Symptom Control

Question 1

Compare nociceptive vs neuropathic pain

Answer 1

nociceptive: functioning nervous system. The pain is localised
neuropathic: dysfunctional nervous system. The pain is generally tingling, it travels and it fluctuates

Question 2

Describe the WHO pain ladder

Answer 2

1. paracetamol, NSAIDs
2. codeine, tramadol, dihydrocodeine
3. morphine, diamorphine, oxycodone, fentanyl

Question 3

What are some side effects of opioids?

Answer 3

constipation 
drowsiness
dry mouth 
N&V
respiratory depression

Question 4

What analgesia is best to use in CKD?

Answer 4

Mild renal impairment: oxycodone

Severe renal impairment: fentanyl and buprenorphine

Question 5

When would you consider up titrating a persons opioid?

Answer 5

> 3 PRN needed a day

Question 6

How is someone’s new up titrated dose of morphine calculated?

Answer 6

BD dose + PRN doses used = TDD

New BD = TDD/2
New PRN = TDD/6

Question 7

What is a typical starting regime for someone new to opioids?

Answer 7

15mg BD zomorph (modified release)

5mg PRN oramorph (immediate release)

Question 8

Compare the side effect profile of oxycodone and morphine

Answer 8

oxycodone is more constipating however leads to less nausea and drowsiness and pruritis

Question 9

What are the causes of vomiting in a cancer patient?

Answer 9

gastric dysmotility 
opioid and chemotherapy induced 
electrolyte disturbances
- uraemia 
- hypercalcaemia 
- hyponatraemia 
anxiety induced 
RICP

Question 10

How is chemotherapy induced N&V managed?

Answer 10

Ondansetron

Question 11

How is metabolic derangement induced N&V managed?

Answer 11

haloperidol or levomepromazine

Question 12

How is N&V due to reduced gastric motility managed?

Answer 12

Metoclopramide

Question 13

How is N&V due to mechanical bowel obstruction managed?

Answer 13

Cyclizine

Question 14

How is anxiety induced N&V managed?

Answer 14

Lorazepam

Question 15

How is RICP in palliative care managed?

Answer 15

Cyclizine + dexamethasone + radiotherapy

Question 16

What are some causes of breathlessness in palliative care?

Answer 16

anxiety 
pneumonia 
PE
SVCO
rib metastasis

Question 17

How is breathlessness in palliative care managed?

Answer 17

Open windows and increase air flow 
Sit the patient up
Talk about any anxieties they are having
Breathing exercises and physiotherapy 
Morphine 
Benzodiazepines 
Oxygen

Question 18

What causes hiccups in palliative patients?

Answer 18

Gastric distention
Phrenic nerve involvement
Uraemia

Question 19

How are intractable hiccups managed?

Answer 19

Chlorpromazine

+/- haloperidol, gabapentin and dexamethasone

Question 20

What causes constipation in palliative care?

Answer 20

Opioids
Weakness to push 
Dehydration and malnutrition 
Immobility 
Hypercalcaemia 
Spinal cord compression

Question 21

How is constipation in palliative care managed?

Answer 21

Co-danthramer (stimulant + softener)
Or
Lactulose + Senna

Question 22

How does end stage lymphoedema present?

Answer 22

Non-pitting oedema

Chronic skin changes

Question 23

How is lymphoedema managed?

Answer 23

Gradient compression bandaging

Question 24

How should psychological distress associated with cancer/ palliation be managed?

How should it be managed in the terminal phase of illness?

Answer 24

Non-pharmacologically: breathing exercises, religious support, CBT
Haloperidol or chlorpromazine

Terminal phase: Midazolam

Question 25

What are the drug options for respiratory secretions? What is the advantage of one vs the other?

Answer 25

Hyoscine hydrobromide: sedating
Hyoscine butylbromide: non-sedating

Can also use glycopyrronium

Question 26

What are the advantages and disadvantages of using a patch for analgesia?

Answer 26

+ Less constipating

• Analgesia requirements need to be stable to use
• Increased N&V
• Withdrawal symptoms