Palliative

Question 1

What do hyoscine hydrobromide n dem man treat? (2 things)

Answer 1

1. Resp secretions
2. Bowel colic (bowel obst)

Question 2

What is the MOA hyoscine hydrobromide n dem man?

Answer 2

Muscarinic receptor antagonist

Question 3

What pain relief should you not give if a pt has mild-moderate renal impairment?

Answer 3

Morphine, so give Oxycodone instead

Question 4

What pain relief should you not give if a pt has SEVERE renal impairment?

Answer 4

Even don’t give Oxycodone, so give: Fentanyl / Buprenorphine instead

Question 5

How do you remember what pain relief you can give in relation to GFR?

Answer 5

eGFR MORe than 50 = Morphine
eGFR 10-50 = Oxycodone
eGFR less than TEN = FenTENyl / BuTENorphine

Question 6

What do you get if you give Morphine in a pt with Renal impairment?

Answer 6

Opiate toxicity

Question 7

What are the CF of Opiate toxicity? (4 things)

Answer 7

1. LOC (or reduced)
2. Pinpoint pupils
3. Slow RR
4. Myoclonic jerks

Question 8

How do you convert between Oral to SC morphine?

Answer 8

Divide dose by 2
(2:1 strength ratio of SC:PO)

Question 9

Even tho its CI for bowel obstruction, what anti-emetic can you give for gastric stasis?

Answer 9

Metoclopramide

Question 10

If pt not opened bowels but is passing wind, is their bowel obstructed?

Answer 10

No, so you can give them Metoclopramide

Question 11

What route of administration is a Syringe driver?

Answer 11

Subcut
(so divide oral dose by 2 when converting from oral –> syringe driver)

Question 12

What is FIRST line anti-emetic for nausea caused by Intracranial cause?

Answer 12

Cyclizine

Question 13

What is a PassMed commenters way of remembering Anti-emetics and their indication in palliative? (3 things)

Answer 13

• C - Christ my head hurts from that cancer = Cyclizine
• M - My bowels don’t be moving = Metoclopromide
• D - Damn my bowels still not moving and I have Parkinson’s = Domperidone

Question 14

What is the pain relief option for Headache caused by raised ICP in brain cancer?

Answer 14

Dexamethasone

Question 15

How do you convert between Codeine to Morphine?

Answer 15

Divide dose by 10
(morphine 10 times stronger)

Question 16

How do you convert between Oral Morphine to SC Diamorphine (syringe driver)?

Answer 16

Divide by 3
(SC diamorphine 3x stronger)

Question 17

What are the Mx options for Metastatic bone pain? (3 things)

Answer 17

1. Analgesia (like morphine)
2. Bisphosphonates
3. Radiotherapy

Question 18

What mouthwash can you use to reduce painful mouth that occurs at end of life?

Answer 18

Benzydamine hydrochloride
(my boi benzy)

Question 19

If pain not controlled, by how much should you increase morphine dose?

Answer 19

30-50%

Question 20

What meds can you give for end of life Hiccups? (2 things)

Answer 20

1. Chrlopromazine
2. Haloperidol
   (HiCCups)

Question 21

What is the FIRST line meds for palliative Agitation / Confusion?

Answer 21

Haloperidol (oral)