palliative care

Question 1

choice of opiod in palliative care ?

Answer 1

oral modified-release (MR) or oral immediate-release morphine
WITH
oral immediate-release morphine for breakthrough pain

in preference to transdermal patches

Question 2

opiod dose in patients with no co morbidities ?

Answer 2

20-30mg of MR a day with 5mg morphine for breakthrough pain
eg 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required

Question 3

when offering opioids such as morphine what is one of the side effects we should warn patients about ?

Answer 3

nausea is often transient. If it persists then an antiemetic should be offered
drowsiness is usually transient - if it does not settle then adjustment of the dose should be considered
Pruritis

Question 4

which opiod is preferred in patients with mild to moderate renal disease ?

Answer 4

oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment

Question 5

which opiod is preferred in patients with moderate-severe renal disease ?

Answer 5

alfentanil, buprenorphine and fentanyl are preferred

Question 6

In addition to strong opioids what may be used to treat metastatic bone pain?

Answer 6

bisphosphonates
and radiotherapy,
and denosumab

Question 7

conversion of oral codeine into oral morphine ?

Answer 7

Divide by 10

Question 8

advantage and disadvantage of oxycodone to morphine ?

Answer 8

less sedation, vomiting and pruritis than morphine but more constipation.

Question 9

conversion of oral morphine to Oral oxycodone

Answer 9

Divide by 1.5-2

Question 10

conversion of oral morphine to SC morphine ?

Answer 10

Divide by 2

Question 11

conversion of oral morphine to SC diamorphine ?

Answer 11

Divide by 3

Question 12

conversion of oral oxycodone to SC diamorphine ?

Answer 12

Divide by 1.5

Question 13

x

Answer 13

x

Question 14

x

Answer 14

x

Question 15

x

Answer 15

x

Question 16

x

Answer 16

x

Question 17

x

Answer 17

x

Question 18

x

Answer 18

x

Question 19

x

Answer 19

x

Question 20

x

Answer 20

x

Question 21

indication for syringe driver ?

Answer 21

unable to take oral medication due to nausea, dysphagia, intestinal obstruction, weakness or coma

Question 22

commonly used drugs for nausea and vomiting ?

Answer 22

cyclizine, levomepromazine, haloperidol, metoclopramide

Question 23

commonly used drugs for respiratory secretions/bowel colic: ?

Answer 23

hyoscine hydrobromide,
hyoscine butylbromide,
or glycopyrronium bromide.

Question 24

commonly used drugs for agitation/restlessness ?

Answer 24

midazolam, haloperidol, levomepromazine

Question 25

which drugs in the syringe driver are compatible with other drugs ?

Answer 25

diamorphine

and cyclizine

cyclizine may precipitate with diamorphine when given at higher doses

Question 26

discomfort associated with a painful mouth that may occur at the end of life what should we give ?

Answer 26

Benzydamine hydrochloride
Benzydamine is a non-steroidal anti-inflammatory drug which acts topicall