Palliative Care

Question 1

OMED of Parenteral Morphine

Answer 1

Parenteral Morphine 3x stronger
i.e. 5mg Parenteral Morphine = 15mg oral Morphine

Question 2

OMED of Oral Oxycodone

Answer 2

1.5x stronger, so 10mg Oxycodone = 15mg Morphine

Question 3

OMED of SC Fentanyl

Answer 3

50mcg SC Fentanyl = 10mg oral Morphine

So essentially divide fentanyl dose by 5 and just swap the units.

Question 4

OMED of Transdermal Buprenorphine

Answer 4

2x stronger
So 5mcg/hr patch = 10mg/day Morphine

Question 5

OMED of Hydromorphone

Answer 5

5x stronger for oral
15x stronger for SC

So 1mg oral hydromorphone = 5mg oral morphine
1mg SC hydromorphone = 15mg oral morphine

Question 6

OMED of Parenteral Morphine

Answer 6

3x stronger

So 5mg parenteral Morphine = 15mg oral Morphine

Question 7

What pain fibre types transmit pain signals?

Answer 7

A delta fibres an C fibres within the spinothalamic pathway

Question 8

What is Allodynia?

Answer 8

Pain from a stimulus that shouldn’t be painful

Question 9

What is hyperalgesia?

Answer 9

Excessive pain from something that while can be painful shouldn’t be as painful

Question 10

Role of Naloxone when used in combination with oxycodone in Targin, etc.?

Answer 10

Minimise side effects, antagonise effect of opioid in gut lumen to reduce constipation.

Naloxone can accumulate in hepatic failure and reduce analgesic effect

Question 11

What are some of the issues with Methadone?

Answer 11

Needs specialist authorisation to prescribe
Causes QT prolongation
CYP450 system metabolism → dose/effect can be variable

Question 12

Mechanism of Pregabalin

Answer 12

Acts on Alpha 2 subunit of calcium channels in the CNS

Question 13

What is the most effective agent for chemotherapy induced nausea/vomiting?

Answer 13

Neurokinin inhibitors - aprepitant

Question 14

Key difference between Hyoscine butylbromide and hydrobromide?

Answer 14

Butylbromide can’t cross the BBB, hydrobromide can → increased risk of delirium with hydrobromide

Question 15

Most effective drug for managing dyspnoea in palliative setting?

Answer 15

Morphine

Better than other opioids
For patients with severe heart failure, continuing Furosemide is appropriate, but not helpful otherwise

Question 16

Risk factors for death within 2 years of hospital admission

Answer 16

• Increasing age (>80 = 3x higher risk)
• Cardiovascular disease
• > 2 admission within 1 year → 58% dead within 48 months
• Oxygen requirement at discharge = 2x increased risk

Question 17

Patients at high risk of catastrophic bleeding in palliative setting

Answer 17

• Large head and neck carcinomas, esp. ulcerated lesions near large vessels
• Centrally located lung cancers
• Thrombocytopaenia
• Refractory acute and chronic leukaemia
• Myelodysplasia
• Liver disease and deranged clotting

Question 18

Which malignancies are most likely to cause major airway obstruction?

Answer 18

• Primary lung malignancy
• Laryngeal and nasopharyngeal carcinoma
• Oesophageal carcinoma
• Mediastinal tumours