Palli, onc, geri

Question 1

agitation and confusion tx

Answer 1

1: haloperidol

other options: chlorpromazine, levomepromazine

In the terminal phase of the illness: midazolam

Question 2

Management of hiccups

Answer 2

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 3

secretions mx

Answer 3

1. hyoscine hydrobromide or hyoscine butylbromide
2. glycopyrronium bromide may also be used

Question 4

Nausea & vomitting

Answer 4

Raised ICP
- cyclizine

Reduced gastric motility (serotonin (5HT4) and dopamine (D2))
1. metoclopramide and domperidone (Metro CI: complete bowel instruction/ post-gastric surgery/ perforation)

chemically mediated
- ondansetron, haloperidol and levomepromazine

Visceral/serosal causes (constipation/ candidiasis)
1. Cyclizine and levomepromazine
- Anti-cholinergics

Vestibular
(acetylcholine and histamine (H1)
1. cyclizine
- metoclopramide or prochlorperazine
- refactory - olanzapine or risperidone

Cortical (emotions - GABA and histamine (H1) receptors)
- anticipatory nausea - a short acting benzodiazepine (lorazepam)
- if Benz not ideal - cyclizine

Question 5

palliative pain relief in CKD?

Answer 5

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 6

important opioid points & conversion

Answer 6

increase opiod dose by 30-50%.

oral codeine/ tramadol or -> oral morphine = divide by 10

oral morphine to oral oxycodone = divide by 1.5-2

oral morphine to sc mornphine = div by 2

oral morphine to sc diamorphine = Divide by 3

oral oxycode to subcut diamorphine = Divide by 1.5

transdermal fentanyl 12 microgram= 30 mg oral morphine daily

transdermal buprenorphine 10 microgram patch = 24 mg oral morphine daily.