Pallative, Neuro

Question 1

10 mg of morphine is the equivalent of
- ? tramadol
- ? Codeine + dihydrocodeine
- ? Oxycodone
- ? Diamorphine SC
- ?morphine SC

Answer 1

50-100mg
100mg
6.6mg ( /1.5)
3.3mg (/3)
5mg (/2)

Question 2

In renal impairment what strong anaglesia would you consider

Answer 2

EGFR <30
- fentanyl
- buprenoprhine
- alfentail
- oxycodone

Question 3

Morphine equivalent of
- Fentanyl 12mcg/hr
- bupreborphine 5mch/hr

Answer 3

30mg every 24hours
9-12 mg every 24hours

Question 4

Names the laxative combo you could start in constipation related to opioid

Answer 4

Movical/docusate + senna

Can add naloxegol

Question 5

What are some signs of opioid toxicity

Answer 5

Drowsiness, confusion, hallucinations, myoclonic jerks
Pin point pupils

Question 6

What are some screening tools you could use for memory assessment

Answer 6

10-CS
6CIT
Min-cog

(Not GPCOG, AMSTE, MMSE - good for monitoring)

Question 7

Name some drugs that have anti-cholengric burden

Answer 7

Amitripylline, paroxetine, chlorpheamie, promethazine, olanzpaine, Quintapine

Question 8

What are the 3 drugs you use for mild - mod alzheimers
Some s/es

Answer 8

Acetylcholinesterase inhibitor - Donepzil (insomnia), Galantamine, Rivastigmine
- N+v, cramps, dizziness, headaches, syncope, sick sinus

Caution BB and rate limiting CCB for bradycardia

Question 9

Choice for mod (>10MMSE)

Answer 9

Memantine (Glutamate Recpetor antagonist)
Increase BP, sleepiness

Question 10

What is license for levy body

Answer 10

Donepzil + rivastgaime
Severe memantine

Question 11

PD: What is medication for motor symptoms with reduce QoL
S/Es

Answer 11

Levodopa with carbidopa (Co-careldopa)
Reduced effectiveness with time, Dyskinesia, On/Off, dry mouth

Question 12

PD: What is medication for motor symptoms which don’t reduce QoL
S/Es

Answer 12

Dopamine agonists - Rotigotine, Prampiexole, Ropintile (Bromocriptine, Carbegoline)
S/E Impulse, excessive sleepiness, postural hypotension

Or
MAO - B inhibitor - Selegiline, Rasagline

Question 13

how soon should a first fit be reviewed in clinic

Answer 13

seen within 2 weeks
<2years is straight to paeds

Question 14

what are DVLA rules regarding seizures

Answer 14

6months off after single seizure
1year after sleep seizure
1 year if structural cause/epilepsy seizure

Question 15

options for focal/partial epilepsy

Answer 15

Lamotrigine or Levetiracetam
2nd line carbamazepine

Question 16

options for generalised epilepsy

Answer 16

SV or lamotrigine in girls
2nd line levetiracetam

Question 17

option for absence

Answer 17

ethosuximide, then SV or lamotrigene

Question 18

Some side effects of sodium valproate

Answer 18

abnormal lfts, bone denisity, ataxia, weight gain, thrombocyotpenia, pancreatitis, fetus spinabifia, cleft

Question 19

s/es of lamotrigene
laevetiectam

Answer 19

SJS, agitation

anxiety
both safe in pregnancy

Question 20

what is the most frequnt complient for motor neuro disease (after developing weakness)

Answer 20

cognitive decline

Question 21

When would you consider an urgent direct access MRI scan of the brain (to be performed within 2 weeks) to assess for brain or central nervous system cancer

in children within 48hours

Answer 21

in adults with progressive, sub-acute loss of central neurological function.

abnormal cerebellar or other central neurological function.

Question 22

what reflex aids badys sitting at 6-9month

Answer 22

symmeterical tonic neck reflex

Question 23

what aids the baby crawling (hip movmenet)

Answer 23

spinal galant reflex