Side effects of Palliative Medications

Question 1

What is the most common side effect of morphine?

Answer 1

Constipation >90% of patients

Question 2

Give 5 side effects of morphine sulphate

Answer 2

1. Nausea and vomiting
2. Drowsiness
3. Confusion and agitation
4. Physical dependence
5. Reduced respiratory rate

Question 3

What are the signs and symptoms of opioid toxicity?

Answer 3

1. Persistent drowsiness
2. Pinpoint pupils
3. Confusion (often persistent)
4. Myoclonic jerks
5. Hallucinations (intense)
6. Respiratory depression

Question 4

What is Hyoscine hydro/butylbromide used for?

Answer 4

Prescribed for palliative patients with excessive secretions to prevent production of mucous.

Question 5

What type of drug is Hyoscine Butlybromide? What side effects are common?

Answer 5

1. Anticholinergic drug that acts by slowing down peristalsis and reduces secretions in GI tract

SIDE EFFECTS:
a. dry eyes
b. dry mouth
c. constipation/bowel obstruction
d. urinary retention
e. blurred vision

Question 6

What type of anti-emetic is Metoclopramide?

Answer 6

D2 receptor antagonist

Question 7

How does Metoclopramide work?

Answer 7

1. Prokinetic, promotes gastric emptying by smooth muscle contraction
2. Indicated for opioid nausea

Question 8

Metoclopramide side effects and contra indications

Answer 8

SE: colic/abdo pain as it can irritate the gut lining

Do NOT give with cyclizine or in patients with Parkinson’s

Question 9

What type of anti-emetic is
Domperidone?

Answer 9

D2 receptor antagonist

Question 10

What type of anti-emetic is Haloperidol?

Answer 10

D2 receptor antagonist

Usually used in those with renal failure. Used for patients with drug induced nausea.

Question 11

What is Levomepromazine?

Answer 11

Broad spectrum anti-emetic used in EoL. H1 receptor antagonist that can cause drowsiness, postural hypotension and SEIZURES

Question 12

What is Cyclizine?

Answer 12

Anticholinergic antihistamine with an unknown mechanism of action (it is to be avoided with metoclopramide as it is anti-kinetic)

Question 13

What is cyclizine most often used for?

Answer 13

• Raised Intercranial pressure
• Motion sickness

Question 14

Side effects of Cyclizine

Answer 14

1. Delirium
2. Hallucinations
3. Can exacerbate heart failure
4. Anticholinergic e.g. dry eyes, mouth, urinary retention

Question 15

Why can Cyclizine and Levopromazine not be prescribed simultaneously?

Answer 15

Can never prescribe Cyclizine and Levopromazine together as they have opposite mechanisms so they block the pathways for each other

Question 16

Ondanseteron - what is it and how does it work?

Answer 16

1. Anti emetic used for chemotherapy nausea and vomiting
2. 5HT3 receptor antagonist

Question 17

What is the main side effect of Ondanseteron?

Answer 17

Constipation

Question 18

What is Midazolam prescribed for?

Answer 18

Defined as a anxiolytic, used in patients with terminal agitation.

Question 19

Side effects of Midazolam

Answer 19

1. Agitation
2. Drowsiness and confusion
3. Seizures/myoclonic jerks