated with fentanyl?

Answer 5

CYP3A4 is the bad boy in this case

this is problematic with inhibitors such as fluconazole, erythromycin, diltiazem and cimetidine

Question 6

how does buprenorphine work?

Answer 6

it is a partial mu receptor agonist.

it has high affinity but low efficacy

SAFE IN RENAL FAILURE

Question 7

why do some people get no response to codeine?

Answer 7

this is because they are slow metabolisers of CYP2D6

10% of caucasians

Question 8

what opioids are safe in renal failure?

Answer 8

fentanyl, sufentanil
methadone
buprenorphine

renail function has a MAJOR influence on regular morphine. Oxycodone is significantly impacted, and hydromorphone - we don’t know