Palliative care

Question 1

Chemoreceptor trigger zone situated where

Answer 1

postrema on the floor of 4th ventricle

Question 2

Vomiting centre situated where

Answer 2

Close to CTZ, in medulla

Question 3

With regards to BBB where are CTZ/ vomiting centre are

Answer 3

Inside BBB ; VOMITING CENTRE

Outside BBB: CTZ

Question 4

Vomiting centre role

Answer 4

Collection of motor nuclei

Coordinates emetic process

Question 5

Antiemetics for peripheral cause of nausea/vomitting

Answer 5

prokinetics

Question 6

Prokinetics eg

Answer 6

Domperidone

Metoclopramide

Question 7

Antiemetics for CTZ centrally caused nausea and vomiting

Answer 7

D2 antagonist

Question 8

D2 antagonist eg

Answer 8

Haloperidol

Question 9

Antiemetics for other centrally caused nause and vomiting

Answer 9

H1 antagonist

Question 10

H1 antagonist eg

Answer 10

cyclizine

Question 11

Levomepromazine

Answer 11

Broad spectrum antiemetic

antagnoist at 5HT2, H1, A1

Question 12

Granisetron

Answer 12

anti emetic 2nd line

5HT3 antagonist

Question 13

Aprepitant

Answer 13

antiemetic 2nd line

neurokinin receptor antagonist

Question 14

Nabilone

Answer 14

2nd line antiemetic

cannabinoid (specialist use only)

Question 15

Laxative classes

Answer 15

Softner

Stimulant

Osmotic

Bulk forming

Question 16

Softner eg

Answer 16

docusate

Question 17

Stimulant eg

Answer 17

Senna

Bisacodyl

Question 18

Osmotic eg

Answer 18

Movicol

Laxido

Lactulose

Question 19

Bulk forming eg

Answer 19

Fybogel

Question 20

Opiod induced constipation rx eg

Answer 20

Methylnaltrexone injection,

naloxegol

Question 21

Glycerine

Answer 21

softening suppository

Question 22

Bisacodyl

Answer 22

Stimulant suppository

Question 23

Micralax

Answer 23

combined suppository

Question 24

Arachas oil

Answer 24

softening enema

Question 25

Phosphate

Answer 25

stimulant enema

Question 26

Rx of diarrhoea

Answer 26

Loperamide Opioids Hyoscine butylbromide Octreotide Creon (steatorrhoea)

Question 27

Xerostomia

Answer 27

dry mouth

Question 28

Xerostomia mx

Answer 28

saliva substitute saliva stimulant

Question 29

Malignant obstruction mx

Answer 29

opioid for analgesia antispasmodic for colic Haloperidol +/- octreotide

Question 30

Antispasmodic eg

Answer 30

Hyoscine butylbromide

Question 31

Octreotide

Answer 31

dry GI secretion malignant bowel obstruction rx

Question 32

WHO analgesic ladder

Answer 32

Non opioids Weak opioids Strong opioids

Question 33

Non opioids

Answer 33

Paracematol NSAID

Question 34

Weak opioid eg

Answer 34

cocodamol (30/500) Tramadol Tapentadol

Question 35

Strong opioid eg

Answer 35

Morphine Diamorphine Hydromorphone Oxycodone Fentanyl Buprenorphine Methadone

Question 36

Adjuvant analgaesic

Answer 36

Amatryptiline Gabapentin Pregabalin Steroids

Question 37

Morphine metabolism

Answer 37

Liver metabolises to - M3G (inactive) - M6G (active) Kidney -\> excretion

Question 38

How steroids work as analgesic

Answer 38

reduces oedema around tumour, reduce compression

Question 39

Myoclonic jerks

Answer 39

opioid toxicity symmetrical twitches arms flexed (vs hepatic flap=arms extended)

Question 40

Morphine hallucinations

Answer 40

Ants/moths/bats/rats crawling/flying Arms coming down from the ceiling Hallucinating a close relative

Question 41

Pethidine use

Answer 41

labour very short duration of action doesnt distress fetal resp on delivery (still shouldnt be given within 2hours of delivery)

Question 42

Strong opioid in liver failure

Answer 42

Methadone

Question 43

Strong opioid in kidney failure

Answer 43

fentanyl

Question 44

Calculation for break through pain dose of opioid

Answer 44

1/6th of total 24hr morphine dose

Question 45

How much to increase opioid dose by if no pain relief

Answer 45

Increase total 24hr dose by 1/3rd

Question 46

How long does opioid induced constipation last?

Answer 46

Entire duration of opioid use

Question 47

How long does opioid induced N/V last?

Answer 47

~ 1 wk