Palliative

Question 1

What is the 1st line treatment for confusion in patients who are end of life?

Answer 1

haloperidol

Other options include chlorpromazine and levopromazine.

Question 2

What medication is used for the management of agitation/restlessness in patients who are end of life?

Answer 2

Midazolam

This is the preferred medication for agitation in end-of-life care.

Question 3

What is the 1st line treatment for hiccups in patients who are end of life?

Answer 3

chlorpromazine

Other options include haloperidol, gabapentin, and dexamethasone.

Question 4

What is the regime for oral morphine for pain in opioid naive patients who are end of life?

Answer 4

Oral morphine MR 10-15mg BD with oral morphine 5mg for breakthrough

Increase dose by 30-50% to adequately control pain.

Question 5

What is the preferred opioid in mild-moderate renal impairment?

Answer 5

Oxycodone

Oxycodone is typically used due to its safer profile in renal impairment.

Question 6

What are the preferred opioids in severe renal impairment?

Answer 6

• Alfentanil
• Buprenorphine
• Fentanyl

These opioids are preferred due to their pharmacokinetic properties.

Question 7

What is the management for metastatic bone pain?

Answer 7

• Strong opioids
• Bisphosphonates
• Radiotherapy

These treatments are commonly used for managing pain associated with bone metastases.

Question 8

What is the management of pain associated with liver metastases?

Answer 8

Dexamethasone

Dexamethasone is often used to alleviate pain in this context.

Question 9

What are the transient side effects associated with opioids?

Answer 9

• Nausea
• Drowsiness

These side effects are typically temporary and may resolve with continued use.

Question 10

What is a persistent side effect associated with opioids?

Answer 10

Constipation

Constipation is a common and often long-lasting side effect of opioid use.

Question 11

What is the conversion factor from oral codeine to oral morphine?

Answer 11

Divide by 10

This conversion is important for dosing in pain management.

Question 12

What is the conversion factor from oral tramadol to oral morphine?

Answer 12

Divide by 10

This is used to calculate equivalent doses for effective pain management.

Question 13

What is the conversion factor from oral morphine to oral oxycodone?

Answer 13

Divide by 1.5

This conversion helps in switching opioids while managing pain.

Question 14

What is the conversion from a transdermal fentanyl patch to oral morphine?

Answer 14

Transdermal fentanyl patch 12 micrograms/hour = oral morphine 30mg/day

This conversion is crucial for opioid rotation.

Question 15

What is the conversion from a transdermal buprenorphine patch to oral morphine?

Answer 15

Transdermal buprenorphine 10 microgram patch/hour = oral morphine 24mg/day

This helps in managing pain effectively when switching medications.

Question 16

What is the conversion factor from oral morphine to s/c morphine?

Answer 16

Divide by 2

This conversion is important for parenteral administration.

Question 17

What is the conversion factor from oral morphine to s/c diamorphine?

Answer 17

Divide by 3

This is used for effective pain management in palliative care.

Question 18

What is the conversion factor from oral oxycodone to s/c diamorphine?

Answer 18

Divide by 2

This conversion is essential for opioid switching.

Question 19

What drugs should be suspended in sodium chloride 0.9% in a syringe driver rather than water?

Answer 19

• Ondansetron
• Granisetron
• Ketamine
• Ketorolac
• Octreotide

These drugs require specific diluents for safe administration.

Question 20

What drugs is cyclizine incompatible with in a syringe driver?

Answer 20

• Clonidine
• Dexamethasone
• Hyoscine
• Ketamine
• Ketorolac
• Metoclopramide
• Midazolam
• Octreotide
• Sodium chloride 0.9%

Awareness of incompatibilities is crucial for safe medication administration.