Palliative medicine

Question 1

In the terminal phase of the illness then agitation or restlessness is best treated with ………..

Answer 1

midazolam

Question 2

In Palliative care, treatment of confusion or agitation

Answer 2

Underlying causes of confusion need to be looked for and treated as appropriate

specific treatments fail then the following may be tried:

first choice: haloperidol

other options: chlorpromazine, levomepromazine

Question 3

Management of hiccups

Answer 3

chlorpromazine is licensed for the treatment of intractable hiccups

haloperidol, gabapentin are also used

dexamethasone is also used, particularly if there are hepatic lesions

Question 4

What is the first-line to manage secretions in a palliative care setting

Answer 4

Hyoscine hydrobromide or

hyoscine butylbromide

Question 5

Treatment of nausea and vomiting

Answer 5

cyclizine,
levomepromazine,
haloperidol,
metoclopramide

• CLMH

Question 6

Treatment of pain

Answer 6

diamorphine is the preferred opioid

Question 7

cyclizine is incompatible with a number of drugs including

Answer 7

Cats Drink Hot Milk, Keeping Mice Out Safely.”

Cats: Clonidine
Drink: Dexamethasone
Hot: Hyoscine butylbromide
Milk: Metoclopramide
Keeping: Ketamine, ketorolac
Mice: Midazolam
Out: Octreotide
Safely: Sodium chloride 0.9

Question 8

cyclizine may precipitate with diamorphine when given at ……

Answer 8

higher doses

Question 9

Opioid side-effects

Usually transient

Answer 9

Nausea
Drowsiness

Question 10

Opioid side-effects

Usually persistent

Answer 10

Constipation

Question 11

When increasing the dose of opioids the next dose should be ………

Answer 11

increased by30-50%.

Question 12

the breakthrough dose of morphine is……

Answer 12

one-sixth the daily dose of morphine

Question 13

all patients who receive opioids should be prescribed

Answer 13

laxative

Question 14

in palliative patients with mild-moderate renal impairment
Which opioids is preferred ?

Answer 14

oxycodone is preferred to morphine

Question 15

in palliative patients with renal impairment is more severe
Which opioids is preferred ?

Answer 15

alfentanil
buprenorphine
fentanyl

Question 16

metastatic bone pain may respond to

Answer 16

strong opioids, bisphosphonates or radiotherapy.

Question 17

Conversion between opioids

From oral codeine or tramadol to oral morphine divide by

Answer 17

10

Question 18

Conversion between opioids

From Oral morphine to Oral oxycodone divide by

Answer 18

1.5 - 2

Question 19

Conversion between opioids

From Oral morphine to s.c morphine

Answer 19

Divide by 2

Question 20

Conversion between opioids

From Oral morphine to Subcutaneous diamorphine

Answer 20

Divide by 3

Question 21

Conversion between opioids

From Oral oxycodone to Subcutaneous diamorphine
Divide by

Answer 21

1.5

Question 22

transdermal fentanyl 12 microgram patch equates to approximately ….. mg oral morphine daily

Answer 22

30 mg

Question 23

transdermal buprenorphine 10 microgram patch equates to approximately ….. mg oral morphine daily.

Answer 23

24 mg

Question 24

Headache caused by raised intracranial pressure due to brain cancer (or metastases) can be palliated with

Answer 24

dexamethasone

Question 25

Benzydamine hydrochloride mouthwash or spray may be useful in reducing the discomfort associated with

Answer 25

painful mouth that may occur at the end of life