Category Archives: Palliative care

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

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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

Palliative care in end-stage chronic respiratory disease

(COPD, interstitial lung disease, CF, etc.) 1st-line: Small hand-held fan to blow air on face. (Not much evidence that it works in the palliative care setting, but has the benefit of being cheap and simple, so worth a try.) 2nd-line: … Continue reading

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Palliative care for CCF

Remember that the downward trajectory might be less obvious than it is in people with cancer, since the pattern is more one of flare-ups on a gradual background deterioration; death usually seems sudden when it happens, but the background deterioration … Continue reading

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Refractory opioid-induced constipation

As anyone with even a smattering of palliative care knowledge should be aware, opiates typically cause constipation and a laxative should typically be co-prescribed. This week’s BMJ has a useful tip on what to do about opioid-induced constipation that is … Continue reading

Posted in Credits 2017, Medication, Palliative care | Leave a comment

Nausea and vomiting in palliative care

I get involved with a lot of palliative care, so this BMJ review article on management of this very common problem was well worth the read. Good news, first off; as problems go, this is one that’s very amenable to … Continue reading

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Palliative care

(From BMJ learning module) Palliative Care Adult Network Guidelines Plus are a useful resource. Opiates in renal impairment Some good ones: Oxycodone, which is 90% excreted by the liver and only needs dose reduction in CKD5 Fentanyl – fine down … Continue reading

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