Palliative Care

Question 1

Palliative care agitation and confusion?

Answer 1

1. 1st line = Haloperidol
2. 2nd line = Chlorpromazine, levomepromazine

Question 2

Terminal agitation and restlessness?

Answer 2

Midazolam

Question 3

Starting palliative pain regimen?

Answer 3

20-30mg Modifified release morphine + 5mg for breakthrough pain

Question 4

Breakthrough dose of morphine?

Answer 4

1/6th the daily dose

Question 5

Opioid choice in mild-moderate CKD?

Answer 5

Oxycodone

Question 6

Severe renal impairment painkiller?

Answer 6

1. Alfentanil
2. Buprenorphine
3. Fentanyl

Question 7

Metastatic bone pain Rx?

Answer 7

1. Strong opioids
2. Bisphosphonates
3. Fentanyl
4. Radiotherapy
5. Denosumab

Question 8

How much to increase dose of opioids by?

Answer 8

30-50%

Question 9

Transient opioid s/e?

Answer 9

Nausea and drowsiness

Question 10

Persistent opioid s/e?

Answer 10

Constipation

Question 11

Oral codeine to oral morphine?

Answer 11

Divide by 10

Question 12

Oral tramadol to oral morphine?

Answer 12

Divide by 10

Question 13

Oral morphine to oral oxycodone?

Answer 13

Divide by 1.5-2

Question 14

Transdermal 12 mcg fentanyl patch morphine equivalent?

Answer 14

30mg oral morphine daily

Question 15

Transdermal 10mcg buprenorphine patch equivalent?

Answer 15

24mg oral morphine daily

Question 16

Oral morphine to subcutaneous morphine?

Answer 16

Divide by 2

Question 17

Oral morphine to subcutaneous diamorphine?

Answer 17

Divide by 3

Question 18

Oral oxycodone to subcutaneous diamorphine?

Answer 18

Divide by 1.5

Question 19

Palliative hiccups management?

Answer 19

1. Chlorpromazine for intractable hiccups
2. Haloperidol, gabapentin also used
3. Dexemethasone particularly used if hepatic lesions

Question 20

6 Palliative care N&V syndromes?

Answer 20

1. Reduced gastric motility = opioid related
2. Chemically mediated = hypercalcaemia, opioids, chemo
3. Visceral/serosal = constipation, candidiasis
4. Raised ICP = cerebral metastases
5. Vestibular = opioid related
6. Cortical = anxiety, pain, fear and/or anticipatory nausea

Question 21

Reduced gastric motility nausea and vomiting Rx?

Answer 21

Metoclopramide and domperidone (prokinetics)

Question 22

Chemically mediated nausea and vomiting Rx?

Answer 22

Ondansetron, haloperidol, levopromazine

Question 23

Visceral/serosal nausea and vomiting causes?

Answer 23

Cyclizine and levopromazine

Question 24

Raised ICP N&V Rx?

Answer 24

Cyclizine, Dexamethasone, Radiotherapy

Question 25

Vestibular N&V Rx?

Answer 25

1. Cyclizine 2. Prochlorperizine/metoclopromide 3. Olanzapine/risperidone in refractory cases

Question 26

Cortical N&V Rx?

Answer 26

1. Lorazepam if anticipatory 2. If BZDs not ideal, try cyclizine 3. Can try ondansetron and metoclopramide