Palliative Care

Question 1

What is step 1 of the analegesic ladder?

Answer 1

Non-opioids (e.g. paracetamol or aspirin)

Question 2

What is step 2 of the analgesic ladder?

Answer 2

Weak opioids (e.g. codeine)

Question 3

What is step 3 of the analgesic ladder?

Answer 3

Strong opioids (e.g. morphine)

Question 4

How is ‘background’ pain treated?

Answer 4

Slow-release medication.

Question 5

How is ‘breakthrough’ pain treated?

Answer 5

Immediate-release medication.

Question 6

What can be given if pain does not respond to opioids?

Answer 6

Addition of an adjuvant or alternative drug therapies (e.g. gabapentin).

Question 7

How does opioid toxicity present?

Answer 7

Hallucinations
Myoclonus
Drowsiness
Respiratory depression (if life-threatening)

Question 8

What is myoclonus?

Answer 8

Involuntary twitching of the limbs.

Question 9

How can respiratory depression following opioid overdose be reversed?

Answer 9

Naloxone

Question 10

What is the first-line strong opioid?

Answer 10

Morphine

Question 11

What is the second-line strong opioid?

Answer 11

Oxycodone

Question 12

What strong opioid is used in those with severe renal impairment?

Answer 12

Fentanyl

Question 13

What treatable conditions can mimic dying?

Answer 13

Opioid/Drug toxicity
Sepsis/Infection
Hypercalcaemia
Acute kidney injury
Hypocalcaemia

Question 14

What can be used when oral medications become too difficult to take?

Answer 14

Syringe drivers

Question 15

What is a syringe driver?

Answer 15

A pump, allowing continuous subcutaneous infusion of drugs.

Can give 3 together within this.

Question 16

What 3 types of medication are commonly given together in a syringe?

Answer 16

Opioid
Antioxylitic drug
Anti-sickness drug

Question 17

Is subcutaneous morphine weaker than oral morphine?

Answer 17

No, it is 2x stronger.

Reduce dosage when swapping from oral to subcutaneous methods.