Four Anticipatory Medication Domains — SCE Palliative Medicine MCQ

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EasyEnd of Life CareFour Anticipatory Medication DomainsSCE Palliative Medicine

A 70‑year‑old man with advanced cancer is prescribed anticipatory medications for use at home. The standard set includes: morphine sulphate SC PRN, midazolam SC PRN, levomepromazine SC PRN, and glycopyrronium SC PRN. What does each drug treat?

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Reveal the answer and explanation

Correct answer: B — Morphine = pain and/or breathlessness; Midazolam = agitation/anxiety; Levomepromazine = nausea and vomiting; Glycopyrronium = respiratory secretions

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

Option B is correct. UK end‑of‑life anticipatory prescribing guidance (e.g. NHS trust patient information and NICE-aligned practice) clearly maps each drug to a distinct symptom domain: morphine for pain and breathlessness, midazolam for agitation or anxiety, levomepromazine for nausea and vomiting, and glycopyrronium for managing respiratory secretions. These PRN medications are intended for use if the specific symptom arises, not to be given routinely or together. Options A, C, D, and E are incorrect because they either misattribute indications, suggest inappropriate simultaneous administration, or imply interchangeability where none exists.

Reference: Northern Care Alliance: End of Life Care – A guide to anticipatory medications (2025–26); Dudley Group NHS Foundation Trust: Anticipatory medicines (2025–26), https://www.northerncarealliance.nhs.uk/patient-information/patient-leaflets/end-life-care-guide-anticipatory-medications