Pallative medicine EOL

Question 1

Underlying causes of confusion IN Palliative care prescribing: agitation and confusion

need to be looked for and treated as appropriate, for example

Answer 1

hypercalcaemia, infection, urinary retention and medication

Question 2

If specific treatments fail then the following may be tried:
FOR

Palliative care prescribing: agitation and confusion

Answer 2

first choice: haloperidol

other options: chlorpromazine, levomepromazine

In the terminal phase of the illness then agitation or restlessness is best treated with midazolam

Question 3

Management of hiccups
1st line

others used

WHAT IF there are hepatic lesions

Answer 3

chlorpromazine is licensed for the treatment of intractable hiccups

haloperidol, gabapentin are also used
dexamethasone is also used, particularly if there are hepatic lesions

Question 4

Palliative care prescribing: secretions

Answer 4

:
hyoscine hydrobromide or hyoscine butylbromide is generally used first-line

Question 5

hyoscine hydrobromide or hyoscine butylbromide is generally used first-line
the BNF does not suggest one is first-line over the other

what is more sedative

Answer 5

hyoscine butylbromide may be less sedative than hyoscine hydrobromide

Question 6

what should be prescribed for all patients initiating strong opioids

Answer 6

laxatives

Question 7

the breakthrough dose of morphine is______ the daily dose of morphine

Answer 7

is one-sixth

Question 8

what is preferred to morphine in palliative patients with mild-moderate renal impairment

Answer 8

oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment

Question 9

what should be used if renal impairment more severe for pain managmeent

Answer 9

if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

Question 10

When increasing the dose of opioids the next dose should be increased

Answer 10

by 30-50%.

Question 11

metastatic pain

Answer 11

In addition to strong opioids, bisphosphonates and radiotherapy, denosumab may be used to treat metastatic bone pain.

Question 12

opoid transient SE

Answer 12

Nausea
Drowsiness

Question 13

OPOID PERSISTENT SE

Answer 13

Constipation

Question 14

oral codeine to oral morphine

Answer 14

Divide by 10

Question 15

oral tramadol to oral morphine

Answer 15

Divide by 10**

Question 16

Oral morphine to Subcutaneous morphine Divide by

Oral morphine to Subcutaneous diamorphine Divide by

Oral oxycodone to Subcutaneous diamorphine Divide by

Answer 16

Oral morphine to Subcutaneous morphine Divide by 2

Oral morphine to Subcutaneous diamorphine Divide by 3

Oral oxycodone to Subcutaneous diamorphine Divide by 1.5