Cardiorespiratory and other symptom management

Question 1

Morphine dose pain

Answer 1

5mg every 4-hours for pain, subcut/oral/IM

20-30mg/24h in palliativefor opioid naive + titrate up to 60mg

Question 2

Non-pain indications of morphine

Answer 2

MI

Cough

Dyspnoea

Pulmonary oedema

Question 3

Management of chronic cough

Answer 3

Screen for reflux + anage

If productive –> carbocysteine (mucolytic)

If dry –> low-dose opioids

Question 4

Management of pleural effusion in palliative care

Answer 4

Indwelling catheter

Pleurodesis (adhesion of pleura)

Question 5

Management of haemoptysis in palliative care

Answer 5

Thrombogenic agents (e.g. TXA)

Sedation

IR/Radiotherapy

Question 6

Pharmacological management of anorexia/fatigue

Answer 6

Consider steroids

Psychological interventions

Question 7

Non-pharmacological management of breathlessness

Answer 7

Breathing exercises - e.g. rectangular breathing to raise expiratory time

Fan therapy - for trigeminal stimulation

Positioning - for secretions/HF

OT - energy rationing/planning

Question 8

Morphine dose dyspnoea

Answer 8

10 mg OD PO for breathlessness

Consider adding BDZ for anxiety or at end-of-life

Question 9

Agents reducing efficacy of codeine

Answer 9

Antipsychotics

Antidepressants (fluoxetine, paroxetine, amitryptilline)

Question 10

Opioid side effects

Answer 10

N+V - self-limiting

Drowsiness - self-limiting

Constipation - prescribe senna 15mg

Dry mouth - mouth care + pilocarpine drops

Sweating

Itch

Question 11

Signs of opioid toxicity

Answer 11

Drowsiness

Hallucinations (often visual)

Myoclonus

Vomiting

Respiratory depression

Question 12

Titration of opioids

Answer 12

Review every 24-hours, titrate to pain

Then convert to modified-release equivalent (12-hourly) when pain controlled for 24h

Question 13

Treatment of noisy respiratory secretions in end-of-life

Answer 13

Atropine or hyoscine

Only if causing significant distress