palliative care

Question 1

which opioid do you always start with for palliative pain management?

Answer 1

morphine sulfate

Question 2

in WHICH cases would you not use morphine sulfate?

Answer 2

renal impairment

Question 3

starting does of cyclizine?

Answer 3

50 mg

Question 4

signs of opioid toxicity?

Answer 4

• myoclonus
• hallucinations
• drowsiness
• slurred speech
• pinpoint pupils
• plucking at the sheets

Question 5

morphine sulfate slow release onset and duration?

Answer 5

4 hours and 12 hours

Question 6

morphine sulfate immediate release onset and duration?

Answer 6

15-45 minutes, 4 hours

Question 7

what eGFR should morphine sulfate be avoided in?

Answer 7

<50

Question 8

oxycodone use should be avoided in…

Answer 8

hepatic impairment

Question 9

why should oxycodone be avoided in hepatic impairment?

Answer 9

metabolites accumulate

Question 10

which is more potent, oxycodone or morphine sulphate?

Answer 10

oxycodone is twice as potent

Question 11

can oxycodone be giving with a morphine allergy?

Answer 11

yes

Question 12

what is the opioid PRN dose?

Answer 12

1/6 the total regular dose in 24 hours

Question 13

when should you increase the opioid dose?

Answer 13

when a patient requires 3 or more PRN doses in 24 hours

Question 14

how much should you increase an opioid dose by?

Answer 14

33-50%

Question 15

subcutaneous opioid is ___ as potent as PO?

Answer 15

twice

Question 16

how do you calculate a subcutaneous opioid dose?

Answer 16

divide the PO dose by 2

Question 17

when would you give subcutaneous opioids?

Answer 17

when patient is vomiting, too drowsy, dying

Question 18

indications for opioid transdermal patches?

Answer 18

• poor oral intake
• poor compliance
• renal impairment

Question 19

which drugs are used for end of life nauseau?

Answer 19

• cyclizine

- haloperidol

Question 20

why do patients at end of life have increased resp secretions?

Answer 20

-inability to cough effectively or swallow and clear secretions

Question 21

how to manage secretions at end of life?

Answer 21

-hyoscine SC

Question 22

how do increased secretions present at end of life?

Answer 22

a rattling or gurgling sound

Question 23

how to manage agitation at end of life?

Answer 23

• midazolam

- haloperidol (avoid in parkinsons)

Question 24

how to try dry mouth at end of life?

Answer 24

artifical saliva