A company is conducting a study on a new antibiotic called Novobact, which is administered intravenously. In a controlled experiment on a healthy participant, 500 mg of the drug is given. After a short while, the drug concentration in the plasma is measured to be 10 mg/L. If there has been no metabolism or excretion of the drug, what is the volume of distribution?
A 20-year-old man presents to the emergency department after ingesting 30 tablets of paracetamol 500 mg. He reports feeling nauseated and his girlfriend confirms that he took the tablets two hours ago. To guide treatment, a plasma paracetamol level will be taken. What is the minimum recommended time interval between ingestion and measuring the plasma level to accurately assess the paracetamol level?
A 58-year-old woman is admitted to the hospital with cholecystitis. During her stay, her blood glucose levels remain consistently high. Her lab results reveal an HbA1c level of 68 mmol/mol. As her healthcare provider, you initiate treatment with metformin 500 mg immediate release. What is the recommended time interval before considering a dose increase?
A 57-year-old retired nurse is receiving palliative care for terminal metastatic lung cancer. Her pain has been well managed until recently, when she started experiencing discomfort about an hour before her next dose of pain medication. This is causing her to feel anxious and concerned about her ability to cope with the pain.
What are the advantages of treating pain during palliative care?
A 75-year-old man comes to his GP for a medication review. He has metastatic bowel cancer and is in relatively good health, still able to move around and take care of himself. He has been eating and drinking well. Currently, he is taking modified release morphine sulphate tablets (MST) 20 mg twice daily and using oramorph 10 mg/5 ml for breakthrough pain 4-6 times a day. He has not reported any adverse effects.
What would be the best course of action for managing his medication?
A 78-year-old man is currently receiving end-of-life care due to advanced lung cancer. He has been experiencing intermittent episodes of vomiting, reflux and early satiety believed to be caused by autonomic dysfunction resulting in gastric stasis. He also has a history of Parkinson’s disease.
What would be the most suitable pharmacological treatment to prescribe for this patient?
A 67-year-old woman with metastatic oesophageal cancer is being visited at home by her GP. She is believed to be nearing the end of her life. Due to her condition, she is bedridden and unable to swallow. Her current medication includes taking MST 40 mg tablets twice a day, and she seldom requires oramorph for breakthrough pain. What would be the most suitable course of action for her management?
A 70-year-old man with colorectal carcinoma, Dukes stage D, has severe pain from bony metastases. He has undergone courses of radiation therapy and intravenous infusion of bisphosphonates, which have failed to control his pain. He is currently taking regular paracetamol and ibuprofen. When previously given opiate analgesia, he became very drowsy and poorly responsive. His pain score is 9/10 at rest and he becomes very distressed when being moved by nursing staff.
Which of the following is the most appropriate intervention?
A 72-year-old retired teacher with advanced ovarian cancer is reviewed at home by her General Practitioner (GP). Her daughter requested a home visit due to significant deterioration in her health over the past few days, and she is concerned that she can no longer meet her healthcare needs at home without assistance.
During the consultation, the GP discusses considering hospice care for the patient.
To be appropriate for hospice care management, a patient must:
An 80-year-old man with metastatic cancer of the prostate is experiencing breakthrough pain in between his oral morphine doses. The Palliative Care team is consulted to evaluate the patient and modify or supplement his medications to improve pain management.
What is the analgesic with the longest duration of action?