Palliative Care

Question 1

What are the non-drug aspects of palliative care?

Answer 1

Self-help and education
Psychological support
Social support
Rehabilitation
Spiritual services
Bereavement care

Question 2

How do you convert oral codeine/dihydrocodeine to oral morphine sulphate?

Answer 2

Divide by 10

Question 3

How do you convert oral tramadol to oral morphine sulphate?

Answer 3

Divide by 10

Question 4

What is the maximum daily dose of codeine?

Answer 4

240mg

Question 5

What is the usual dose for codeine?

Answer 5

30-60mg 4hrly

Question 6

What is the usual does of amitriptyline?

Answer 6

10mg ON working up to 75mg ON

Question 7

What should you always prescribe with NSAIDs

Answer 7

Omeprazole 20mg OD

Question 8

What should prescribe alongside opiates?

Answer 8

Metoclopramide 10mg TDS

Senna

Question 9

What is the PRN dose of morphine if on MST?

Answer 9

1/6th of daily MST dose

Question 10

How do you convert oral morphine to subcut MST?

Answer 10

Divide by 2

Question 11

How do you convert oral morphine to subcut Diamorphine?

Answer 11

Divide by 3

Question 12

What opiate should you use if they have poor renal function?

Answer 12

Oxycodone

Question 13

How do you convert oral morphine to oral oxycodone?

Answer 13

Divide by 2

Question 14

How do you convert oral to subcut oxycodone?

Answer 14

Divide by 2

Question 15

How do you convert oral morphine to subcut oxycodone?

Answer 15

Divide by 4

Question 16

How do you convert oral morphine to transdermal fentanyl?

Answer 16

Divide by 3.6

Mg -> micrograms

Question 17

When is oromorph effective?

Answer 17

After 30mins

Up to 4 hours

Question 18

When in MST (Zomorph) effective?

Answer 18

After 4 hours

Up to 12 hours

Question 19

What is the typical daily starting dose for morphine-naive patients?

Answer 19

20-30mg

Question 20

How should morphine dose be titrated?

Answer 20

Achieve stable daily dose with oromorph
Convert this dose to MST
Add in 1/6th PRN
Follow-up in 2wks

Question 21

Which opiates can be given by syringe pump?

Answer 21

MST
Oxycodone
Diamorphine

Question 22

How frequently are fentanyl patches applied?

Answer 22

Every 72hrs

Question 23

What doses of fentanyl patches are available?

Answer 23

12micrograms
25mcg
50mcg
75mcg
100mcg

Need oral morphine PRN as well

Question 24

How often are Buprenorphine patches applied?

Answer 24

Every 7 days

5, 10, 20mcg

Question 25

How do you convert oral morphine to buprenorphine?

Answer 25

Divide by 1.7 | Mg -> mcg

Question 26

What is good for skeletal muscle spasms?

Answer 26

Diazepam 2-5mg ON

Question 27

Which antiemetics may worsen Parkinson Sx?

Answer 27

Metoclopramide Haloperidol Levomepromazine

Question 28

Which antiemetics may be useful in those with Parkinson's?

Answer 28

Domperidone | Ondansetron

Question 29

What are the features of intestinal obstruction in advanced cancer?

Answer 29

Nausea post meals Vomiting undigested food Dull aching or colicky pain Distension

Question 30

What is the differential diagnosis of intestinal obstruction?

Answer 30

Constipation secondary to faecal impaction

Question 31

What drugs should be avoided with intestinal obstruction?

Answer 31

Metoclopramide | Laxatives if complete obstruction

Question 32

What drugs may help intestinal obstruction?

Answer 32

Hyoscine butylbromide = antispasmodic

Question 33

What are some stool-softening laxatives?

Answer 33

Lactulose Movicol Docusate

Question 34

What are some stimulant laxatives?

Answer 34

Senna | Bisacodyl

Question 35

What is the first line antiemetic in bowel obstruction?

Answer 35

Cyclizine or haloperidol Cyclizine may be incompatible with Buscopan

Question 36

What is the first line antiemetic for chemical nausea?

Answer 36

Haloperidol

Question 37

What is the first line antiemetic for raised ICP

Answer 37

Dexamethasone +/- cyclizine

Question 38

What are the 4 anticipatory medications in SC?

Answer 38

Morphine 5-10mg/24hr Haloperidol 500mcg PRN Hyoscine butybromide 20mg PRN Midazolam 2-5mg PRN Remember water for injection