Palliative Care

Question 1

What is the first line pain management in palliative care
Give examples

Answer 1

Non-opioid
Paracetamol
NSAIDs

Question 2

What is the second line pain management in palliative care
Give examples

Answer 2

Opioids
E.g. codeine and morphine

Question 3

What adjuvants are used in pain management in palliative care
Give examples

Answer 3

Anti epileptics - gabapentin

Antidepressants - amitriptylline

Question 4

What tool is used to decide what pain medication should be used in cancer care

Answer 4

WHO analgesic ladder

Question 5

What type of pain medication is used for cancer pain

Answer 5

Strong opioids

Question 6

What is the first line for cancer pain

Answer 6

Morphine oral MR and IR morphine for breakthrough pain

Question 7

Is morphine is not tolerated and a patient has cancer pain what 4 alternatives can be used ?

Answer 7

Oxycodone
Fentanyl
Buprenorphine
Hydromorphone

Question 8

What is required when administering morphine/ strong opioids for cancer pain

Answer 8

Regular monitoring of pain and side effects

Question 9

What side effects are associated with laxatives and how can they be reduced/solved?

Answer 9

Respiratory depression
Nausea/vomitting - give antiemetic
Constipation - laxatives [avoid bulk forming]

Question 10

What is the most common cause of dysphasia in pallative care

Answer 10

Oesophagitis

Question 11

What medication is given to treat dysphasia

Answer 11

Dexamethasone

Question 12

What is the medication used to treat dysphasia caused by oesophagitis

Answer 12

Sublingual glyceryl trinitrate before meals

Question 13

What 3 drug classes cause dry mouth

Answer 13

Antidepressants
Antiemetics
Antimuscarinics

Question 14

How do you treat dry mouth [there are 5 things]

Answer 14

Artificial saliva
Sucking ice chips
Good mouth care
Frequently sipping water
Chewing sugar free gum

Question 15

What medication used to treat hiccups is pro kinetic

Answer 15

Metoclopramide

Question 16

What medications used to treat hiccups are antiflatulents [2]

Answer 16

Simeticone
Peppermint oil

Question 17

What 5 drugs are used for hiccups

Answer 17

Lansoprazole
Omeprazole
Simethicone
Peppermint oil
Metoclopramide

Question 18

What is used to treat an intractable dry cough ? And give examples

Answer 18

Demulcents

E.g. simple linctus and morphine

Question 19

What is used to treat an intractable cough with sticky sputum ? And give examples

Answer 19

EXPECTORANTS
E.g. nebulised NaCl

MUCROLYTICS
E.g. Acetylcysteine

Question 20

First line for constipation in palliative care

Answer 20

Stimulant laxatives such as Senna

Question 21

2nd line for constipation in palliative care

Answer 21

Osmotic laxative such as lactulose

Question 22

Which laxatives should be avoided in patients in palliative care with constipation? And why

Answer 22

Bulk forming laxatives
Can cause intestinal obstruction

Question 23

What is used to treat bowel colic

Answer 23

Hyoscine butylbromide

Question 24

What is used to treat colic in palliative care

Answer 24

Docusate sodium suppositories or enemas

Question 25

What is used for unresponsive opioid induced constipation

Answer 25

Methylnaltrexone

Question 26

What medication can cause insomnia [2]

Answer 26

Corticosteroids Diuretics

Question 27

What 5 conditions can cause insomnia in palliative care patients

Answer 27

Pain Depression Anxiety Delirium Obstructive sleep apnoea

Question 28

What 5 medication groups are used to treat insomnia in palliative care patients Give examples of each

Answer 28

Benzodiazepines - Midazolam Z drugs - Zolpidem Antidepressants - Doxepin, Trazadone Antipsychotics - Olanzapine Melatonin

Question 29

What is used to treat agitation with anxiety

Answer 29

Benzodiazepines

Question 30

What is used to treat agitation and delirium

Answer 30

Haloperidol

Question 31

What medication is used to treat anxiety that has lasted/lasts months

Answer 31

SSRI without BZP

Question 32

What 2 medications are used to treat anxiety that lasts for weeks-months

Answer 32

Diazepam Lorazepam

Question 33

Non pharmacological treatment for anxiety

Answer 33

CBT

Question 34

What is the first line pharmacological treatment for breathlessness in palliative care patients

Answer 34

Trial of bronchodilators

Question 35

What is the pharmacological treatment for advanced breathlessness in palliative care patients

Answer 35

Low dose morphine

Question 36

What are the pharmacological treatments for anxiety induced breathlessness in palliative care patients There are 3

Answer 36

SSRI Benzodiazepines Corticosteroids

Question 37

What non pharmacological interventions/advice can be given/advised for breathlessness There are 4

Answer 37

Using a fan Breathing technology Relaxation Positioning [slight elevation]

Question 38

What is the first line treatment of seizures for patients in palliative care

Answer 38

Levetiracetam

Question 39

What seizure medication is used in the last days of life

Answer 39

Midazolam

Question 40

What is anticipatory prescribing

Answer 40

Prescribing that ensures that patients with advancing illness and uncontrolled symptoms have timely access to medication

Question 41

What antiemetic is given in anticipatory prescribing

Answer 41

Levomepromazine subcutaneous injection 2.5-5mg

Question 43

What antisecretory is given in anticipatory prescribing

Answer 43

Hyoscine butylbromide injection 20mg [buscopan]

Question 44

What medication is given for pain and breathlessness in anticipatory prescribing

Answer 44

10 ampoules of morphine sulphate injection 2.5mg/hr

Question 45

What anxiety/agitation/breathlessness is given for pain and breathlessness in anticipatory prescribing Not terminal patients

Answer 45

Sedative anxiolytics e.g. Midazolam injection

Question 46

What anxiety/agitation/breathlessness is given for pain and breathlessness in anticipatory prescribing For terminal patients

Answer 46

Terminal agitation and delirium Levomepromazine

Question 47

what is palliative care

Answer 47

Interdisciplinary approach designed to improve the QOL for patients with serious, chronic or life-threatening illnesses

Question 48

Goal of palliative care

Answer 48

Symptom management Psychological, social and spiritual support

Question 49

What is end of life care

Answer 49

Specialised palliative care provided in the final phase of a patients life

Question 50

Goal of end of life care

Answer 50

Focuses on comfort, dignity and support as the patient approaches death It must respect a persons wishes Provides support to family

Question 51

What is deprescribing

Answer 51

Safely withdrawing medication that is no longer beneficial or wanted in agreement with patient or family/carer