Palliative Medicine

Question 1

What are some step 3 analgaesics?

Answer 1

Morphine
Fentanol
Oxycodone
Methadone
Hydromorphine

Question 2

What are the side effects of morphine?

Answer 2

Constipation (95%)
Nausea and Vomiting (30%)
Sedation (25%)
Itch
Respiratory depression 
Urinary retention
Myoclonus
Dry mouth

Question 3

What the the three criteria for addiction?

Answer 3

1. Withdrawl symptoms
2. Craving - a psychological dependence
3. Higher levels required for same effects

Question 4

What should you give if you are worried about an opiod OD?

Answer 4

Naloxone

Question 5

Morphine prescribing: how do you calculate the breakthrough (immediate) dose from the MST dose?

Answer 5

MST dose over 24 hrs and devide by 6

i.e. MST 90mg bd = (90x2)/6 = 30mg oromorph

Question 6

Should you give the the oromorph every 4 hours (as per BNF) even if he is pain free?

Answer 6

Yes, you are giving it to PREVENT pain, not in response to pain

Question 7

What are some common adjuvants/co-analgeasics?

Answer 7

NSAIDs
Corticosteriods (brain tumour, liver mets)
Anticonvulsants - neuropathic pain
Antidepressants - neuropathic pain/mood
Muscle relaxants

Question 8

What pathways are involved in vomiting?

Answer 8

Higher centres (raised ICP, anxiety)

Area Postrema (chemoreceptor trigger zone) (drugs, hypercalaemia, toxins)

Vestibular centres (motion sickness)

Vagal pathways (bowel obstruction, abdo tumour)

ALL ENTER INTO VOMITING CENTRE

Question 9

What types of receptors are involved in vomitting?

Answer 9

Area Postrema - D2 + 5HT3

Vestibular Cetres - H1 + ACh m

Vagal pathways - 5HT3

Vom Centre - 5HT2 + H1 + ACh m

Question 10

Which anti-emetics act on which receptors?

Answer 10

5HT3 - Olansotron and granisetron

Dopamine - metaclopramide, domperidone, halliperidol

Histamine - cyclazine

5 hT2 - levomepromazine (plus the others)

ACh - hydrobromide