ethics

Question 1

Agitation + confusion meds palliative

Answer 1

Check causes
Haloperidol (or chlorpromazine).
In terminal phase - midazolam

Question 2

Hiccups mx palliation

Answer 2

Chlorpromazine
(Also haloperidol, gabapentin)

Question 3

nausea and vom mx palliation

Answer 3

Mechanical
↓ gastric motility - need pro-kinetic like metoclopramide/domperidone

Empirical
Metoclopramide (physicican choice)

Chemically med - odansetron/haloperidol/levopromazine
Visceral/serosal - cyclizine/ levopromazine
↑ ICP - cyclizine, dex, radioT
Vestibular - cyclizine
Cortical - anticipatory nausea - lorazepam or cyclizine
Oral and if not poss then parenteral

Question 4

Pain mx palliation

Answer 4

No comorbidities = 20-30mg morphine moderate release + 5mg breakthrough (⅙ daily dose) + laxatives
Caution with opiates in CKD
If ↑ dose opioids then do so by 30-50%

Question 5

PO codeine/tramadol -> morphine

Answer 5

/10

Question 6

PO morphine to subcut morphine conversion

Answer 6

/2

Question 7

Secretions mx in palliative care

Answer 7

Conservative = avoid ↑ fluids
Hyoscine hydrobromide