Palliative

Question 1

Management of gastric distension

Answer 1

Try antacid or domperidone 10 mg TDS

Question 2

Management of bowel colic

Answer 2

Loperamide or buscapan (hyoscine hydrobromide)

Question 3

Management of muscle spasm

Answer 3

Baclofen, diazepam

Question 4

Management of bone pain

Answer 4

Opiates, NSAIDs, radiotherapy

?bisphosphonates

Question 5

Management of nerve compression pain

Answer 5

Dexamethasone if due to inflammation, radiotherapy

Question 6

Management of neuropathic pain

Answer 6

tricyclic antidepressants, gabapentin, pregabalin

Question 7

Management of pain (from primary care)

Answer 7

Mild: paracetamol, ibuprofen

Moderate: diclofenac 50 mg TDS, co-codamol 30/500

Severe: Oramorph

Question 8

How to find appropriate morphine dose

Answer 8

Oramorph is 10 mg/5 mL

Start at 5 mg (2.5 mL) 4-hourly
Titrate upwards - increase dose, not interval

Once dose achieved with no breakthrough pain, divide 24h dose by 2. Give as morphine sulphate tablets BD

Up to one-sixth for breakthrough pain

Change to suppositories, patches or injections if unable to swallow

Question 9

Management of anorexia

Answer 9

Small feeds, small plates, prednisolone 15-30 mg

Question 10

Management of anxiety

Answer 10

Manage cause, involve carers/ MDT
Citalopram 20 mg OD
Diazepam 2-5 mg QDS
Temazepam for insomnia

Question 11

Management of cough

Answer 11

Steam inhalation, codeine linctus, oramorph

Question 12

Management of dyspnoea

Answer 12

Exclude pneumonia, effusion, bronchospasm

Consider prescribing: oramorph, diazepam
Secretions: hyoscine, atropine
Bronchospasm: dexamethasone

Question 13

Most common cause SVC obstruction

Answer 13

primary bronchial ca