Palliative

Question 1

What are the 4 key symptoms you would consider prescribing pre-emptive meds for in a palliative patient?

Give an example med for each

Answer 1

Pain (morphine, oxycodone, fentanyl, buscopan)

Secretions (buscopan, hyoscine butylbromide, glycopyronium bromide)

Agitation (midazolam, haloperidol)

Nausea (metoclopramide, haloperidol, ondansetron, domperidone, levomepromazine)

Question 2

Antiemetics. What is a possible unwanted side effect of levomepromazine?

Answer 2

Sedating

Question 3

Briefly outline the pain ladder

Answer 3

PCM ibuprofen, aspirin

Codeine

Tramadol

Morphine/oxycodone/diamorphine/methadone

Fentanyl/alfentanil

(neuropathic: pregabalin, amitryptilline, gabapentin)

Question 4

2 things to check before prescribing paracetamol?

Answer 4

1) Weight of patient (if <50kg, max dose of 500mg QDS)

2) Hx of liver impairment

Question 5

5 things to check before prescribing NSAID?

Answer 5

1) Renal function
2) Platelet count
3) Hx asthma (can be triggered)
4) Hx GI/duodenal bleed
5) DHx (warfarin, digoxin, steroids)