General

Question 1

oral to subcut morphine

Answer 1

Oral morphine Subcutaneous morphine Divide by 2

Question 2

oral morphine to subcut diamorphine

Answer 2

Oral morphine Subcutaneous diamorphine

Divide by 3

Question 3

oral oxycodone to subcut diamorphine

Answer 3

Oral oxycodone Subcutaneous diamorphine Divide by 1.5

Question 4

Oral morphine to Oral oxycodone

Answer 4

Divide by 1.5-2***

Question 5

Oral codeine to Oral morphine

Answer 5

Divide by 10

Question 6

Oral tramadol to Oral morphine

Answer 6

Divide by 10**

Question 7

breakthrough morphine dose

Answer 7

the breakthrough dose of morphine is one-sixth the daily dose of morphine

Question 8

general regime for palliative pain relief

Answer 8

if no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain. For example, 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required
oral modified-release morphine should be used in preference to transdermal patches
laxatives should be prescribed for all patients initiating strong opioids
patients should be advised that nausea is often transient. If it persists then an antiemetic should be offered
drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered

Question 9

opioids and renal disease

Answer 9

opioids should be used with caution in patients with chronic kidney disease
oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

Question 10

COPD and other infection

Answer 10

A course of steroids, e.g. 30mg prednisolone OD for 5 days, should be given even if there’s no evidence of an acute COPD exacerbation (e.g. wheeze, dyspnoea).

Question 11

vestibular schwannoma

Answer 11

estibular schwannoma, also known as acoustic neuroma, is a cerebellopontine tumour that affects the vestibulocochlear nerve. It may also affect the trigeminal and facial nerve during the late stages. The vestibulocochlear nerve involvement is characterised by unilateral sensorineural hearing loss (most common symptom), tinnitus and dizziness. Trigeminal and facial nerve involvement may manifest as unilateral facial pain and unilateral facial weakness respectively.