Prescribing in Palliative Care

Question 1

What is licensed for treatment of intractable hiccups in palliative care? (2)

Answer 1

1) Chlorpromazine

2) Haloperidol

Question 2

2 key steps in conservative mx of secretions in end of life?

Answer 2

1) Avoiding fluid overload - stopping IV or SC fluids

2) Educating the family that the patient is likely not troubled by secretions

Question 3

1st line mx of secretions in palliative care?

Answer 3

Hyoscine hydrobromide or hyoscine butylbromide

Glycopyrronium bromide may also be used

Question 4

What are 6 broad N&V syndromes in palliaite care?

Answer 4

1) Reduced gastric motility

2) Chemical

3) Visceral/serosal

4) Raised ICP

5) Vestibular

6) Cortical

Question 5

What is chemically mediated N&V in palliative care typically 2ary to? (3)

Answer 5

1) Hypercalcaemia

2) Opioids

3) Chemotherapy

Question 6

What 2 receptors is reduced gastric motility causing N&V related to?

Answer 6

1) Serotonin

2) Dopamine

Question 7

What is raised ICP causing N&V in palliative care usually in context of?

Answer 7

Brain mets

Question 8

1st line mx of N&V due to reduced gastric motility?

Answer 8

Pro-kinetic agents –> Metoclopramide & domperidone

Note - should NOT be used in complete bowel obstruction, GI perforation, or immediately following gastric surgery.

Question 9

Mx of chemically mediated N&V?

Answer 9

1) Correct chemical disturbance (if possible)

2) Mx –> haloperidol, levomepromazine, ondansetron

Question 10

What 3 medications may be used in mx of chemically mediated N&V?

Answer 10

1) haloperidol
2) ondansetron
3) levomepromazine

Question 11

2 causes of visceral/serosal N&V?

Answer 11

1) Constipation
2) Oral candidiasis

Question 12

1st line in mx of visceral/serosal N&V? (2)

Answer 12

Cyclizine & levomepromazine

Question 13

Mx of raised ICP causing N&V?

Answer 13

1) Cyclizine

2) Dex can also be used

Question 14

1st line mx of vestibular causes of N&V?

Answer 14

Cyclizine

Question 15

1st line mx of agitation in TERMINAL phase?

Answer 15

Midazolam

Question 16

1st line mx of agitation if not in terminal phase?

Answer 16

Haloperidol

Note - Underlying causes of confusion need to be looked for and treated, e.g. hypercalcaemia, infection, urinary retention and medication.

Question 17

What may be used in reducing the discomfort associated with a painful mouth that may occur at the end of life?

Answer 17

Benzydamine hydrochloride mouthwash or spray

Question 18

What lung cancer is most associated with smoking?

Answer 18

Squamous cell carcinoma