Palliative care

Question 1

what pain treatment can you start a patient on

Answer 1

15mg morphine MST BD

+ 5mg morphine IR PRN

Question 2

what is the dose of breakthrough dose you can give

Answer 2

1/6 of total morphine in 24h

Question 3

what opioid is appropriate for GFR 30-60

Answer 3

oxycodone

Question 4

what opioid is appropriate for GFR <30

Answer 4

alfentanyl
fentanyl
bupremorphine

Question 5

how much do you increase opioid in if still in pain

Answer 5

increase by 1/3 of total daily dose

Question 6

what is the first line antiemetic if nauseatied

Answer 6

CYCLizine

Question 7

when is cyclizine contraindicated

Answer 7

if fluid retention / HF

Question 8

what do you give as antiemetic if non nauseated

Answer 8

cyclizine PRN

or metoclopramide PRN if in fluid retentin

Question 9

what meds do you give for aagitation or confusion

Answer 9

1. haloperidol

2. chlorpromazine, levomepromazine , lorazepoam

Question 10

what med can you give for secretions

Answer 10

muscarinic receptor antagonist

e.g. hyoscine hydrobromide, glycopyrronium

Question 11

what med can you give for hiccups

Answer 11

chlorpromazine

Question 12

what antiemetic can you give in nausea due to gastric stasis

Answer 12

metoclopramide (because it has prokinetic action)