Palliative care

Question 1

Which Benzo for breathlessness

Answer 1

Lorazepam 0.5mg PRN SL
-> short acting benzo

Question 2

Which laxative would you avoid in palliative care and why?

Answer 2

bulk forming diuretics

can’t use with poor oral intake or poor bowel motility

Question 3

Summarise the different types of laxatives

Answer 3

• softening agents -> lubricate the stool (e.g. liquid paraffin/milpar)
• bulking agents -> increase faecal mass stimulating peristalsis (e.g. Bran, fybogel)
• stimulant agents -> increase intestinal motility (e.g. senna or bisacodyl)
• osmotic agents -> pull liquid into stool (e.g. macrogol)

Question 4

What are the common symptoms at the end of life?

Answer 4

pain
agitation/distress/anxiety
respiratory tract secretions
breathlessness
N&V

Question 5

PC management of breathlessness

Answer 5

• treat reversible cause
• oxygen if hypoxic
• morphine sulfate immediate release 1mg PO PRN / sustained release 5mg BD
• manage anxiety component with therapies, mindfulness etc or: LORAZEPAM 0.5 mg PRN SL

-> short acting benzo

Question 6

Which antiemetic for central causes?

main SE

Answer 6

cyclizine

irritant SC
severe HF - avoid

Question 7

Which antiemetic post chemo/abdo surgery / abdo radiotherapy?

main SE

Answer 7

ondansetron

-> very constipating, QT prolongs

Question 8

Which antiemetic for chemical causes?

Answer 8

chemical causes = renal failure, drug induced, acid base imbalance..

Haloperidol

Risks: lowers seizure threshhold, avoid in Parkinsons

Question 9

Which antiemetic for delayed GIT transit/obstruction without colic?

Answer 9

metoclopramide / domperidone

risks:
BO with colic
Parkinsons
cardiac conduction disorders
young women - SE movement disorders

Question 10

3rd line antiemetic for all causes

Answer 10

levopromazine

risks: long half life, sedating, lowers seizure threshold, severe HF, CVD and PD

Question 11

Which opioids are safe in renal failure

Answer 11

buprenoprhine
fentanyl
alfentanyl

Question 12

Common anticipatory medications

Answer 12

PAIN
- morphine sulfate
(oxycodone alternatively)

SECRETIONS
Glycopyrronium
(alt: hyoscine butylbromide, butylbromide (buscopan))

AGITATION/DISTRESS
- Midazolam

BREATHLESSNESS
- Midazolam
or
- Morphine

N&V
- Haloperidol
(alt: cyclizine)

Question 13

What is never the correct route in palliative care?

Answer 13

IM