Palliative care

Question 1

what should be offered initially for pain in advanced and progressive disease?

Answer 1

regular oral modified release (MR) or oral immediate release morphine

plus

oral immediate release morphine for breakthrough pain

Question 2

what should be prescribed in addition to strong opioids?

Answer 2

laxatives

Question 3

compare the transient and long lasting side effects of strong opioids?

Answer 3

transient: nausea and drowsiness

long lasting: consitpation

Question 4

what opiod is preferred in palliative patients with mild/moderate renal impairment?

Answer 4

oxycodone

Question 5

what pain relief is given rather than opioids in patients with severe renal impairment?

Answer 5

buprenorphine and fentanyl

Question 6

what 3 medications are most responsive to metastatic bone pain?

Answer 6

strong opioids

biphosphonates

radiotherapy

Question 7

what should the next dose of opioids be increased by if the previous dose did not successfully control pain?

Answer 7

increase dose by 30-50%

Question 8

how do you work out the conversion dose if switching from oral codeine to oral morphine?

Answer 8

divide by 10

Question 9

how do you work out the conversion dose if switching from oral morphine to oral oxycodone?

Answer 9

divide by 1.5 - 2

Question 10

how do you work out the conversion dose if switching from oral morphine to subcut morphine?

Answer 10

divide by 2

Question 11

in cases of reduced gastric motility, which pro-kinetic agents can be used?

Answer 11

metoclopramide and domperidone

metoclopramide should not be used if there is bowel obstruction or perforation

Question 12

which medications are 1st line for chemically mediated N&V?

Answer 12

ondansetron, haloperidol and levomepromazine

ondansetron is 1st line for N&V due to chemotherapy

Question 13

what is used 1st line for N&V due to intracranial disease?

Answer 13

cyclizine or haloperidol

cyclizine is also used 1st line for disorders of the vestibular system

Question 14

what is used 1st line to reduce secretions?

Answer 14

hyoscine hydrobromide or hyoscine butyl bromide

Question 15

when should a syringe driver be used in the palliative care setting?

Answer 15

when a patient is unable to take oral medication

Question 16

how should the breakthrough dose of morphine be calculated?

Answer 16

1/6 of the daily morphine dose

Question 17

what is most useful to treat colicky pain due to obstruction caused by bowel cancer?

Answer 17

hyoscine butyl bromide

cant give them metoclopramide

Question 18

what is the 1st line Tx for confusion and agitation in a palliative setting, once all other underlying causes have been ruled out?

Answer 18

1st line: haloperidol

Question 19

how do you convert the dose of codeine to morphine?

Answer 19

codeine –> morphine = divide by 10

Question 20

compare the opioids preferred for mild/moderate and severe renal impairment?

Answer 20

mild/moderate = oxycodone

severe: fentanyl

Question 21

compare the uses of cyclizine and dexamethasone to manage cranial symptoms?

Answer 21

cyclizine: used for intracranial or intravestibular causes of N&V
dexamethasone: used to manage raised ICP that occurs due to brain lesions/metastatic brain cancer