Palliative

Question 1

Mx of agitations and confusion in pal care?

Answer 1

Treat underlying cause as appropriate

Pharmacological - Haloperidol 1st line - also chlorpromazine + levopromazine

Terminal phase - midazolam

Question 2

respiratory secretions/bowel colic: in pal care what to use?

Answer 2

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

Question 3

Painful mouth in EOL - mx?

Answer 3

Benzydamine hydrochloride mouthwash or spray

Question 4

Severe renal impairment

What is the analgesia of choice and why?

Answer 4

Buprenorphine or fentanyl - not renally excreted hence less likely to cause toxicitiy

Question 5

Oral morphine Subcutaneous diamorphine conversion?

Answer 5

divide by 3

Question 6

Oral oxycodone Subcutaneous diamorphine conversion?

Answer 6

Divide by 1.5

Question 7

Oral morphine Subcutaneous morphine conversion?

Answer 7

divide by 2

Question 8

Oral codeine Oral morphine conversion?

Answer 8

Divide by 10

Question 9

Oral tramadol Oral morphine conversion?

Answer 9

Divide by 10

Question 10

Oral morphine Oral oxycodone conversion?

Answer 10

Divide by 1.5-2***

Question 11

Mx of metastatic bone pain?

Answer 11

analgesia, bisphosphonates or radiotherapy

Question 12

Mx of Hiccups in palliative care?

Answer 12

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 13

Mx of secretions in palliative care?

Answer 13

hyoscine hydrobromide or hyoscine butylbromide is generally used first-line
>the BNF does not suggest one is first-line over the other
>hyoscine butylbromide may be less sedative than hyoscine hydrobromide

glycopyrronium bromide may also be used