Marie Curie Nursing Service — SCE Palliative Medicine MCQ

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HardEnd of Life CareMarie Curie Nursing ServiceSCE Palliative Medicine

A dying patient has distressing noisy respiratory secretions despite repositioning. Intermittent doses helped and a continuous infusion is now chosen. Which glycopyrronium dose range is guideline-concordant over 24 hours?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — 600–1200 micrograms over 24 hours

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

D is correct. Scottish palliative guidance lists glycopyrronium 600–1200 micrograms by continuous subcutaneous infusion over 24 hours for chest secretions or colic. A–C are below that infusion range, while E is substantially above it. Explain that treatment aims to reduce new secretions, may not abolish existing noise and is primarily considered when secretions are distressing; review benefit and anticholinergic harms.

Reference: Scottish Palliative Care Guidelines: subcutaneous infusion tables: https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/test-scottish-palliative-care-guidelines/medicines/syringe-pump-driver-guidelines/syringe-pump-driver-compatibles/compatibility-and-stability-tables-for-subcutaneous-infusion-single-drug-tables-1a-to-1f/ NICE NG31: care of dying adults: https://www.nice.org.uk/guidance/ng31/chapter/Recommendations