Palliative medicine

Question 1

domperidone

Answer 1

pro kinetic

doesn’t cross blood brain barrier

Question 2

odansetron

Answer 2

irritated gut for post chemo/radio

SE v constipating

Question 3

levoprepromazine

Answer 3

multiple causes of N/V or unknown cause and inappropriate to ix

Question 4

metaclopririmide

Answer 4

pro kinetic 
absolute bowel obstruction 
gastric stasis 
constipiated 
SE colic/cramps

Question 5

cyclising

Answer 5

good for increased ICP

SE constipating

Question 6

for constipaton stimulants

softners

Answer 6

senna, busidol

doxylase, lactulose

Question 7

laxido

Answer 7

both stimulant and softner

Question 8

what can help subacute constpation

Answer 8

steroids

Question 9

what shouldn’t be given in obstruction and why

Answer 9

metacloprimide
domperidone

risk of perf

Question 10

opiod toxicity

Answer 10

nightmares first
waking up still in a nightmare
drowsy
confused
visual hallucinations - peripheral shadows
delirum
in extreme: resp distress, myoclonic jerks

Question 11

distress

Answer 11

midazolam 2mg SC hourly

immediate release onset 45 mins lasts 3-4 hours

Question 12

pain/sob

Answer 12

morphine 2mg SC hourly

Question 13

nausea, agitation

Answer 13

levomepromazine 2.5mg SC three hourly

Question 14

resp secretions

Answer 14

hyoscine (buscopan) 20mg SC hourly

Question 15

breakthrough for morphine

Answer 15

1/6 of total daily dose including fentanyl/buponephrine patches

Question 16

if GFR 30-60
<30
renal impairment

Answer 16

oxycodone
alfentanil/fentayl
increases risk of toxicity

Question 17

what GFR is the best

Answer 17

> 60

Question 18

switch from oral morphine to infusion

Answer 18

half dose

Question 19

codiene/tramadol for oral morphone

Answer 19

divide by 10

Question 20

oral morphine to oral oxycodone

Answer 20

divide by 2

Question 21

if high dose of morhphine and can’t get it through drive consider

Answer 21

diamorphine

Question 22

katemine

Answer 22

fast acting 
anaesthetic
palliative 
chronic pain 
dissociating

Question 23

to treat opiod toxicity

Answer 23

alternate oxycodon - half the morphine dose

Question 24

codeine divide by what to get morphoe dose

Answer 24

10

Question 25

convert morphine to subcut if can’t swallow

Answer 25

half the total dose

Question 26

buscupan

Answer 26

hyoscine budo

Question 27

constipation causing nausea and vomitng

Answer 27

pro kinetic like metoclopririme

Question 28

should hyoscine be prescribed in everyone

Answer 28

no not everyone has secretions

Question 29

majority of deaths

Answer 29

dont occur in hospices

most at home

Question 30

parental fluid in dying px

Answer 30

can be given

Question 31

can you complete the DNA CPR without discussion it with the family

Answer 31

ye

Question 32

amitrip and BP

Answer 32

causes hypotension

Question 33

nausea related to opioids

Answer 33

wears off in 2 w

Question 34

morphine treats agitation and distress

Answer 34

no midaz does