Palliative Care

Question 1

Describe the 1st step of the WHO pain ladder

Answer 1

MILD PAIN

Paracetamol +/- NSAID e.g. naproxen +/- other adjuvant

Question 2

Describe the 2nd step of the WHO pain ladder

Answer 2

MODERATE PAIN

Codeine/co-codomol +/- adjuvant

Question 3

Describe the 3rd step of the WHO pain ladder

Answer 3

SEVERE PAIN
Stop codeine and switch to a strong opiod like morphine + paracetamol/ NSAIDs/ adjuvants
DIVIDE DOSE OF MORPHINE BY 10 (10 X AS POTENT)

Question 4

What are some adverse effects of morphine? How are these managed?

Answer 4

Opiod tolerant (withdrawal if stopped)
Respiratory depression (reverse with naloxone)
Opiod toxicity (switch to oxycodone)

Question 5

What are the symptoms of opiod toxicity?

Answer 5

Hallucinations
Myoclonus (jerky contractions of muscles)
Drowsiness

Question 6

What are the types of morphine?

Answer 6

MR twice daily for background pain

Immediate release PRN (sevredol) or liquid oromorph for breakthrough pain - 1/6 OF BACKGROUND DOSE

Question 7

What aspect of advanced care planning should all patients have the opportunity to complete?

Answer 7

Key information summary (resuscitation wishes, preferred place of death, anticipatory meds, power of attorney)

Question 8

What route of administration should be considered when oral cannot be tolerated?

Answer 8

Syringe drivers - continuous s/cut infusion of up to 3 medications
DIVIDE MORPHINE ORAL DOSE BY 2

Question 9

What anticipatory medication should be prescribed 1st line in pain or SOB?

Answer 9

Morphine

Question 10

What anticipatory medication should be prescribed 1st line in distress?

Answer 10

Midazolam

Question 11

What anticipatory medication should be prescribed 1st line in nausea?

Answer 11

Levomepromazine

Question 12

What anticipatory medication should be prescribed 1st line in secretions?

Answer 12

Buscopan (hyoscine butyl bromide)