A 75-year-old patient of yours has terminal lung cancer and is taking morphine. One day you visit him at home to review his medication and check on symptoms. He and his wife are both confused with dosing and think he may have taken too much.
Which of the following symptoms and signs suggests opioid toxicity?
A 65-year-old gentleman with terminal metastatic breast cancer has been on a syringe driver for four days following a period of vomiting. He is currently taking a total of 30 mg of diamorphine over 24 hours via a syringe driver, but his nausea is now well controlled and he wishes to go back on to oral medication.
What total dose of oral morphine should you prescribe over a 24-hour period?
A 16-year-old girl presents with chronic leg pain and is diagnosed with an osteosarcoma.
Which of the following is true of osteosarcoma?
You are asked to prescribe diamorphine to go into a syringe driver for a 85-year-old gentleman with terminal metastatic colorectal cancer. He is currently taking a total of 100 mg of oral morphine over 24 hours.
Having calculated the correct dose of diamorphine for his syringe driver over 24 hours, what dose of subcutaneous diamorphine would you prescribe for breakthrough pain?
A patient in their late 60s with end stage chronic obstructive pulmonary disease on home oxygen is presenting with intractable cough and breathlessness.
They use regular nebulised salbutamol and ipratropium as well as saline nebulised PRN. They also have a regular inhaled corticosteroid and long acting beta agonist combination inhaler and once daily tiotropium inhaled. They take regular oral theophylline. They keep an emergency pack of prednisolone and amoxicillin at home in case they develop any infective symptoms.
On examination, they are apyrexial and chest auscultation reveals globally reduced air entry, with no focal acute signs. There is no evidence of cardiac failure or peripheral oedema.
What is the most appropriate additional treatment for their cough and breathlessness?
A 50-year-old woman with lung cancer is experiencing bone pains. Her biochemistry screen shows borderline hypercalcaemia. She has a medical history of hypertension and is currently taking multiple medications for it.
What is the most probable factor contributing to the exacerbation of her hypercalcaemia?
A 68-year-old man with known Hodgkin’s lymphoma presents with concerns of facial swelling. Upon examination, his face appears red and puffy, with engorged neck veins and a non-rising jugular venous pulse upon liver palpation. What is the likely diagnosis?
A 53-year-old woman who was diagnosed with lung cancer almost a year ago presents feeling progressively unwell over the last week or two.
You review her notes and see that she is under the care of the local respiratory team with a histological diagnosis of squamous cell carcinoma. The tumour is not suitable for surgical resection and the patient is being treated palliatively.
Her current medication consists of: paracetamol 1 g QDS, morphine sulphate 30 mg BD, Oramorph PRN for breakthrough pain, lactulose 15 mls BD and metoclopramide 10 mg TDS.
She describes feeling generally weak and lethargic and complains of thirst and widespread aches and pains. Her family reports that she has also been a bit more vague and slightly confused over the last few days.
Further questioning reveals that she is also suffering from some generalised abdominal pain and despite taking a regular laxative has been very constipated.
What is the underlying cause of this patient’s symptoms?
A 58-year-old gentleman with known lung cancer is seen as an emergency. He has developed a significant deterioration in his breathlessness over the last few days. He also complains of headache and dizziness.
On examination he has a soft stridor and you notice some dilated veins on his chest wall.
What is the most appropriate management plan?
A 75-year-old gentleman being treated palliatively for prostate cancer is reviewed.
He has advanced metastatic disease and is currently taking modified release morphine tablets at a dose of 60 mg BD for pain control. He tells you that since increasing his dose of morphine several weeks ago he is having a lot of problems with constipation.
He weighs 70 kgs and has no known drug allergies or intolerances.
What is the most appropriate regimen to prescribe alone as an initial treatment for his constipation?