Ageing and End of Life Care

Question 1

1. For how long does slow release morphine last? What is it prescribed as? Give an example.
2. For how long does rapid release morphine last? What is it prescribed as? Give an example.

Answer 1

1. 12 hrs and dosage twice daily. Morphine Sulfate M/R. Zomorph or MST
2. 4 hrs and taken PRN. Morphine Sulfate I/R. Oramorph or Sevredol.

Question 2

1. Identify three symptoms of opioid toxicity.
2. What organ’s function should be tested? Why?
3. What major effect can morphine have on the respiratory system?
4. What drug can be used to reverse opioid toxicity?

Answer 2

1. Hallucinations, drowsiness and myoclonus.
2. Renal function.
3. Respiratory depression
4. Naloxone

Question 3

1. What is the second line opioid to morphine?

2. Name two strong opioids used in severe renal impairment.

Answer 3

1. Oxycodone

2. Fentanyl, alfentanil.

Question 4

1. What would you give for the following: Pain, nausea, distress, secretions?
2. What are the 5 factors to confirming death?

Answer 4

1. Pain- morphine, nausea- Levomepromazine, Distress- midazolam, secretions- buscopan
2. Absence of carotid pulse over one minute
   Absence of heart sounds over one minute
   Absence of respiratory sounds over one minute
   No response to painful stimulus (trapezium squeeze)
   Fixed dilated pupils (unresponsive to bright light)

Question 5

1. Identify some of the possible side effects of polypharmacy.
2. Identify some anti-cholinergic side effects

Answer 5

1. Effects cognition- increased risk of delirium, constipation, dizziness and balance problems i.e. parkinsons and postural hypotension, thus increased falls and immobility, anticholinergic syndrome.
2. Confusion and hallucinations
   Tachycardia
   Blurred vision
   Urinary retention
   Constipation
   Dizziness

Question 6

1. Name a prescribing tool used for elderly patients.

Answer 6

1. STOPP-START