Palliative

Question 1

What is the starting dose for pain management using morphine?

Answer 1

15mg MR BD and 5mg for breakthrough pain

Question 2

Increasing morphine dose

Answer 2

Increase 50%

Question 3

Breakthrough morphine dose

Answer 3

1/6th - 1/10th

Question 4

Codeine –> morphine conversion

Answer 4

/10

Question 5

Tramadol –> morphine conversion

Answer 5

/10

Question 6

Oral morphine –> SC/IV/IM morphine conversion

Answer 6

/2

Question 7

Oral morphine –> oral oxycodone conversion

Answer 7

/1.5

Question 8

Oral morphine –> SC oxycodone

Answer 8

/2

Question 9

Oral morphine –> SC diamorphine conversion

Answer 9

/3

Question 10

Oral oxycodone –> SC diamorphine conversion

Answer 10

/1.5

Question 11

Oral morphine —> SC alfentanil

Answer 11

/30

Question 12

What does a transdermal fentanyl 12 microgram patch equate to in oral morphine

Answer 12

30mg

Question 13

What does a transdermal buprenorphine 10 microgram patch equate to in oral morphine

Answer 13

24mg

Question 14

Mx metastatic bone pain

Answer 14

Strong opioids
Bisphosphonates
Radiotherapy
Denosumab (Inhibits RANKL preventing osteoclasts, preferred to bisphosphonates when eGFR <30)

Question 15

Mx agitation/confusion in palliative

Answer 15

first choice: haloperidol
other options: chlorpromazine, levomepromazine

Question 16

Mx secretions (conservative or medical)

Answer 16

Conservative:
Avoiding fluid overload

Medical:
Hyoscine hydrobromide or hyoscine butylbromide (less sedative)
Glycopyrronium bromide may also be used

Question 17

Mx N&V

Answer 17

Cyclizine then levomepromazine
Ondansetron for acute post chemo
Dexamethasone for delayed post chemo
Haloperidol for opoid induced nausea

Question 18

Antiemetic in syringe driver

Answer 18

Levomepromazine

Question 19

Mx hiccups

Answer 19

Chlorpromazine is licensed
Haloperidol is also used
Gabapentin is also used

Question 20

Mx in hepatic mets

Answer 20

Dexamethasone

Question 21

Example of bulk formin laxative, stool softner, osmotic laxative and stimulant

Answer 21

Bulk forming laxatives = ispaghula husk, methylcellulose
Stool softener = docusate sodium
Osmotic = lactulose or macrogol
Stimulant = senna or biscodyl (senna for opioid induced)