Palliative

Question 1

when are syringe drivers indicated in palliative care

Answer 1

unable to take oral meds

Question 2

what rate are blue syringe drivers

Answer 2

blue = delivery rate in mm per hour

Question 3

what rate are green syringe drivers

Answer 3

green = mm per 24/hours

Question 4

what drugs need sodium chloride 0/9% infusion as opposed to water

Answer 4

ket // ocreotide // ondansetron // grainsetron

Question 5

N+V drugs palliative care (4)

Answer 5

cyclizine // levopromazine // haloperidol // metoclopramide

Question 6

resp secretion drugs

Answer 6

1 = hyosine brutylybromide // 2 = glycopyronnium bromide

Question 7

1st line mx anti-emetic palliative care

Answer 7

levomepromazine injection (2.5 - 5mg/sc) // (or metoclopramide)

Question 8

which anti-emetic palliative drug is incompatible with lots of things

Answer 8

cyclizine

Question 9

1st line mx for agitation + confusion palliative care

Answer 9

haloperidol

Question 10

2nd line mx for agitation + confusion palliative care

Answer 10

chlorpromazine, levomepromazine

Question 11

terminal mx for agitation + confusion palliative care

Answer 11

midazolam

Question 12

1st, 2nd, 3rd line end of life pain palliative

Answer 12

1 = morhpine or diamorph // 2 = oxycodone // 3 = Alfentanil

Question 13

what 2 types of morphine are regularly used in palliative care

Answer 13

oral modified release (MR) and immediate release (normal morphine)

Question 14

1st line pain mx in CKD 4/5

Answer 14

alfenatil

Question 15

morphine regeime for breakthroigh pain in palliative care

Answer 15

oral 20-30mg of MR release morphine a day+ 1/6 oral morphine (as requried)

Question 16

what medication should always be prescribed with morphine in palliative care

Answer 16

laxatives (osmeotic eg senna + docusate) // (+/- antiemetic eg metoclopramide)

Question 17

what is the dose of breakthrough morphine

Answer 17

1/6 of daily dose

Question 18

what pain relief is recommended to palliative patients with mild-moderate renal impairment

Answer 18

oxycodone

Question 19

pain relief in severe renal impairment

Answer 19

alfentanil, buprenorphrine, fentanyl

Question 20

pain relief metastatic bone pain

Answer 20

opioids, bisposophonates, radio

Question 21

when increasing opioid doses how much should you increae

Answer 21

30-50%

Question 22

how is oral coedine + tramadol converted to oral morphine

Answer 22

’/, 10

Question 23

how is oral morphine converted to subcut morphine

Answer 23

’/, 2

Question 24

how is oral morphine converted to subcut diamorphine

Answer 24

’/, 3

Question 25

suitable anti-emetic for reduced gastric mobility

Answer 25

prokinetic eg metaclopramide or domperidone (good with opioid constipation)

Question 26

what causes virsceral pain in paliative care + what to prescribe

Answer 26

constipation - levopromazine or cyclizine

Question 27

N+V for raised ICP palliative + vestibular

Answer 27

cyclizine +/- dex

Question 28

mx palliative hiccups

Answer 28

1 = chlorpramazine // 2 = haloperidol, gabapentin // dexamethasone

Question 29

4 ACPs palliative

Answer 29

midazolam, hyoscine, levomepromazine, morphone