Palliative Care

Question 1

o Starting doses for oromorph?

Answer 1

2.5-5mg, 4-hourly

Question 2

if pain not 90% relieved, how much should the dose be increased by?

Answer 2

o Increase by 1/3rd (30-50%)

Question 3

o Breakthrough doses of morphine should be what?

Answer 3

= 1/6th of total morphine in 24 hours

Question 4

Bony metastasis pain:

Answer 4

1st: Analgesia
2nd: Bisphosphonates
3rd: Radiotherapy

Question 5

• Immediate release morphine formualations: (IR; ≤4 hours):

Answer 5

o Oromorph (liquid)
o Sevredol (tablet)
o Morphine injection

Question 6

• Modified release morphine (MR):

Answer 6

o MST / zomorph (BD)
o MXL (OD)

Question 7

Metoclopramide - avoid in which patients?

Answer 7

• Avoid in Parkinson’s (DA antagonist) – use domperidone (does not cross BBB)
• Avoid in young women (risk of dyskinesia i.e. acute dystonia)

Question 8

Which anti-emetic to prescribe in fluid retention?

Answer 8

Metoclopramide, avoid cyclizine

Question 9

Vestibular N&V drug choice?

Answer 9

Cyclizine

Question 10

Raised ICP N&V drug choice?

Answer 10

Cyclizine (± dexamethasone)

Question 11

Chemical N&V drug choice?

Answer 11

Ondansetron, haloperidol, levomepromazine

Question 12

Which drug for chemotherapy nausea?

Answer 12

Ondansetron

Question 13

Gastric stasis N&V drug choice?

Answer 13

Metoclopramide (CI: BO), domperidone

Question 14

Constipation, oral candidiasis N&V drug choice?

Answer 14

Cyclizine, levomepromazine

Question 15

Anxiety, pain, fear, anticipatory nausea N&V drug choice?

Answer 15

BDZ (lorazepam), cyclizine

Question 16

2nd line Mx for agitation/confusion?

Answer 16

o 2nd line: chlorpromazine, levomepromazine

Question 17

Terminal restlessness treatment?

Answer 17

Midazolam (PRN SC injections or SC infusion by syringe driver)

Question 18

Treatment for excess secretions?

Answer 18

o Medical:
1st line: hyoscine hydrobromide / butylbromide
2nd line: glycopyrronium bromide

Question 19

Hiccups mx in palliative care?

Answer 19

• Management:
  o 1st line: chlorpromazine
  o 2nd line: haloperidol, gabapentin
  o Hepatic lesions: dexamethasone

Question 20

Treatments for neuropathic pain?

Answer 20

Amitriptyline, gabapentin, pregablin, duloxetine

Question 21

Which cancers are most likely to cause Bone metastases?

Answer 21

Precious bone killed through lesions
Prostate, breast, kidney, thyroid, lung

Question 22

Marker of bone degeneration?

Answer 22

ALP

Question 23

Most common histological prostate cancer?

Answer 23

Adenocarcinoma

Question 24

Tx for intermediate/high grade prostate cancer?

Answer 24

Radical prostectomy

Question 25

Types of breast cancer?

Answer 25

Ductal carcinoma in situ, lobular carincoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, paget's disease of the breast, inflammatory breast cancer

Question 26

Sites of metastasis in breast cancer?

Answer 26

Lung, liver, bone, brain, adrenals

Question 27

Treatment for HER2 positive breast cancer?

Answer 27

Herceptin

Question 28

ER/PR positive breast cancer treatments?

Answer 28

Pre-menopausal = tamoxifen Post-menopausal = aromatase inhibitors: letrozole, anastrozole

Question 29

Small cell lung cancer buzzwords?

Answer 29

Cushing's syndrome (ACTH production) SIADH ( ADH production)

Question 30

Large cell lung cancer buzzwords?

Answer 30

Gynaecomastia

Question 31

Squamous cell lung carcinoma buzzwords?

Answer 31

Hypercalcaemia secondary to PTHrp production

Question 32

Adenocarcinoma of the lung buzzwords?

Answer 32

Low smoking risk, most common

Question 33

Tx for SVCO?

Answer 33

Give dexamethasone Might need intubation Diuretics Endovascular stenting

Question 34

What is adjuvant chemotherapy?

Answer 34

Given AFTER surgery

Question 35

What is neo-adjuvant chemotherapy?

Answer 35

Given before surgery to help reduce the size of the tumour

Question 36

Tx for end of life breathlessness?

Answer 36

oral morphine, midazolam

Question 37

Conversion from oral to SC morphine?

Answer 37

x0.5

Question 38

Conversion from oral to SC diamorphine?

Answer 38

x0.33

Question 39

Conversion from morphine to tramadol?

Answer 39

x10

Question 40

Conversion from oral morphine to oral oxycodone?

Answer 40

x0.5

Question 41

Conversion from morphine to codeine?

Answer 41

x10

Question 42

Conversion from morphine to pethidine IV?

Answer 42

x2.5

Question 43

Conversion from morphine to fentanyl IV?

Answer 43

x0.005