Palliative Care

Question 1

What medication can be used in palliative care to treat anorexia?

Answer 1

Prednisolone or Dexamethasone

Question 2

What medication can be used in palliative care to treat bowel colic and excessive respiratory secretions?

Answer 2

S.C. Injection of hyoscine hydrobromide, or hyoscine butylbromide, or glycopyrronium bromide

Question 3

What medication can be used in palliative care to treat capillary bleeding?

Answer 3

Orally: tranexamic acid

Gauze soaked in tranexamic acid or adrenaline/epinephrine

Question 4

What medication can be used in palliative care to treat constipation?

Answer 4

Faecal softener with a peristaltic stimulant (e.g. co-danthramer)
Lactulose solution with a senna preparation
Methylnaltrexone bromide is licensed for opioid-induced constipation

Question 5

What medication can be used in palliative care to treat convulsions?

Answer 5

Prophylactic: phenytoin or carbamazepine, Diazepam rectally, Phenobarbital by injection

Question 6

What medication can be used in palliative care to treat dry mouth?

Answer 6

Good mouth care, sucking ice, pineapple chunks
Artificial saliva
Dry mouth associated with candidiasis: oral nystatin or miconazole, or fluconazole

Question 7

What medication can be used in palliative care to treat dysphagia?

Answer 7

Corticosteroid such as dexamethasone may help temporarily if obstruction due to tumour. Also dry mouth medications.

Question 8

What medication can be used in palliative care to treat dyspnoea?

Answer 8

Oral morphine if breathless at rest.
Diazepam for dyspnoea associated with anxiety.
Corticosteroid such as dexamethasone may be helpful if bronchospasm or partial obstruction

Question 9

What medication can be used in palliative care to treat GI Pain?

Answer 9

Loperamide hydrochloride, Hyoscine hydrobromide (sublingual).
Bowel colic: SC injections of hyoscine butylbromide, hyoscine hydrobromide, glycopyrronium bromide

Question 10

What medication can be used in palliative care to treat hiccup?

Answer 10

Preparation incorporating antacid with antiflatulent. Metoclopramide hydrochloride (oral or SC or IM) can be added. Baclofen, nifedipine or chlorpromazine hydrochloride can be tried.

Question 11

What medication can be used in palliative care to treat insomnia?

Answer 11

Treat the underlying cause if one is present.

Benzodiazepines such as temazepam may be useful.

Question 12

What medication can be used in palliative care to treat intractable cough?

Answer 12

Relieved by moist inhalations or regular oral morphine

AVOID methadone hydrochloride linctus; has a long duration of action and tends to accumulate

Question 13

What medication can be used in palliative care to treat muscle spasm?

Answer 13

Pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen

Question 14

What medication can be used in palliative care to treat N&V with advanced cancer?

Answer 14

Determine cause first; a pro kinetic antiemetic may be a preferred choice 1st line

Question 15

What medication can be used in palliative care to treat N&V with opioid therapy?

Answer 15

Can be prevented with antiemetic such as haloperidol or metoclopramide hydrochloride; usually only necessary for first 4 or 5 days; long-term SE’s

Question 16

What medication can be used in palliative care to treat N&V associated with gastritis, gastritis stasis, or functional bowel obstruction?

Answer 16

Metoclopramide hydrochloride: has a prokinetic action (oral)

Prokinetic drugs antagonise antimuscarinic drugs and so if possible should not be used concurrently

Question 17

What medication can be used in palliative care to treat metabolic causes of vomiting (e.g. hypercalcaemia, renal failure)?

Answer 17

Haloperidol by mouth

Question 18

What medication can be used in palliative care to treat N&V due to mechanical bowel obstruction / raised ICP / motion sickness?

Answer 18

Cyclizine by mouth

Question 19

What medication can be used in palliative care to treat pruritis?

Answer 19

Often responds to simple measures such as application of emollients; in the case of obstructive jaundice, further measures include administration of colestyramine

Question 20

What medication can be used in palliative care to treat raised ICP?

Answer 20

Headache due to raised ICP often responds to high does corticosteroid e.g. dexamethasone

Question 21

What medication can be used in palliative care to treat restlessness and confusion?

Answer 21

May require an antipsychotic e.g. haloperidol or levomepromazine (mouth or SC), with midazolam as an adjunct.
Levomepromazine is licensed to treat pain in palliative care - reserved for distressed patients with severe pain unresponsive to other measures.

Question 22

What are the indications for using the parenteral route in patients under palliative care?

Answer 22

Patient unable to take meds bu mouth (N&V, dysphagia, severe weakness or coma)
Malignant bowel obstruction in patients for whom further surgery is inappropriate
Occasionally when patient does not want regular oral meds

Question 23

What are the 4 basic principles of ethical decision making?

Answer 23

1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice (respect for patients’ rights)

Question 24

What medication can be used in palliative care to treat nausea?

Answer 24

Cyclizine

Question 25

What is the general process for confirming death?

Answer 25

Wash hands and confirm patient identity
Inspect for signs of life, any respiration signs and response to verbal stimuli
Any response to pain (pinch trapezius muscle)
Check pupils to see if fixed and dilated
Carotid pulse for 2 minutes, heart sounds for 2 minutes, respiratory sounds for 3 minutes