Monthly Archives: May 2019

Hyperemesis gravidarum

Found an article in a BMJ from a few months back that I hadn’t read: First-line medications Prochlorperazine – can go up to 10 mg 6-hrly, apparently, though I think I’d want to check that before prescribing. Promethazine – 12.5 … Continue reading

Posted in Credits 2019, Medication, Medication in pregnancy, Obstetrics | Leave a comment

Aspirin in people on oral anticoagulants? Probably not.

This DEN has come up a couple of times lately; do people on oral anticoagulants gain any further benefit from taking aspirin as well? This article has a good summary: If it’s for primary prevention, then no and also why … Continue reading

Posted in Anticoagulants, Cardiovascular, Credits 2019, Medication | Leave a comment

Vaginal dryness

(Note that this comes from a Pulse Learning module that was actually sponsored by Replens; I hadn’t realised it was sponsored when I clicked on it, so, lesson learned, I will look more carefully in future. It did have some … Continue reading

Posted in Gynaecology | 1 Comment

Inherited cardiomyopathies

These can be pretty difficult to pick up; they’re often asymptomatic, examination is often normal, and many of the symptoms (exertional breathlessness, syncope, palpitations) can overlap with those of other illnesses. However, there are some red flags to be aware … Continue reading

Posted in Cardiovascular, Credits 2019, Don't miss | Leave a comment

Tips on chronic pain

If a neuropathic painkiller isn’t working after four weeks at an adequate dose, it’s probably not going to work. Opiates for chronic pain can have tachyphylactic effects. Avoid letting patients go over the equivalent of 120 mg morphine/24 hrs. Arrange … Continue reading

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Palliative care in Parkinson’s disease

Sleep disturbances are common, for various reasons (painful spasms, changes in levodopa levels, some anti-Parkinson’s meds acting as stimulants, day-night reversal in dementia). One useful tip is to avoid high-protein meals late in the evening, which can affect levodopa levels. … Continue reading

Posted in Neurology, Palliative care | Leave a comment

Spasticity and pain in multiple sclerosis

Spasticity 1st-line treatments advised by NICE guidelines are Baclofen or Gabapentin (the latter is off-licence; titrate up carefully from the lowest dose). Titrate up until symptoms relieved; up to maximum dose, if necessary and tolerated. If necessary, the two can … Continue reading

Posted in Credits 2019, Neurology, Palliative care | Leave a comment