Palliative Medicine

Question 1

What is the transdermal equivalent to morphine?

Answer 1

The current BNF gives the following conversion factors for transdermal perparations
a transdermal fentanyl 12 microgram patch equates to approximately 30 mg oral morphine daily
a transdermal buprenorphine 10 microgram patch equates to approximately 24 mg oral morphine daily.

Question 2

What can you use for hiccups in palliative patients?

Answer 2

Chlorpromazine (or haloperidol)

Question 3

How do you convert from codeine to morphine?

Answer 3

Divide by ten

Question 4

What can be used first line for secretions/noisy breathing?

Answer 4

Hyoscine

Question 5

What is the best form of pain relief in severe renal impairment?

Answer 5

Buprenorphine or fentanyl are the opioids of choice for pain relief in palliative care patients with severe renal impairment, as they are not renally excreted and therefore are less likely to cause toxicity than morphine

Question 6

How do you convert from morphine to oxycodone?

Answer 6

Divide by 1.5-2

Question 7

How do the side effects of oxycodone compare to that of morphine?

Answer 7

Oxycodone generally causes less sedation, vomiting and pruritis than morphine but more constipation.

Question 8

Conversion from oral to SC morphine

Answer 8

Divide by 2

Question 9

Conversion from oral morphine to SC diamorphine

Answer 9

Divide by 3

Question 10

Conversion from oral oxycodone to SC diamorphine

Answer 10

Divide by 1.5