Palliative Care

Question 1

What morphine is prescribed for background pain?

Answer 1

Morphine sulphate MR (modified release)

Question 2

Brand names for morphine sulphate MR

Answer 2

MST

Zomorph

Question 3

What morphine is prescribed for breakthrough pain?

Answer 3

Morphine sulphate IR (immediate release)

Question 4

Brand names for morphine sulphate IR

Answer 4

Oramorph

Sevredol

Question 5

What dose of morphine sulphate IR is given?

Answer 5

Approx 1/6th of total daily background dose

Question 6

What two opioids are twice as strong as oral morphine?

Answer 6

Oxycodone (2nd line)

SCUT morphine

Question 7

What are the symptoms of opioid toxicity?

Answer 7

Hallucinations
Vivid dreams
Confusion
Myoclonus (involuntary limb twitching)
Sleepiness
Pin-point pupils
Respiratory depression

Question 8

What drug is used to reverse respiratory depression due to opioid toxicity?

Answer 8

Naloxone

Question 9

What are anticipatory medications and their indications?

Answer 9

Pain/SOB = morphine 
Distress = midazolam 
Nausea = levomepromazine 
Secretions = buscopan (hyosine butylbromide)

Question 10

How is death confirmed?

Answer 10

Absence of carotid pulse over one minute
Absence of heart sounds over one minutes
Absence of respiratory sounds over one minute
No response to painful stimulus (trapezium squeeze)
Fixed dilated pupils (unresponsive to bright light)

Question 11

What opioids are safest in renal impairment?

Answer 11

Fentanyl

Alfentanil