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Discontinuing Oxygen in Agonal Phase — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareDiscontinuing Oxygen in Agonal PhaseSCE Palliative Medicine

A patient with multifactorial nausea started levomepromazine 5 mg by CSCI six hours ago. Nausea is improving but has not settled completely; blood pressure is stable and a 2.5 mg SC dose previously helped. Which pharmacokinetic fact and interim plan best fit current Scottish guidance?

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

Reveal the answer and explanation

Correct answer: A — Steady state takes about 3 days; give 2.5 mg SC for breakthrough symptoms meanwhile

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

C is correct. Levomepromazine has a long half-life and does not reach steady state for about three days. The guideline notes that low SC rescue doses may be needed more frequently during initial control, for example 2.5 mg every three hours, before the settling dose is translated into the 24-hour infusion. Escalating the background dose after only six hours risks delayed accumulation, hypotension and sedation.

Reference: Scottish Palliative Care Guidelines: nausea and vomiting: https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-management/nausea-and-vomiting/