Palliative Care

Question 1

How is opioid toxicity managed if the patients pain is controlled?

Answer 1

Reduce opioid dose by a third
Ensure adequate hydration
Seek advice

Question 2

How is opioid toxicity managed if the patients pain is uncontrolled?

Answer 2

Consider reducing opioid dose by a third
Consider adjuvant analgesics, an opioid switch or booth
Ensure adequate hydration
Seek advice

Question 3

When is naloxone needed for opioid toxicity?

Answer 3

Only in cases of life-threatening respiratory depression

Question 4

What are some non-pharmacological ways to manage breathlessness?

Answer 4

Breathing exercises and pacing
Physiotherapy
Relaxation exercises
Fans

Question 5

What are some pharmacological ways to manage breathlessness?

Answer 5

Oral opioids
Benzodiazepines
Long term oxygen if hypoxic

Question 6

What are the steps in verifying a death?

Answer 6

No response to voice
No response to painful stimuli
Absence of carotid pulse (1 min)
Absence of heart sounds (2 min)
Absence of breath sounds (2 min)
Fixed, dilated pupils

Question 7

What is a common side effect of ondansetron?

Answer 7

Constipation

Question 8

What anti-emetic is most appropriate for someone on an opioid?

Answer 8

Metoclopramide

Question 9

What is the dose of metoclopramide given?

Answer 9

PRN 10mg max TDS

Question 10

Describe the presentation of opioid toxicity?

Answer 10

Drowsy
Myoclonus
Pinpoint pupils + resp depression in severe cases

Question 11

When is oxycodone not an appropriate analgesia and why?

Answer 11

Liver disease
It is metabolised by the liver

Question 12

How long does IR morphine need to start working and how long does it work for?

Answer 12

20 minutes to work
Lasts four hours

Question 13

What should be prescribed for an opioid naive patient starting morphine?

Answer 13

Low dose IR morphine e.g. oramorph 2mg QDS
Breakthrough 2mg PRN