Palliative prescribing

Question 1

Name 2 opioids for moderate pain

Answer 1

Codeine phosphate

Tramadol hydrochloride

Question 2

Name 5 opioids for severe pain

Answer 2

Morphine
Buprenorphine
Oxycodone
Methadone
Fentanyl

Question 3

Adjuvant treatment of pain due to bone mets

Answer 3

Radiotherapy
Bisphosphonates
Strontium Ranelate

Question 4

Name the first line medications for neuropathic pain

Answer 4

Amitriptyline, nortriptyline (TCAs)

Carbamazepine for trigeminal neuralgia

Question 5

2nd line for neuropathic pain

Answer 5

Anti-epileptics (pregabalin, gabapentin, carbamazepine)

Question 6

If neuropathic pain not relieved by TCAs or antiepileptics, what can be used?

Answer 6

Tramadol

Use while waiting for a specialist review

Question 7

What can be used for post-herpetic neuralgia?

Answer 7

Capsaicin cream or patch

Question 8

What can be used to treat neuropathic pain caused by compression?

Answer 8

Prednisolone, reduced swelling and compression

Radiotherapy if spinal cord compression

Question 9

What should be given for breakthrough pain when a pt is taking modified release oral morphine?

Answer 9

Immediate release oral morphine

Question 10

If the dose of morphine is not covering the pain, what can be done?

Answer 10

Calculate how many rescue doses were taken in a 24hr period and increase the 24hr total dose by that much
Or, increase the dose by 1/3

Question 11

What should be prescribed with morphine

Answer 11

Laxative (senna, lactulose, methylnaltrexone bromide)

Anti-emetic for first 3 days (haloperidol/metoclopramide)

Question 12

Which analgesia can be given transdermally?

Answer 12

Fentanyl

Buprenorphine

Question 13

What can help with anorexia and dysphagia?

Answer 13

Prednisolone

Dexamethasone

Question 14

What can be given for excessive respiratory secretions?

Answer 14

Hyoscine butylbromide (buscopan)
Glycoperonium bromide

Question 15

3 options for capillary bleeding associated with liver failure

Answer 15

Tranexamic acid
Topical adrenaline
Vit K

Question 16

What can be used prophylactically to prevent convulsion in pts with cerebral tumours or uraemia?

Answer 16

Phenytoin
Carbamazepine
or rectal diazepam

Question 17

Treatment of dry mouth

Answer 17

Good mouth care
Sugar free gum
Sucking ice or pineapple chunks
Artificial saliva

Question 18

Management of oral candida

Answer 18

Oral nystatin, fluconazole

Question 19

Management of fungating tumours

Answer 19

Metronidazole

Regular dressings

Question 20

Management of hiccup

Answer 20

Anti flatulant medicines (simeticone? asoefoetida?)
+ antacid (aluminium hydroxide)
2nd line: metoclopamide
2rd line: baclofen, nifedipine

Question 21

Management of intractable cough

Answer 21

Moist inhalations
Morphine
(avoid methadone linctus)

Question 22

Management of muscle spasm

Answer 22

Diazepam

Baclofen (muscle relaxant)

Question 23

When is cyclizine used?

Answer 23

Raised IVP
Motion sickness
Mechanical bowel obstruction

Question 24

Itching with obstructive jaundice

Answer 24

Emollients

2nd line: colestyramine

Question 25

Management of restlessness and insomnia

Answer 25

Levomapromazine
Haloperidol
Midazolam

Question 26

Name 6 signs of opioid toxicity

Answer 26

Myoclonic jerks
Agitation
Hallucinations
Confusion
Pin point pupils
Respiratory depression

Question 27

Which anti-emetics work well for gut problems?

Answer 27

Dopamine antagonists, work outside BBB
Domperidone
Also prokinetic

Question 28

Which antiemetic works well for chemical causes of nausea?

Answer 28

Haloperidol low dose

Works at CTZ

Question 29

Which antiemetic is useful in bowel obstruction?

Answer 29

Cyclizine

Not prokinetic

Question 30

How do you treat breathlessness in end-of-life pts?

Answer 30

Opioids

Benzodiazepines

Question 31

Management of hypercalcaemia?

Answer 31

Check calcium, renal function, albumin
Rehydrate (minimum 2L)
Bisphosphonates