Palliative randomised

Question 1

Mx hiccups

Answer 1

Chlorpromazine is licensed
Haloperidol is also used
Gabapentin is also used

Question 2

Oral morphine —> SC alfentanil

Answer 2

/30

Question 3

Mx N&V

Answer 3

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

Question 4

Mx in hepatic mets

Answer 4

Dexamethasone

Question 5

Oral morphine –> SC/IV/IM morphine conversion

Answer 5

/2

Question 6

Oral morphine –> SC oxycodone

Answer 6

/2

Question 7

Antiemetic in syringe driver

Answer 7

Levomepromazine

Question 8

Mx agitation/confusion in palliative

Answer 8

first choice: haloperidol
other options: chlorpromazine, levomepromazine

Question 9

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

Answer 9

30mg

Question 10

Oral oxycodone –> SC diamorphine conversion

Answer 10

/1.5

Question 11

Oral morphine –> oral oxycodone conversion

Answer 11

/1.5

Question 12

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

Answer 12

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

Question 13

What is the starting dose for pain management using morphine?

Answer 13

15mg MR BD and 5mg for breakthrough pain

Question 14

Increasing morphine dose

Answer 14

Increase 50%

Question 15

Tramadol –> morphine conversion

Answer 15

/10

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

Oral morphine –> SC diamorphine conversion

Answer 17

/3

Question 18

Codeine –> morphine conversion

Answer 18

/10

Question 19

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

Answer 19

24mg

Question 20

Mx metastatic bone pain

Answer 20

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

Question 21

Breakthrough morphine dose

Answer 21

1/6th - 1/10th