Wattle Pharmacy Prep

Pain and palliative care
Practice questions with explanations

Pain and palliative care belongs to Therapeutics and patient care, which makes up about 45% of the Overseas Pharmacist Readiness Assessment (OPRA®). Answer each question yourself before opening the explanation.

1. Which advice applies to using paracetamol regularly in an older patient with chronic pain?

  1. Regular dosing is more effective than as-needed use, and the daily maximum may be reduced in low body weight, frailty, malnutrition or chronic alcohol use
  2. The maximum dose is the same for everyone
  3. As-needed use is always preferable
  4. Paracetamol has no maximum in the elderly
Show answer

A. Regular dosing is more effective than as-needed use, and the daily maximum may be reduced in low body weight, frailty, malnutrition or chronic alcohol use

Regular dosing maintains a therapeutic concentration and works better for persistent pain than waiting for it to become severe. Reduced doses are advised in patients under about 50 kg and in those with hepatic risk factors, and hidden paracetamol in combination products must be counted toward the total.

2. Which explains why laxatives are prescribed alongside opioids in palliative care even when the patient is eating little?

  1. Laxatives are unnecessary
  2. Reduced intake prevents constipation
  3. It only occurs with a normal diet
  4. Opioid constipation results from reduced motility rather than from stool volume, so it occurs regardless of intake
Show answer

D. Opioid constipation results from reduced motility rather than from stool volume, so it occurs regardless of intake

Patients and families often assume that eating little means the bowels need not open, and faecal impaction develops with overflow that is mistaken for diarrhoea. Regular assessment of bowel function, prophylactic laxatives and a low threshold for rectal examination prevent a distressing and avoidable complication.

3. What is the role of low-dose morphine in refractory breathlessness at the end of life?

  1. It has no effect on breathlessness
  2. It works only if given intravenously
  3. It is contraindicated because it always causes respiratory failure
  4. It reduces the sensation of breathlessness and the associated distress without hastening death when titrated appropriately
Show answer

D. It reduces the sensation of breathlessness and the associated distress without hastening death when titrated appropriately

Opioids reduce the central perception of breathlessness and the ventilatory response to hypercapnia, easing distress. Evidence supports careful low-dose use, and titrated appropriately it does not shorten life, a fear that leads to undertreatment. Non-drug measures — a fan directed at the face, positioning, pacing and explanation — are effective and used alongside.

These are 3 of the 51 questions on pain and palliative care in the app.

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More topics in Therapeutics and patient care

Australian pharmacy practice and law · Cardiovascular therapeutics · CNS and psychiatry · Counselling, OTC and triage · Dermatology · Diabetes and endocrine therapeutics · Eye, ear, nose and throat · Gastrointestinal therapeutics · Infectious diseases · Musculoskeletal · Older people and polypharmacy · Oncology and supportive care · Paediatrics · Pharmaceutical calculations · Renal and urology · Respiratory therapeutics · Vaccines and immunisation · Women's health