Drugs

Question 1

What to prescribe in case of noisy breathing due to excess respiratory secretions?

Answer 1

Hyoscine butylbromide (Buscopan)

MoA: anticholinergic → to reduce respiratory secretions

Question 2

What medication to prescribe for pain and dyspnoea?

Answer 2

Morphine

Question 3

What to prescribe for agitation?

Answer 3

Midazolam

Question 4

What to prescribe for nausea and vomiting?

Answer 4

Haloperidol

Cyclizine (for nausea)

Question 5

What opioid drugs (2) to use for pain relief in a palliative patient with severely impaired renal function?

Answer 5

Buprenorphine or Fentanyl

*these two drugs are not excreted via the kidney (therefore less likely to cause toxicity than e.g. morphine)

Question 6

What’s the first-line in terms of pain relief in palliative person when an oral treatment is not possible?

Answer 6

Transdermal opioid patch (e.g. fentanyl)

Question 7

Reticulocytes (increased or decreased) in:

• aplastic crisis
• sequestration crisis

Answer 7

• Aplastic crisis → reduced reticulocytes
• Sequestration crisis → increased reticulocytes

*sequestration crisis →common in sickle cell anaemia and beta-thalassemia; it is life-threatening → spleen is occluded by sickling and therefore the large blood volume is trapped in the spleen

** aplastic crisis → caused by parvovirus infection; sudden fall in haemoglobin

Question 8

What is the conversion factor between oral codeine and oral morphine?

Answer 8

Codeine to morphine → divide by 10

Question 9

What medication can be used as breakthrough pain in end-stage CKD?

Answer 9

Oxycodone

• mainly metabolised in the liver and thus safer to use in patients with moderate to end-stage renal failure with dose reduction

Question 10

Can morphine be prescribed in end-stage CKD?

Answer 10

No

• Active metabolites of morphine accumulate in renal failure
• long-term use is contraindicated in patients with moderate/severe renal failure
• These toxic metabolites can accumulate causing toxicity and risk overdose

Question 12

(2) types of hyoscine meds used in syringe drivers
- names
- indication

Answer 12

• respiratory secretions: hyoscine hydrobromide
• bowel colic: hyoscine butylbromide

Question 13

When to consider syringe drivers use in the palliative care setting?

Answer 13

Syringe drivers when a patient is unable to take oral medication due to:

• nausea
• dysphagia
• intestinal obstruction
• weakness
• coma

Question 14

What drugs while giving by syringe driver, do we need to give with NaCl 0.9%?

Answer 14

The majority of drugs are compatible with water for injection although for the following drugs sodium chloride 0.9% is recommended:

• granisetron
• ketamine
• ketorolac
• octreotide
• ondansetron