Palliative Care Module 1

Which of the following opioid is NOT safe for use in patients with renal impairment?

The parents of a child in the Intensive Care unit with a terminal illness make a choice not to pursue further treatment for their child’s condition. Medical advice has been that there is little hope that any intervention would prolong the child’s life. In this situation, which of the following should not be withheld?

A patient has severe pain from locally advanced pancreatic cancer. The pain is eventually well controlled by 80 mg per 24 hours of subcutaneous morphine infusion in hospital. It is intended to discharge the patient on oral sustained-release morphine.

Which one of the following is likely to be the most appropriate dose?

Which of the following opiod has increased risk of QT prolongation?

Which of the following opioid increases the risk of convulsions?

Which of the following is least consistent with a drug seeking behaviour?

With regards to the management of opioid induced constipation in a patient with advanced metastatic disease currently in hospice care, which of the following is least likely to be useful?

A 78-year-old woman with metastatic breast cancer who has received palliative doses of morphine for 2 months is hospitalized with a 2-week history of abdominal pain and distention. Passage of a bowel movement alleviates her pain, although she reports that the stools are quite hard. Abdominal examination reveals distention and slight tenderness. Rectal examination reveals hard stool in the rectal vault.

Which of the following treatment will most likely relieve this patient’s abdominal symptoms and constipation?

You are reviewing a 66-year-old man with metastatic prostate cancer in the ward. He is known to have spinal metastases but until now has not had any significant problems with pain control. Unfortunately he is now getting regular back pain despite taking regular paracetamol 1g QID. Neurological examination is unremarkable.

What is the most appropriate next step?

A 70-year-old man with chronic kidney disease stage 4 and metastatic prostate cancer presents to hospital as his pain is not controlled with ParaCode (paracetamol and codeine phosphate).

Which one of the following opioid is the most appropriate to use given his impaired renal function?

A 57-year-old man with lung cancer is currently taking Sevredol 10mg Q4hrly for pain relief.

What dose of oral morphine solution should he be prescribed for breakthrough pain?

If a patient takes 60mg of oral codeine phosphate every 6 hours, what is the equivalent dose to oral morphine in 24 hours?

A 65 year old man with a diagnosis of metastatic lung cancer is opiate naive and has been prescribed short acting morphine (elixir) at a dose of 5mg every four hours. He required an additional 10mg as breakthrough over the last 24 hours. His pain appears to be well controlled with this medication. So after 3 days, you decide to switch him over to a long acting preparation.

Which of the following dose would be the most appropriate long acting preparation?

Which of the following is the most common side effect of opioid?

Which of the following is the correct single dose equivalent?