Palliative Care

Question 1

Symptoms for palliative intervention?

Answer 1

• fatigue
• weakness
• pain
• breathlessness
• poor appetite
• dry mouth
• nausea
• anxiety

Question 2

Explain the opioid ladder

Answer 2

• simple analgesia (NSAIDs, paracetamol, aspirin)
• weak opioid (codeine, tramadol)
• strong opioid (morphine, oxycodone, fentanyl)

Question 3

Prescribing morphine?

Answer 3

• slow release (lasts 12hrs, twice daily)

- immediate release morphine (lasts 4hrs, PRN, Breakthrough dose, 1/6th of daily dose)

Question 4

Signs of opioid toxicity?

Answer 4

• hallucinations
• myoclonus
• drowsiness
• renal failure = opioid build up
• respiratory depression

Question 5

Potential contraindication of morphine or oxycodone?

Answer 5

• renally excreted

- renal failure contraindicated (consider fentanyl)

Question 6

What can be used to reverse opioid?

Answer 6

• naloxone

Question 7

Role of syringe drivers?

Answer 7

• oral route for drugs not possible

- infused over 24hrs

Question 8

Difference between oral and SCUT morphine?

Answer 8

• SCUT (subcutaneous via syringe) is twice as strong as oral

- divide oral / 2

Question 9

Palliative prescribing for pain?

Answer 9

• morphine 2mg hrly SCUT

Question 10

Palliative prescribing for SOB?

Answer 10

• Morphine 2mg SCUT hrly

Question 11

Palliative prescribing for distress?

Answer 11

• midazolam 2mg SCUT hrly

Question 12

Nausea palliative prescribing?

Answer 12

• levomepromazine 2.5mg 12hrly

Question 13

Palliative prescribing for secretions?

Answer 13

• buscopan 20mg scut hrly