Pallative care

Question 1

What are 5 key symptoms which can occur in the last days/hours of life

Answer 1

• Pain
• Dyspnoea
• Nausea & Vomiting
• Agitation
• Respiratory tract secretions

Question 2

What is prescribed for N+V?

Answer 2

Haloperidol

Question 3

What is prescribed for agitation?

Answer 3

Midazolam

Question 4

What is prescribed for secretions?

Answer 4

Hyoscine Butylbromide

Question 5

What is prescribed for SOB?

Answer 5

Morphine

Question 6

What is prescribed for palliative pain?

Answer 6

Morphine

Question 7

What is the initial dose of morphine prescribed for patients with with advanced and progressive disease?

Answer 7

• 20-30mg of MR a day (divided into 2 doses)
• 5mg IR for breakthrough pain (breakthrough dose should be 1/6th daily dose)

Question 8

What else should be prescribed for all patients on strong opioids?

Answer 8

Laxatives

Question 9

What is analgesia is preferred in renal impairment?

Answer 9

• 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

How is metastatic bone pain managed?

Answer 10

• Strong opioids
• Bisphosphonates
• Radiotherapy
• Denosumab

Question 11

How do you convert from oral codeine to oral morphine?

Answer 11

Divide by 10

Question 12

How do you convert from oral oxycodone to oral morphine?

Answer 12

Divide by 1.5-2

Question 13

How do you convert from oral morphine to SC morphine?

Answer 13

Divide by 2

Question 14

When are syringe drivers considered in palliative care?

Answer 14

When a patient is unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma

Question 15

What deaths need to be referred to the coroner?

Answer 15

• Unexpected or sudden deaths
• When the doctor attending the deceased did not see them within 28 days before death (increased from 14 days during the COVID pandemic)
• If a death occurs within 24 hours of hospital admission
• Accidents and injuries
• Suicide
• Industrial injury or disease (e.g. asbestosis)
• Deaths occurring as a result of ill treatment, starvation or neglect
• The death occurred during an operation or before recovery from the effect of an anaesthetic poisoning, including taking illicit drugs
• Stillbirths - if there is doubt as to whether the child was born alive
• Prisoner or people in police custody
• Service disability pensioners