Palliative

Question 1

How should you prescribe opioids in palliative patients?

Answer 1

Offer regular oral modified-release (MR) or oral immediate-release morphine, depending on the patient’s preference with oral immediate-release morphine for breakthrough pain

Question 2

What’s the standard regime for morphine?

Answer 2

If no cormorbidities:

20-30mg of MR with 5mg for breakthrough pain - e.g. 15mg twice a day + 5mg breakthrough

Question 3

Do we prefer patches or oral for MR morphine?

Answer 3

Oral (no idea why?)

Question 4

What should you prescribe alongside strong morphine?

Answer 4

Laxatives (opioids cause constipation)

Question 5

What are common side effects of morphine?

Answer 5

Constipation
Nausea (transient)
Drowsiness (transient)

Question 6

When should you avoid morphine?

Answer 6

Chronic kidney disease - fentanyl or buprenorphine are preferred

Question 7

How should you manage hiccups in palliative care?

Answer 7

Chlorpromazine

Haloperidol/gabapentin also used

Question 8

How do we treat confusion/agitation in palliative care?

Answer 8

Haloperidol (first line)

Chlorpromazine

Question 9

How to avoid copious secretions in last days of life?

Answer 9

Conservative:
Avoid fluid overload
Educate the family the patient is likely untroubled by secretions

Medical:
First-line: hyoscine butylbromide
Second-line: Glycopyrronium bromide

Question 10

When do you use a syringe driver?

Answer 10

When a patient can no longer take oral medication due to:
Nausea
Dysphagia
Intestinal obstruction
Weakness
Coma

Question 11

Which drugs do you need to combine with 0.9% saline?

Answer 11

Granisetron
Ketamine
Ketorolac
Octreotide
Ondansetron

Question 12

Commonly used drugs in syringe drivers

Answer 12

Diamorphine
Cyclizine
Hyoscine hydrobromide (secretions)
Hyoscine butylbromide (bowel colic)
Midazolam (restlessness)