Medicine/palliative

Question 1

Bowel colic and excessive respiratory secretions (SC)

Answer 1

Hyoscine hydrobromide (sedative too)Hyoscine butylbromide (less sedative)Glycopyrronium bromide

Question 2

Confusion and restlessness (SC)

Answer 2

Haloperidol (little sedative effect)Levomepromazine (sedative effect)Midazolam (is a sedative + antiepileptic. may be used in addition to an antipsychotic if v. restless) also used in myoclonus

Question 3

Convulsions (SC)

Answer 3

If already on an antiepileptic should not be stoppedmidazolam is drug of choice

Question 4

Nausea and vomiting (SC)

Answer 4

haloperidollevomepromazine (limited by sedative effect)cyclizine likely to precipitate (esp with diamorphine)metoclopramide hydrochloride can cause skin reactionsOctreotide (gi effect of water and electrolyte absorption + reduced intestinal secretions) reduces vomiting due to bowel obstruction

Question 5

Pain control (SC)

Answer 5

Diamorphine Hydrochloride is the preferred opioid

Question 6

Anorexia

Answer 6

PrednisoloneDexamethasone

Question 7

Bowel colic and excessive respiratory secretions

Answer 7

Hyoscine hydrobromideHyoscine butylbromideGlycopyrronium bromide

Question 8

Capillary bleeding

Answer 8

Oral tranexamic acidLocal gauze soaked in tranexamic acid or adrenalineVit K in liver disease

Question 9

Constipation

Answer 9

Regular laxatives e.g. lactulose with a senna preparationMethylnaltrexone bromide opioid induced constipation

Question 10

Convulsions

Answer 10

Oral Prophylaxis w/ phenytoin or carbamazepineDiazepam RectallyPhenobarbital IVMidazolam SC

Question 11

Dry mouth

Answer 11

Good mouth careSucking ice, chewing gum, artificial saliva?candidiasis? nystatin/miconazoleMedication r/v

Question 12

Dysphagia

Answer 12

Dex

Question 13

Dysopnoea

Answer 13

Breathlessness at rest: Oral morphineAnxiety: DiazepamObstructive: Dexamethasone

Question 14

Fungating tumours

Answer 14

Regular dressings + antibacterialsMetronidazole

Question 15

Gastro-intestinal pain

Answer 15

Loperamide hydrochlorideHyoscine hydrobromide sub-lingualHyoscine butylbromideGlycopyrronium bromide

Question 16

Hiccup

Answer 16

Gastric distention: antacid + antiflatulentFailure: metoclopramide hydrochlorideFailure again: baclofen/nifedipine/chlorpromazine hydrochloride

Question 17

Insomnia

Answer 17

Benzodiazepines: temazepam

Question 18

Intractable cough

Answer 18

Moist inhalation or regular oral morphine

Question 19

Muscle spasm

Answer 19

DiazepamBaclofen

Question 20

Nausea and vomiting

Answer 20

Identify causeProkinetics (first line) metoclopramide hydrochloride (antimuscarinics antagonise)Metabolic cause HaloperidolMechanical BO/raised ICP/motion sickness CyclizineBedtime LevomepromazineAdjunct: Dexamethasone

Question 21

Pruritus

Answer 21

EmollientsColestyramine

Question 22

Raised intracranial pressure

Answer 22

Raised ICP: Dexamethasone

Question 23

Restlessness and confusion

Answer 23

HaloperidolLevomepromazine (also licenced to treat pain)