PALLIATIVE/GERIATRICS

Question 1

Palliative Pain Relief Prescribing

• Start with first-line i.e. 1)__ or 2)__ if unable to swallow.
• Breakthrough dose = Reguar Dose/3)
• While increasing the dose, the factor is 4)_
• In CKD, 5)__ are preferred.
• Hierarchy of treatment of Metastatic Bone Pain is 6)__
• S/E of opioids are 7)__. All patients must be prescribed 8)__

Answer 1

1 - Oral MR/Oral IR morphine 15mg bd + Oral IR morphine for
breakthrough pain 5mg

2 - Transdermal fentanyl patch

3 - 6

4 - 30-50%

5 - Oxycodone/Alfentanil/Buprenorphine/Fentanyl

6 - Strong opioids/Bisphonates/Radiotherapy/Denosumab

7 - Transient nausea/Drowainess/Pruritus, Persistent Constipation

8 - Laxatives

Question 2

OPIOD Conversion factors

Oral Codeine to Oral morphine - 1

Oral Tramadaol to Oral Morphine - 2

Oral Morphine to Oral Oxycodone - 3

Oral Morphine to S/C Morphine - 4

Oral Morphine to S/C Diamorphine - 5

Oral Oxycodone to S/C Diamorphine - 6

7) __mg Oral Morphine = 8)__mcg Transdermal Fentanyl
9) __mg Oral Morphine = 10)__mcg Transdermal Buprenorphine

Answer 2

1 = 2 = Divide by 10

3 = 1.5

4 = 2

5 = 3

6 = 1.5

7 = 30. 8 = 12.

9 = 24. 10 = 10.

Question 3

Dementia popular causes - 1

MMSE Score of 2)__ is diagnostic

Investigations - 3)__ to rule out 4)__

Rx of choice - 5)

6)__ should be avoided in all dementia patients due to increase in mortality

Answer 3

1 - Alzheimer —> Vascular —> Lewy Body

2 - (<=24/30)

3 - Blood Screen —> Neuroimaging

4 - Reversible Causes (Hypothyroidism/VIT B 12 def/NPH/Head Injury)

5 - Supportive care + Ach.esterase inh (Donepezil/Galantamine/
Rivastigmine) —> MDMA inh (Memantine)

6 - Antipsychotics

Question 4

TERMINAL ILLNESS PRESCRIBING SCENARIOS

Rx of choice of Agitation and Restlessness in Terminally ill is 1)__

Rx of choice in Acute Confusion State/Delirium is 2)__

Rx of choice in intractable hiccups is 3)__

Rx of choice in mouth pain post chemo/radio is 4)

Answer 4

1 - S/C Midazolam

2 - Haloperidol —> Lorazepam if underlying Parkinson’s

3 - Chlorpromazine —> Gabapentin/Haloperidol —> Dexamethasone (hepatic lesions)

4 - Benzydamine Mouthwash

Question 5

Delirium vs Dementia

Factors favouring Delirium over dementia are

Answer 5

Impaired Consciousness
Fluctuating Symptoms
Delusions/Illusions/Hallucinations
Fear and agitation

Question 6

Commonly used drugs in syringe drivers

N&V = 1

Respiratory secretions = 2

Bowel Colic = 3

Agitation/Restlessness = 4

Pain = 5

Answer 6

1 = Cyclizine/Levomepromazine/Haloperidol/Metoclopramide

2 = Hyoscine Hydrobromide

3 = Hyoscine Butylbromide

4 = Midazolam/Haloperidol/Levomepromazine

5 = Diamorphine

Question 7

Rx of Choice for Vascular Dementia is 1)__

Answer 7

1 = Tight control of vascular risk factors

Question 8

Donepezil is contraindicated in

Answer 8

Brady/Heart Block

Concurrent use of Beta blocker/CCB/Digoxin