Palliative care pharmacotherapy and symptom control MCQs With Answer

Palliative care pharmacotherapy and symptom control MCQs With Answer

This quiz collection is designed specifically for M.Pharm students studying Pharmacotherapeutics II (MPP 202T). It focuses on practical and evidence-based pharmacological approaches used in palliative care: analgesia (including opioid and adjuvant strategies), management of common symptoms such as dyspnea, nausea, delirium, secretions and constipation, and important safety considerations like renal impairment, opioid rotation, and drug interactions. Questions probe mechanisms, drug selection, dosing principles, and problem-solving in complex clinical scenarios. Use these 20 MCQs to deepen clinical reasoning, prepare for exams, and reinforce the therapeutic rationale behind symptom control in advanced illness.

Q1. Which opioid is generally preferred for severe pain management in patients with significant renal impairment due to lower accumulation of active metabolites?

• Codeine
• Morphine
• Fentanyl
• Tramadol

Correct Answer: Fentanyl

Q2. What is the most appropriate first-line adjuvant pharmacotherapy for neuropathic cancer pain?

• Ibuprofen
• Gabapentin
• Acetaminophen
• Colchicine

Correct Answer: Gabapentin

Q3. For opioid-induced constipation in a palliative patient not responding to stimulant and osmotic laxatives, which drug class is recommended as a targeted therapy?

• Peripheral opioid receptor antagonists (e.g., methylnaltrexone)
• Centrally acting opioid antagonists (e.g., naloxone oral high dose)
• Bulk-forming laxatives (e.g., psyllium)
• 5-HT3 receptor antagonists

Correct Answer: Peripheral opioid receptor antagonists (e.g., methylnaltrexone)

Q4. A patient on a stable strong opioid regimen requires breakthrough dosing. Which rule-of-thumb best describes an appropriate rescue dose?

• Give a single dose equal to the total daily opioid dose
• Give approximately 10%–20% of the total daily opioid dose
• Give a fixed 30 mg oral morphine equivalent for all patients
• Double the background opioid dose for breakthrough pain

Correct Answer: Give approximately 10%–20% of the total daily opioid dose

Q5. Which antiemetic is most appropriate for nausea caused by gastrointestinal stasis in palliative patients?

• Ondansetron
• Metoclopramide
• Haloperidol
• Promethazine

Correct Answer: Metoclopramide

Q6. In suspected opioid-induced hyperalgesia, what is an appropriate pharmacotherapeutic strategy?

• Increase the opioid dose progressively
• Discontinue opioids abruptly without alternatives
• Rotate to a different opioid and consider NMDA antagonist adjunct (e.g., low-dose ketamine)
• Add high-dose benzodiazepines to suppress pain

Correct Answer: Rotate to a different opioid and consider NMDA antagonist adjunct (e.g., low-dose ketamine)

Q7. Which corticosteroid is most commonly used for acute reduction of spinal cord compression symptoms in palliative oncology practice?

• Hydrocortisone
• Prednisone
• Dexamethasone
• Methylprednisolone

Correct Answer: Dexamethasone

Q8. For secretion control (death rattle) at end of life, which anticholinergic is commonly chosen because it does not cross the blood–brain barrier significantly?

• Atropine eye drops (sublingual)
• Glycopyrrolate
• Scopolamine (hyoscine) patch
• Neostigmine

Correct Answer: Glycopyrrolate

Q9. Which class of antidepressants is preferred as first-line therapy for chronic neuropathic pain in palliative patients when sedation is tolerable?

• Selective serotonin reuptake inhibitors (SSRIs)
• Tricyclic antidepressants (TCAs, e.g., amitriptyline)
• Monoamine oxidase inhibitors (MAOIs)
• N-methyl-D-aspartate (NMDA) receptor antagonists

Correct Answer: Tricyclic antidepressants (TCAs, e.g., amitriptyline)

Q10. When performing opioid rotation, what safety adjustment is typically recommended to allow for incomplete cross-tolerance?

• Increase the calculated equianalgesic dose by 50%–100%
• Use the exact calculated equianalgesic dose with no change
• Reduce the calculated equianalgesic dose by 25%–50%
• Stop all adjuvants prior to rotation

Correct Answer: Reduce the calculated equianalgesic dose by 25%–50%

Q11. Which medication is commonly used for refractory breathlessness in advanced disease due to its central respiratory depressant effect at low doses?

• Low-dose oral morphine
• Salbutamol inhaler
• Furosemide
• Sublingual nitroglycerin

Correct Answer: Low-dose oral morphine

Q12. Which adjuvant agent is appropriate for bone pain due to metastatic disease and has evidence for reducing skeletal-related events?

• Vincristine
• Zoledronic acid (intravenous bisphosphonate)
• Allopurinol
• Metoclopramide

Correct Answer: Zoledronic acid (intravenous bisphosphonate)

Q13. Which opioid is most likely to cause clinically significant histamine release and associated pruritus and hypotension?

• Fentanyl
• Morphine
• Methadone
• Buprenorphine

Correct Answer: Morphine

Q14. For chemotherapy-related nausea and vomiting prophylaxis in a high-emetogenic regimen, which combination is guideline-recommended?

• Metoclopramide alone
• 5-HT3 antagonist + NK1 antagonist + dexamethasone
• Promethazine + haloperidol
• Omeprazole + ondansetron

Correct Answer: 5-HT3 antagonist + NK1 antagonist + dexamethasone

Q15. Which anticonvulsant has a renal-dose adjustment requirement and is commonly used for neuropathic pain in palliative care?

• Carbamazepine
• Gabapentin
• Lamotrigine
• Phenobarbital

Correct Answer: Gabapentin

Q16. What is the principal rationale for combining a stimulant laxative (e.g., senna) with a stool softener (e.g., docusate) when initiating opioid therapy?

• To treat diarrhea caused by opioids
• To prevent opioid-induced constipation by targeting different mechanisms
• To enhance opioid analgesia through pharmacodynamic synergy
• Because opioids reduce the efficacy of single-agent laxatives

Correct Answer: To prevent opioid-induced constipation by targeting different mechanisms

Q17. Which benzodiazepine is commonly used for terminal agitation and refractory seizures requiring sedation in palliative care?

• Diazepam oral only
• Midazolam (parenteral)
• Flumazenil
• Clonazepam topical

Correct Answer: Midazolam (parenteral)

Q18. Which opioid-sparing adjuvant is effective for severe cancer-related bone pain due to its action on osteoclasts and tumor microenvironment?

• Acetaminophen
• Bisphosphonates or denosumab
• Metformin
• Spironolactone

Correct Answer: Bisphosphonates or denosumab

Q19. In palliative patients with delirium causing distress, which antipsychotic is commonly recommended as first-line pharmacologic treatment?

• Haloperidol
• Olanzapine only for all cases
• Risperidone immediate release high dose
• Quetiapine as the sole first-line in every patient

Correct Answer: Haloperidol

Q20. Which opioid administration principle is important when switching routes (e.g., from oral to transdermal fentanyl) to maintain analgesia and avoid withdrawal?

• Stop the previous opioid immediately when the patch is applied
• Perform an appropriate equianalgesic conversion and allow overlap until new route achieves effect
• Use the same milligram dose irrespective of route
• Reduce total daily opioid by 90% when changing route

Correct Answer: Perform an appropriate equianalgesic conversion and allow overlap until new route achieves effect

Download