END OF LIFE

Question 1

OPIOID INDUCED CONSTIPATION

Answer 1

• Detergent stool softeners (docusate) not sufficient alone (stimulant also required)

Question 2

OPIOID INDUCED NAUSEA/VOMITING

Answer 2

• Experienced by many patients
• Tolerance develops within few days
• Treat with antiemetics (eg, metoclopramide)

Question 3

NEUROPATHIC PAIN MANAGEMENT

• BURNING TINGLING PAIN
• SHOOTNG STABBING PAIN
• COMPLEX PAIN

Answer 3

• Burning tingling pain
TCA’s (amitriptyline, imipramine), gabapentin
• Shooting stabbing pain
Gabapentin, carbamazepine, valproate
• Complex pain: Combinations may be required (oral
antiarrhythmics, 2 agonists, NMDA receptor
antagonists, corticosteroids etc)

Question 4

BONE PAIN MANAGEMENT

Answer 4

• Opioids = mainstay of treatment
• Second-line drugs:
NSAIDs
corticosteroids
calcitonin

Question 5

CORTICOSTEROIDES ARE USED IN WHAT STAGE OF TX?

Answer 5

Commonly used in advanced illness
• acute nerve compression
• increased intracranial pressure
• bone pain
• visceral pain
• anorexia
• nausea
• depressed mood

Question 6

MANAGEMENT OF ANOREXIA/CACHEXIA?

Answer 6

• non-pharmacological
• corticosteroids (eg, dexamethasone)
• cannabinoids (eg, dronabinol)
• conditions that cause poor intake eg, oral
candidiasis, gastritis should be treated

Question 7

CONSTIPATION Tx

Answer 7

Management:
• stimulant laxatives (eg, casanthranol, senna)
• osmotic laxatives (eg, lactulose, sorbitol)
• detergent laxatives (stool softeners eg, docusate)
• prokinetic agents
• lubricant stimulants
• large-volume enemas

Question 8

DIARRHEA Tx
- Transient / mild
- Persistent /
bothersome
(slow
peristalsis
-Persistent,
severe secretory

Answer 8

• Transient / mild: Bismuth salts
• Persistent /
  bothersome
  (slow
  peristalsis): Loperamide,
  diphenoxylate/atropine, tincture of opium
• Persistent,
  severe secretory:
  Octreotide, parenteral fluid support

Question 9

DOC for dyspnea

Answer 9

DOC = opioids

others: oxygen, anxiolytics

Question 10

Insomnia

Answer 10

pharmacological interventions include:
• antihistamines (eg, diphenhydramine)
• benzodiazepines (eg, lorazepam)
• neuroleptics (eg, chlorpromazine)

Question 11

NAUSEA/VOMITING

Answer 11

Management:
• dopamine antagonists (eg, metoclopramide)
• histamine antagonists (eg, meclizine,
diphenhydramine)
• anticholinergics (eg, scopolamine)
• serotonin antagonists (eg, ondansetron,
granisetron)
• antacids
• cytoprotective agents