Palliative Care

Question 1

Which antidepressant can be used to treat neuropathic pain?

Answer 1

Amitriptyline

Question 2

What is the important rule for pain prescribing?

Answer 2

• By the mouth
• By the clock
• By the ladder

Question 3

What are the 3 strengths of Co-Codamol?

Answer 3

• 8/500
• 15/500
• 30/500

Question 4

What are the two pain medications that can be prescribed as a patch?

Answer 4

• Fentanyl

- Buprenorphine

Question 5

Why is tramadol not used in palliative medicine?

Answer 5

• Serotinergic activity

- Delirium risk

Question 6

Where are opioids metabolised?

Answer 6

Kidney

Question 7

Give 5 side effects of strong opioids

Answer 7

• Constipation
• Nausea
• Drowsiness
• Dry mouth
• Addiction

Question 8

Give 5 signs of opioid of toxicity

Answer 8

• Delirium: Confusion, visual hallucinations, vivid dreams
• Myoclonus
• Respiratory depression
• Persistent nausea/drowsiness/vomiting
• Pin-point pupils

Question 9

When is oral morphine contra-indicated?

Answer 9

• Renal failure

- Inability to swallow

Question 10

Name 3 quick release morphine preparations

Answer 10

• Oromorph
• Sevredol
• Oxynorm

Question 11

Name 3 slow release morphine preparations (12hrs)

Answer 11

• MST
• Zomorph
• Oxycontin

Question 12

How much morphine is the highest dose of codeine equivalent to?

Answer 12

240mg codeine = 24mg morphine

Question 13

By how much should morphine be titrated up by?

Answer 13

30-50%

Question 14

What is the PRN dose of Oromorph equivalent to?

Answer 14

1/6th Total daily morphine

Question 15

How would you convert the following into oral morphine?

1. SC Diamorphine
2. SC MST
3. Transdermal fentanyl
4. Oral codeine
5. Oral oxycodone

Answer 15

1. x3
2. x2
3. x3
4. /10
5. x1.5

Question 16

Which sedative is commonly given with diamorphine in a SC syringe driver?

Answer 16

Midazolam

Question 17

What are the 4 causes for nausea and vomiting?

Answer 17

• Gastric
• Toxic
• Brain
• Vestibular

Question 18

Which Anti-emetics are used in gastric nausea?

Answer 18

• Metaclopramide

- Domperidone

Question 19

When is Metaclopramide contra-indicated?

Answer 19

• Parkinson’s as it is a prokinetic D2 antagonist and crosses the blood brain barrier

Question 20

Which Anti-emetics are used in toxic causes of N+V?

Answer 20

Haloperidol
Danzitron
Ondansitron

Question 21

How does Haloperidol function?

Answer 21

Dopamine antagonist - contra-indicated in Parkinson’s

Question 22

How does Danzitron function?

Answer 22

5-HT antagonist

Question 23

Which anti-emetic is first line for nausea caused by Raised ICP?

Answer 23

Cyclizine

Question 24

What caution must be taken with pro-kinetic agents?

Answer 24

Monitor QT - prolongation

Do not give in complete bowel obstruction - enhances colicky pain

Question 25

Which laxative is a bulking agent?

Answer 25

Fybogel

Question 26

Name 2 laxatives that are softeners

Answer 26

Lactulose

Sodium docusate

Question 27

Name 2 stimulant laxatives

Answer 27

Senna

Dantron

Question 28

Name 4 combination laxatives

Answer 28

Codanthramer
Movicol
Co-danthrusate
Laxido/Macrogol

Question 29

What is the first line laxative in opiate constipation?

Answer 29

Senna

Question 30

Which anticoagulant can cause a sudden onset of SoB?

Answer 30

Tinzaparin

Question 31

Which benzos can be used to treat breathlessness?

Answer 31

Lorazepam and Midazolam

Question 32

What is used to reduce secretions?

Answer 32

Hyoscine butylbromide = Buscopan

Question 33

Which 3 medication are unsuitable for SC/syringe driver/.

Answer 33

• Diazepam
• Chlorpromazine
• Prochloperazine

Question 34

Which 4 medications are the standard for anticipatory medicine?

Answer 34

• Morphine
• Levomepromazine
• Midazolam
• Hyoscine butylbromide

Question 35

In the last days of life, which medications should be considered stopping?

Answer 35

Corticosteroids
Hypoglycaemics
Anticonvulsants