Medicine - Palliative

Question 1

What is the most common side effect of cyclophosphamide?

Answer 1

Haemorrhagic cystitis

Question 2

What are the toxicities of cisplatin?

Answer 2

Ototoxic, nephrotoxic, hypomagnasaemia

Question 3

Which chemotherapy agent is associated with SIADH?

Answer 3

Cyclophosphamide

Question 4

What is the starting dose of morphine in palliative care?

Answer 4

15mg morphine MR PO BD
5mg oromorph IR PO PRN
Can start with IR and then when pain controlled –> MR

Question 5

What is the most common side effect of MR morphine?

Answer 5

Nausea

Question 6

What opioid is best to use for palliative patients with a GFR of 30-60?

Answer 6

Oxycodone

Question 7

What opioids are best to use for palliative patients with a GFR of <30?

Answer 7

Fentanyl

Buprenorphine

Question 8

How much should a breakthrough dose of morphine be?

Answer 8

1/6th of total morphine

Question 9

100mg codeine is equivalent of how many mg of morphine?

Answer 9

10mg

Question 10

What is the equivalent of 30mg IR morphine in a MR formulation?

Answer 10

15mg

prescribe half when doing MR

Question 11

Recall 3 ways in which bony met pain can be managed

Answer 11

1. Analgesia
2. Bisphosphonates
3. Radiotherapy

Question 12

Which anti-emetic is usually prescribed in palliative care?

Answer 12

Cyclizine

Question 13

What is the usual dose of cyclizine in palliative care?

Answer 13

50mg 8-hourly

Question 14

In what patients is it inappropriate to prescribe cyclizine and why?

Answer 14

Cardiac cases

Can worsen fluid retention

Question 15

Recall 2 patient groups in which metoclopramide should be avoided

Answer 15

Parkinson's disease 
Young women (risk of dyskinesia)

Question 16

What is the anti-emetic of choice in Parkinson’s?

Answer 16

Domperidone

Question 17

What is the drug of choice for agitation in palliative care vs for terminal restlessness?

Answer 17

Agitation in palliative pts: haloperidol (and correct underlying cause)
Terminal restlessness: midazolam

Question 18

Recall the 1st and 2nd line drugs used for secretions in palliative care

Answer 18

1. Hyoscine hydrobromide (anti-muscarinic)

2. Glycopyrronium bromide

Question 19

What is the first line for treating hiccups in palliative care?

Answer 19

Chlorpromazine

Question 20

In a patient with cord compression due to spinal mets who is too frail for surgery, what is the treatment of choice?

Answer 20

External beam radiotherapy

Question 21

What is the anti-emetic of choice for patients with chemo/radio-associated nausea?

Answer 21

Ondansetron + dexamethosone

Question 22

What is the antiemetic of choice in palliative care for for nausea and vomiting that is due to gastric dysmotility and stasis?

Answer 22

Metoclopramide

Question 23

What drug is used for painful mouths at end of life care?

Answer 23

Benzydamine hydrochloride

mouthwash / spray

Question 24

What drug should be prescribed with morphine?

Answer 24

Laxatives

morphine causes constipation

Question 25

Converting Morphine IV to Sc and diamorphine and oxycodone

Answer 25

divide by 2
divide by 3
divide by 1.5/2

Question 26

Headache caused by raised intracranial pressure due to brain cancer

Answer 26

Dexamethasone - reduce surrounding oedema

Question 27

Signs of opiate toxicity

Answer 27

reduced conscious level, slow respiratory rate, myoclonic jerks, and pinpoint pupils