Palliative

Question 1

Pain

Answer 1

-> 1st offer regular MR or IR morphine, + IR for breakthrough, laxatives

E.g., 20-30mg MR regular and 5mg IR for breakthough

Dose increase: by 30-50%
Breakthrough: 1/6 - 1/10 daily dose

Renal Impairment
Mild to mod - oxycodone
Severe - buprenorphine/ fentanyl

Mets bone pain
-> strong opioids, bisphosphonates, radiotherapy

Question 2

Opioid Conversions

Answer 2

PO Codeine to Morphine - divide by 10

PO Tramadol to Morphine - divide by 10

PO Morphine to Oxycodone - divide by 1.5-2

Morphine to SC morphine - divide by 2

Morphine to SC diamorphine - divide by 3

Oxycodone to SC diamorphine - divide by 1.5

Question 3

Agitation and Confusion

Answer 3

First look for cause

-> haloperidol 1st, chlorpromazine, midazolam in terminal phase

Question 4

Hiccups

Answer 4

-> chlorpromazine, haloperidol, gabapentin

Question 5

N+V

Answer 5

Reduced gastric motility
-> metoclopramide, domperidone

Chemically mediated
-> ondansetron, haloperidol, levomepromazine

Visceral/serosal causes
-> cyclizine, levomepromazine, hyoscine

Raised ICP
-> cyclizine, dexamethasone, radiotherapy

Vestibular
-> cyclizine

Cortical
-> short BZ (lorazepam) if anticipatory nausea, cyclizine

Question 6

Secretions

Answer 6

-> hyoscine hydrobromide, glycopyrronium

Question 7

Cerebral Mets

Answer 7

Raised ICP causing a headache due to cerebral mets use Dex

Question 8

Pressure Sores

Answer 8

RF - malnourishment, incontinence, v mobility, pain

Inv - waterlow score (screen at risk)

-> hydrocolloid dressings, hydrogels, avoid soap, refer to tissue viability nurse