Drugs

Question 1

What’s enoxaparin?

Answer 1

LMWH
Anticoagulant used to prevent DVT and PE
40mg prophylactic dose
Always given at 6pm

Question 2

What is lorazepam used for?

Answer 2

Lung cancer, breathlessness and agitation

Question 3

What’s metoclopramide?

Answer 3

Anti-emetic
Pro-kinetic increases peristalsis
Avoid in complete obstruction risk of perforation

Question 4

How do you calculate the PRN dose?

Answer 4

Total regular dose divided by 6

Question 5

What’s simple linctus used for?

Answer 5

Cough

Question 6

What’s zopiclone used for?

Answer 6

Sleeping pill

Question 7

What are the step 1, 2 and 3 analgesics?

Answer 7

Step 1- Non-opioids (paracetamol)
Step 2- Weak opioids (codeine/tramadol)
Step 3- Strong opioids (morphine/fentanyl patches)

Question 8

What are the symptoms for being opioid toxic?

Answer 8

Drowsy
Confused
Hallucinating
Pinpoint pupils
Myoclonic jerks
Eventual respiratory depression

Question 9

What are NSAIDs used for?

Answer 9

Inflammation
Raised ICP
Bony pain

Question 10

What are the side effects of NSAIDs?

Answer 10

Impaired renal function
Bleeding
Ulcers

Question 11

What must be prescribed alongside a NSAID?

Answer 11

Prophylaxis PPI (Lansoprazole)

Question 12

What PRN is used when a patient is on step 3 analgesics?

Answer 12

Oramorph/sevredol

Question 13

What must be prescribed alongside codeine?

Answer 13

Laxative
SENNA- stimulating
Sodium docusate- softener + stimulant

Question 14

What are immediate release morphines?

Answer 14

Oramorph (liquid)
Sevredol (tablet)
Onset 30 mins lasts 4 hrs

Question 15

What’s a modified release morphine?

Answer 15

Zomorph

Onset 4 hrs lasts 12hrs

Question 16

What are the side-effects of opioids?

Answer 16

Nausea + vomiting (haloperidol/metochlopramide for delayed gastric emptying)
Unsteadiness
Drowsiness
Constipation 
Dry mouth (oral balance gel)
Urinary retention 
Hallucinations 
Sweating 
Myoclonus
Rash

Question 17

When are alternative stronger opioids used?

Answer 17

Patients are intolerant of morphine
Opioid responsive pain that doesn’t get relief from morphine
Switching can be associated with reduction in side effects and improved pain relief

Question 18

What are the alternative opioids used?

Answer 18

Oxycodone
Immediate release- OxyNorm (capsules and liquid injection)
Modified release- Oxycontin tablets
Fentanyl
Transdermal patch lasts 72 hrs
16-24 hrs to reach peak plasma levels
Increased body temp will increase drug delivery

Question 19

What drugs are used for subcutaneous pain relief?

Answer 19

Diamorphine (x3 stringer than oral morphine)
Morphine
Oxycodone
May be a PRN or via a CSCI using a syringe driver and may be used in conjunction with other medication in the same syringe

Question 20

What are co-analgesics used?

Answer 20

Corticosteroids- Dexamethasone
Anti-depressants- Amitriptyline (used for nerve pain)
Anti-convulsants- Gabapentin (younger patients, interrupts nervous pathway
Anti-spasmodics- Hyoscine Butyl bromide (Buscopan, good sub-cut not orally)
Muscle relaxants- benzodiazepines (lorazepam)
Bisphosphonates- Pamidronate (bony pain)

Question 21

What is used for bone pain?

Answer 21

Widespread pain- bisphosphonates
Localised pain- radiotherapy
Multiple metastases- radio nuclides

Question 22

What is used for neuropathic pain?

Answer 22

Drugs- corticosteroids/anticonvulsant

Nerve block- intercostal (local)/epidural (regional)

Question 23

Which anticipatory medications are used?

Answer 23

Morphine surface injection (uncontrolled pain)
Haloperidol injection (anti-emetic, agitation)
Hyoscine N Butylbromide injection (buscopan) (secretions)
Midazolam injection- (breathlessness, anxiety)