Palliative

Question 1

Assessment used in Pallative care

Answer 1

Biopsychosocial, to inclide spiritual assessment

Question 2

Management of nausea and vomiting in EofL care

Answer 2

Anti-emetics.
PPI and antacids
IV fluids
Mouthwash - lidocaine

Question 3

Different types of anti-emetics

Answer 3

D2 receptor antagonists = Haloperidol.
Prokinetics = D2 and serotonin 4 and 3 antagonists = Metoclopramide, Donperidone
Serotonin3 receptor antagonist = Ondansetron. Can cause QT prolongation.
Anticholineragic/Muscarinic = Scopolamine, glycopyrronium (anti-M1).
Antihistamines = Cyclizine, Meclizine (H1 and H2)
NK1 antagonists = Aprepitant.

Question 4

Types of laxatives

Answer 4

Osmostic = Lactulose
Bulk-forming = Ispagula husk
Stimulants = Senna, bisacodyl.
Softeners = Docusate

Question 5

Mx of opioid induced constiaption

Answer 5

Docusate + Senna

Naloxegol = peripheral opioid anatagonist.

Question 6

Analgesia steps in Pallative care

Answer 6

1. Paracetamol (1g up to 4 times a day) or NSAID.
2. Weak opioid e.g. Codeine + pcm (co-codamol).
3. Strong opioid e.g. modified release morphine + paracetamol + break-through pain immediate release morphine (oropmorph).
4. Fentanyl transmucosal, oxycodone, infusion syringe pumps.

Question 7

How much analgesia for break-through pain

Answer 7

1/6th of total 24hr dose, with a max of 6 doses of the breakthrough medication in 24hrs.
If needing more PRN then increase background modified release dosage.

Question 8

Use of opioids in Pallative care

Answer 8

Analgesia

breathlessness

Question 9

Management of neuropathic pain

Answer 9

Amitriptyline
Gabapentine
Pregabalin

Monitor ECG for QT prolongation.

Question 10

What can you give to help with nausea and anorexia?

Answer 10

Corticosteroids e.g. dexamethasone.

Progestogens

Question 11

Mx of delirium

Answer 11

Find cause with Ix.
Good hydration, oral intake and mobility.
Address patient’s anxieties, continuity of caring staff, quiet room, hearing aids and glasses if needed, good lightening, large clock, normal sleep-wake cycle.
Meds = haloperidol 1st line, midazolam 2nd line.

Question 12

Drug to help with diarrhoea

Answer 12

Loperamide.

Question 13

Mx of fatigue

Answer 13

Plan of activities and schedule them for peak-energy time.
Complementary therapy
Sleep hygiene advice.
?methylphenidate.

Question 14

What to discuss in EofL care

Answer 14

• Preferred place of care.
• Any advance directive or anticipatory care planning documentation.
• Agree on individual care plan for patient, discuss with family and document in records the discussion.
• Discuss DNACPR.
• Spiritual and cultural needs
• Preemptive prescribing

Question 15

Codeine to morphine strength ratio

Answer 15

Codeine and tramadol 1/10th as strong as morphine

240mg of codeine = 24mg morphine

Question 16

What to prescribe alongside an opioid

Answer 16

Laxative + PRN anti-emetic

Question 17

Can you drive if on opioid

Answer 17

Yes you can 🚙 🚘 🚗

Question 18

Metastatic hypercalcaemia Mx

Answer 18

Bisphosphonates e.g. alendronic acid

Question 19

Causes and mx of stridor

Answer 19

Laryngeal carcinoma
ALL
Mx = dexamethasone, salbutamol.

Question 20

Drug to respiratory tract secretions

Answer 20

GLYCOPYRRONIUM

Question 21

Pros and cons to permeative prescribing

Answer 21

Pro:

• Prompt symptoms relief.
• Less admissions or GP visits.
• Reassurance to patient and carers.

Cons:

• Waste of drug if not used.
• Patients uses drug without proper health professional assessment.
• Extended time of drugs in community environment.

Question 22

Good antiemetic in Parkinson’s

Answer 22

Domperidone

Question 23

Bleeding/fungating tumour Rx

Answer 23

Adrenaline (1:1000) soaked gauze+ pressurw