passmed

Question 1

Underlying causes of confusion

Answer 1

Underlying causes of confusion need to be looked for and treated as appropriate, for example hypercalcaemia, infection, urinary retention and medication

Question 2

• If specific treatments for agitation and confusion fail then the following may be tried:

Answer 2

first choice: haloperidol
other options: chlorpromazine, levomepromazine

Question 3

• In the terminal phase of the illness then agitation or restlessness is best treated with:

Answer 3

midazolam

Question 4

Six broad nausea and vomiting syndromes in palliative care: which ones most prominent and common

Answer 4

gastric stasis and chemical disturbance being the most common and prominent.

Question 5

Six broad nausea and vomiting syndromes in palliative care

Answer 5

Question 6

Treatment of nausea and vomiting in end of life care

Answer 6

Question 7

• opioids should be used with caution in patients with

Answer 7

CKD

Question 8

• What other medications should be prescribed when prescribing for pain in end of life care

Answer 8

laxatives and antiemetics if needed

Question 9

…is preferred to morphine in palliative patients with mild-moderate renal impairment

Answer 9

oxycodone

Question 10

• if renal impairment is more severe, ……..are preferred

Answer 10

if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

Question 11

metastatic bone pain treatment

Answer 11

metastatic bone pain may respond to strong opioids, bisphosphonates or radiotherapy.

The assertion that NSAIDs are particularly effective for metastatic bone pain is not supported by studies. Strong opioids have the lowest number needed to treat for relieving the pain and can provide quick relief, in contrast to radiotherapy and bisphosphonates.
All patients, however, should be considered for referral to a clinical oncologist for consideration of further treatments such as radiotherapy

Question 12

• When increasing the dose of opioids, the next dose should be increased by

Answer 12

30-50%

Question 13

Opioid side effects: usually transient and those persistent

Answer 13

transient:Nausea
Drowsiness
persistent: constipation

Question 14

Commonly used drugs in syringe driver

Answer 14

• nausea and vomiting: cyclizine, levomepromazine, haloperidol, metoclopramide
• respiratory secretions/bowel colic: hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide.
• agitation/restlessness: midazolam, haloperidol, levomepromazine
• pain: diamorphine is the preferred opioid

Question 15

which medication is added to syringe drivers for bowel colic

Answer 15

Syringe drivers: respiratory secretions & bowel colic may be treated by hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

Question 16

…may be useful in reducing the discomfort associated with a painful mouth that may occur at the end of life

Answer 16

Benzydamine hydrochloride mouthwash or spray may be useful in reducing the discomfort associated with a painful mouth that may occur at the end of life