gerris, palliative

Question 1

Tx: N/V visceral causes (constip/oral candida)

Answer 1

metoclopramide
cyclizine
hyoscine

Question 2

Tx: resp secretions, bowel colic

Answer 2

hyoscine hydrobromide

Question 3

Tx: aggitation/restless

Answer 3

midazolam
haloperidol
levomepromazine

Question 4

Tx: Pain

Answer 4

diamorphine

Question 5

Tx hiccups

Answer 5

chlorpormazine

haloperidol

Question 6

Tx: N/V from gastric stasis and for gastric dysmobility

Answer 6

metoclopramide (dopamine 2 receptor antagonist)

domperidone

Question 7

Tx: N/V from chemo and post op

Answer 7

odansetron

Question 8

Tx: N/V from raised ICP

Answer 8

Dexamethazone

Cyclizine

Question 9

Tx: N/V from vestibular

Answer 9

Cyclizine

Metoclopramide

Question 10

Lewy body dimentia

Answer 10

dementia
visual hallucinations
parkinsonism

Question 11

Lewy body dimentia tx

Answer 11

acetylcholinesterase inhibitors (donepezil, rivastigmine) and memantine

Question 12

Opioids with CKD

Answer 12

Alfentanil
Buprenorphine
Fentanyl

Question 13

Confusion Screen

Answer 13

Routine bloods
B12/folate - macro anemias and B12/F deficiencies worsen confusion
TFTs: hypothyroid
Glucose: hypoglycemia
Bone profile: hypercalcemia

Question 14

Delirium predisposing factors

Answer 14

>65
dementia
sig. injury (hip #)
frailty, multimorbidity
polypharmacy

Question 15

Delirium precipitating events

Answer 15

infection (UTI)
metabolic (hypercal, hypoglyc, hyperglyc, dehydration)
environment change
CVS, Resp, Neuro, Endo
Pain
Alcohol withdrawal
Constipation

Question 16

Delirium first line sedative

Answer 16

Haloperidol
Olanzapine

IF PARKINSONS
Quetiapine, Clozapine, lorazepam

Question 17

Vascular dementia RFs

Answer 17

Hx of stroke or TIA
A Fib
HTN
DM
Hyperlipidemia
Smoking
Obestiy
Coronary heart disease
FHx stroke, CVD

Question 18

When can you use AChE inhibitors (donepezil) or memantine

Answer 18

Alzheimers
Parkinson’s disease dementia
Lewy body dementia

Question 19

Codeine to morphine divide by:

Answer 19

10

Question 20

How much to increase morphine dose by if pain uncontrolled

Answer 20

30-50%

Question 21

Oral morphine to subcut :

Answer 21

divide by 2

Question 22

Breakthrough morphine dosing:

Answer 22

Divide 24h requirement by 6

Question 23

Tx: confusion

Answer 23

1: haloperidol
2: chlorpromazine or levomepromazine
terminal phase: midazolam

Question 24

Palliation of raised ICP from brain mets

Answer 24

dexamethasone BD x 5-7d

Question 25

Opioid in mile/moderate renal impairment

Answer 25

oxycodone

Question 26

oxycodone metabolism

Answer 26

Liver (19% renal)

Question 27

Fentanyl metabolism

Answer 27

liver

Question 28

morphine metabolism

Answer 28

active metabolites accumulate in renal failure

Question 29

Dihydrocodeine metabolism

Answer 29

renal

Question 30

middle aged adult with insidious onset dementia + personality changes:

Answer 30

Pick's disease - frontotemporal dementia

Question 31

haloperidol in parkinsons?

Answer 31

contraindicated

Question 32

memantine

Answer 32

NMDA receptor antagonist - second line or severe alzheimers

Question 33

donepezil

Answer 33

AChE inhibitor | first line Alz

Question 34

how long warfarin after DVT/PE

Answer 34

6 mo

Question 35

Oral morphine to subcut diamorphine

Answer 35

divide by 3

Question 36

Oral oxy to subcut diamorphine

Answer 36

Divide by 1.5

Question 37

Digoxin tox

Answer 37

GI (N/V/pain), dizziness, confusion, blurry or yellow vision, arrhythmias

Question 38

Anticholinergic SE (amitriptyline)

Answer 38

``` Dry eyes Dry mouth Hypotension (postural) Delirium Constipation Urinary retention Arrhythmias (long QT) Hypothermia ```

Question 39

Indapamide

Answer 39

thiazide diuretic

Question 40

Meds causing postural hypotension

Answer 40

``` Nitrates Diuretics Anticholinergic Antidepressant Beta Blocker L-Dopa ACEi ```

Question 41

Meds causing falls

Answer 41

``` Benzos Antipsychotics Opiates Anticonvulsants Codeine Digoxin Sedatives ```