Rx in palliative care

Question 1

pain med that can be used in renal impairment

Answer 1

alfentanil

Question 2

common cause for N&V in metastatic cancer

Answer 2

malignant hypercalcaemia

Question 3

Can domperidone be given by injection?

Answer 3

NO

Question 4

N&V Tx if metabolic or drug induced

Answer 4

haoperidol

0.5-1.5mg SC hourly PRN

max 3mg/24hrs

Question 5

N&V Tx if bowel distension/obstruction, vestibular problems, raised intracranial pressure

Answer 5

cyclizine injection

50mg SC hourly

max 150mg SC/24hrs

Question 6

When can cyclizine NOT be used?

Answer 6

patients with HF or renal failure

can casue tachycardia

Question 7

alternative antiemetic for cyclizine in HF/renal failure patients

Answer 7

haloperidon

levomepromazine

Question 8

antiemetic for gastric stasis

Answer 8

metoclopramide

domperidone

Question 9

What should NOT be Rx for vomiting due to bowel obstruction?

Answer 9

metoclopramide

it’s a prokinetic

Question 10

N&V that hasn’t responded to previous Tx

Answer 10

combination of antiemetics
OR broader spectrum antiemetic like levomepromazine injection

Question 11

Tx for agitation

Answer 11

midazolam

2.5-5mg SC PRN hourly

Question 12

Tx for agitation when midazolan up to 60mg/24hrs doesn’t work

Answer 12

levomepromaxzine injection

6.25/12.5mg SC PRN up to hourly

Question 13

Tx for secretions

Answer 13

hyoscine hydrobromide

hyoscine butylbromide (non sedating)

Question 14

Tx for secretions if hyoscine HB/BB doesn’t work

Answer 14

glycopyrronium

Question 15

Tx for breathlessness

Answer 15

NOT on opioid:
- opioid injection
- same opioid as analgesic

ON opioid
- midazolam