Palliative medicine

Question 1

First choice for confusion and agitation

Answer 1

Haloperidol
Lorazepam if parkinsons

Question 2

Agitation / confusion in terminal phase of illness

Answer 2

Midazolam

Question 3

Intractable hiccups

Answer 3

Chlorpromazine

Question 4

First line antiemetic if due to reduce gastric motility and an alternative

Answer 4

Pro-kinetic : metoclopramide
Extrapyramidal = domperidone

Question 5

First line antiemetic if constipation or serosal cause, raised ICP due to mets or vestibular cause

Answer 5

Cyclizine

Question 6

First line management of increased secretions

Answer 6

Hyoscine hydrobromide either subcut or infusion
Muscarinic receptor antagonist

Question 7

Initial pain management plan for pts with advanced and progressive disease

Answer 7

• Regular, oral, modified or immediate release morphine up to 20-30mg a day
• Oral immediate release for breakthrough pain (5mg)
• The breakthrough dose should be 1/6 of daily morphine

Question 8

Co prescription with regular opioid medication

Answer 8

1. Stimulant laxatives (senna) AND
2. Osmotic laxative (lactulose or macrogol)

AVOID bulk forming

Question 9

What medication is preferred over morphine in CKD

Answer 9

• Mild = oxycodone
• Severe = buprenorphine and fentanyl

Question 10

Options for bone pain?

Answer 10

• Strong opioids, bisphosphonates infusion radiotherapy
• Denosumab

Question 11

when increase opioid dose, how much should it be increased by ?

Answer 11

20-50%

Question 12

Convertinf oral codeine or oral tramadol to oral morphine

Answer 12

Conversion factor - divide by 10

Question 13

Converting Oral morphine to oral oxycodone

Answer 13

Divide by 1.5-2

Question 14

A transdermal fentanyl patch 12 microgram is approximately what in oral morphine

Answer 14

30mg daily

Question 15

a transdermal buprenorphine 10 microgram patch is approx what in oral morphine daily

Answer 15

24 mg

Question 16

Converting from oral morphine to subcut morphine

Answer 16

Divide by 2

Question 17

Converting from oral morphine to subcut diamorphine

Answer 17

Divide by 3

Question 18

Converting from oxycodone to subcut diamorphine

Answer 18

Divide by 1.5

Question 19

which drugs are not compatible with water for injecting so would require NaCL 0.9% in a synringe driver

Answer 19

granisetron
ketamine
ketorolac
octreotide
ondansetron

Question 20

what pain medication is preferred when using a syringe driver ?

Answer 20

Diamorphine

Question 21

what may precipiate if used in a syringe driver with diamorphine ?

Answer 21

Cyclizine

Question 22

what is cycluzine incompatible with in a synringe driver ?

Answer 22

• Clonidine
• Dexamethasone
• Hyoscine butylbromide (occasional)
• Ketamine
• Ketorolac
  -Metoclopramide
• Midazolam
• Otreotide, sodium chloride 0.9%

Question 23

Comparison of SE of morphone and oxycodone

Answer 23

Oxycodone causes less sedation, vomiting and pruitus but is often more constipation

Question 24

How does metoclopramide work

Answer 24

D2 receptor antagonist

Question 25

N&V options in syringe driver

Answer 25

cyclizine, levomepromazine, haloperidol, metoclopramide

Question 26

Resp secretions and bowelcolic options in syringe driver

Answer 26

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide.

Question 27

Agitation / restlessness options in syringe driver

Answer 27

agitation/restlessness: midazolam, haloperidol, levomepromazine

Question 28

Painful mouth e.g. following radiotherapy

Answer 28

Benzydamine hydrochloride mouthwash

Question 29

Oral candidiasis

Answer 29

Nystatin oral suspension