Passmedicine Questions Flashcards
What pain relief is most appropriate in palliative care patients with severe renal impairment?
Buprenorphine or fentanyl (they are not really excreted so less likely to cause toxicity)
What is the conversation factor between oral morphine to diamorphine?
Divide the total daily morphine by 3
How are respiratory secretions and bowel colic treated?
Hyoscine butyl bromide
Hyoscine hydrobromine
glycopyrronium bromide
What pain relief is preferred in patients with mild-moderate renal impairment?
Oxycodone is preferred over morphine
What should be given to patients who are agitated and confused but not in the terminal phase?
Oral haloperidol
What should be given for agitation and confusion in the terminal phase of the illness?
Subcutaneous midazolam
What can be seen in morphine toxicity?
Reduced consciousness
Slow respiratory rate
Myoclonic jerks
Pinpoint pupils
What is the breakthrough dose of morphine?
Breakthrough dose = 1/6th of daily morphine dose
What is the treatment for metastatic bone pain?
Analgesia
Bisphosphonates
Radiotherapy
What is the treatment for a painful mouth at the end of life?
Benzydamine hydrochloride mouthwash
What are the indications for the use of different anti-emetics?
Cyclizine - good if intracranial cause of nausea and vomiting (+Dexamethasone)
Domperidone + Metoclopramide - good if nausea and vomiting is caused by gastric stasis
Metoclopramide + haloperidol - if nausea induced by drugs (chemotherapy) and toxins
Ondansetron - for chemically mediated symptoms (like opioids)
What is the conversion of codeine to morphine?
Divide by ten
What is the treatment for a headache caused by raised intracranial pressure?
Dexamethasone
How much can morphine be increased if pain is not controlled?
by 30-50%
What is used to treat hiccups in palliative care?
Chlorpromazine or haloperidol
