Latest & greatest articles for palliative care

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Top results for palliative care

81. Palliative care - secretions: Adverse effects of antimuscarinics

Palliative care - secretions: Adverse effects of antimuscarinics Adverse effects of antimuscarinics | Prescribing information | Palliative care - secretions | CKS | NICE Search CKS… Menu Adverse effects of antimuscarinics Palliative care - secretions: Adverse effects of antimuscarinics Last revised October 2016 Adverse effects of antimuscarinics Common adverse effects of antimuscarinic drugs include dry mouth, constipation, urinary retention, agitation, drowsiness and blurred vision (...) butylbromide and glycopyrronium bromide do not readily cross the blood–brain barrier and therefore do not produce central nervous system adverse effects. The information regarding the adverse effect profile of antimuscarinic drugs is based on expert opinion in a systematic review [ ], the Palliative Care Formulary [ ], and the manufacturers' Summaries of Product Characteristics [ ; ; ]. © .

2019 NICE Clinical Knowledge Summaries

82. Palliative care - secretions

Palliative care - secretions Palliative care - secretions | Topics A to Z | CKS | NICE Search CKS… Menu Palliative care - secretions Palliative care - secretions Last revised October 2016 During the terminal phase of a person's illness, airway secretions may accumulate and result in gurgling and rattling noises during breathing Diagnosis Management Prescribing information Background information Palliative care - secretions: Summary During the terminal phase of a person's illness, airway (...) to: Salivary and bronchial secretions Chest infection Aspiration Gastric reflux Pulmonary oedema Bronchorrhoea (the production of 100 mL or more per day of watery mucus) When managing a person with noisy respiratory secretions at the end of life: It is essential to recognize the signs of dying in order to provide appropriate care. Repositioning the person on one side with the upper body elevated, can encourage postural drainage. If repositioning and is ineffective an antimuscarinic drug can be considered

2019 NICE Clinical Knowledge Summaries

83. Palliative care - oral: Scenario: Oral candida infection

Palliative care - oral: Scenario: Oral candida infection Scenario: Oral candida infection | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Oral candida infection Palliative care - oral: Scenario: Oral candida infection Last revised in October 2018 Scenario: Oral candida infection From age 16 years onwards. Oral candida infection Manage predisposing local and systemic for oral candida infection in conjunction with anticandidal treatment. In immunocompetent people (...) and chlorhexidine mouthwash [ ]. Basis for recommendation These recommendations represent the general consensus from palliative care resources and local guidelines written by experts on the basis of experience of clinical practice [ ; ; ; ; ; ]. From an evidence-based perspective: Few trials have compared the use of topical anticandidal treatments in people with cancer in palliative care [ ]. A Cochrane review investigated treatment of oral candidiasis in people with cancer receiving treatment and found

2019 NICE Clinical Knowledge Summaries

84. Palliative care - oral: Scenario: Mouth ulcers and mucositis

Palliative care - oral: Scenario: Mouth ulcers and mucositis Scenario: Mouth ulcers and mucositis | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Mouth ulcers and mucositis Palliative care - oral: Scenario: Mouth ulcers and mucositis Last revised in October 2018 Scenario: Mouth ulcers and mucositis From age 16 years onwards. Aphthous ulcers Correct any underlying iron, folate, or vitamin B 12 deficiency if the prognosis allows. Treatment choices should be guided (...) of metronidazole decreases with prolonged or repeated use. Resistance to metronidazole by the odour-producing anaerobes is unlikely to develop [ ]. Bleeding ulcers The recommendation on management of bleeding ulcers is based on expert opinion in a palliative care textbook [ ]. Neutropenic ulcers Seek urgent specialist advice if neutropenia is suspected from the appearance of the ulcer (see ) or if confirmed by a blood test. Basis for recommendation The basis for this recommendation is pragmatic advice

2019 NICE Clinical Knowledge Summaries

85. Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste

Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste Scenario: Halitosis, excessive salivation and altered taste | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Halitosis, excessive salivation and altered taste Palliative care - oral: Scenario: Halitosis, excessive salivation and altered taste Last revised in October 2018 Scenario: Halitosis, excessive salivation and altered taste From age 16 years onwards. Halitosis due to an oral (...) cause if possible. Modification of dentures may help. Review drug causes such as buprenorphine, clonazepam, haloperidol, risperidone, venlafaxine and ketamine. Head positioning (such as preventing the chin/jaw from dropping and avoiding a flexed neck) with or without suction may help. Local palliative care guidelines on excessive salivation should be followed. If these are not available, specialist advice should be sought regarding off-licence drug management of excessive salivation. There are few

2019 NICE Clinical Knowledge Summaries

86. Palliative care - oral: Scenario: End of life care

Palliative care - oral: Scenario: End of life care Scenario: End of life care | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: End of life care Palliative care - oral: Scenario: End of life care Last revised in October 2018 Scenario: End of life care From age 16 years onwards. How to recognize the terminal phase It can often be difficult to be certain that a person is dying, but it is essential to recognize the signs of dying in order to appropriately care (...) based on the National Institute for Health and Care Excellence (NICE) guideline Care of dying adults in the last days of life [ ]. The basis for the NICE recommendations has been briefly summarized in this section. For detailed information on the evidence NICE used to make these recommendations, see the full How should I manage oral care in the terminal phase? The management of dry mouth should be included in the person's care plan. Consider changing or stopping medications which are causing dry

2019 NICE Clinical Knowledge Summaries

87. Palliative care - oral: Scenario: Dry mouth

Palliative care - oral: Scenario: Dry mouth Scenario: Dry mouth | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Dry mouth Palliative care - oral: Scenario: Dry mouth Last revised in October 2018 Scenario: Dry mouth From age 16 years onwards. Managing underlying cause Treat any of the following underlying causes of dry mouth if appropriate: Adverse effect of a being taken. Reduce the dose or change the drug if possible. However, in practice, it is often very (...) prescriptions 'ACBS'. Note: some products contain mucin from pigs (for example AS Saliva Orthana ® ) which may be unacceptable to certain groups of people, such as vegetarians, and people of Jewish or Muslim faith. Basis for recommendation These recommendations are based on palliative care textbooks and local guidelines written by experts on the basis of experience of clinical practice [ ; ; ; ]. A Cochrane review [ ] found: Limited evidence that pilocarpine is effective in increasing saliva production

2019 NICE Clinical Knowledge Summaries

88. Palliative care - oral: Scenario: Assessment

Palliative care - oral: Scenario: Assessment Scenario: Assessment | Management | Palliative care - oral | CKS | NICE Search CKS… Menu Scenario: Assessment Palliative care - oral: Scenario: Assessment Last revised in October 2018 Scenario: Assessment From age 16 years onwards. Assessment Perform a full history and examination. Assess concurrent symptoms, psychological state, social needs, and spiritual needs. For more information, see the CKS topic on . Assess the person's: Understanding (...) of the diagnosis and their current problems. Coping ability, and how their family/carer is coping. Nutritional status and whether their fluid intake is adequate. Level of oral hygiene and whether they can carry out routine oral care. Estimate the likely prognosis, if possible. For further information, see the , which is part of the Gold Standards Framework and the CKS topic on . Basis for recommendation These recommendations are based on national guidance from the National Institute for Health and Care

2019 NICE Clinical Knowledge Summaries

89. Palliative care - oral: Oral pilocarpine

Palliative care - oral: Oral pilocarpine Oral pilocarpine | Prescribing information | Palliative care - oral | CKS | NICE Search CKS… Menu Oral pilocarpine Palliative care - oral: Oral pilocarpine Last revised in October 2018 Oral pilocarpine Contraindications Pilocarpine should be avoided in people who: Have asthma. Have chronic obstructive pulmonary disease. Have uncontrolled cardiovascular and/or renal disease. Have acute iritis. Are pregnant. Are breastfeeding. How to use Pilocarpine

2019 NICE Clinical Knowledge Summaries

90. Palliative care - oral: Oral antifungals

Palliative care - oral: Oral antifungals Oral antifungals | Prescribing information | Palliative care - oral | CKS | NICE Search CKS… Menu Oral antifungals Palliative care - oral: Oral antifungals Last revised in October 2018 Oral antifungals Recommended oral antifungals In immunocompetent people, oral fluconazole is recommended for second-line treatment if candidiasis persists. In immunocompromised people, oral fluconazole is generally preferred for first-line treatment. Oral antifungals

2019 NICE Clinical Knowledge Summaries

91. Palliative care - cough: Scenario: COVID-19 Management

Palliative care - cough: Scenario: COVID-19 Management Scenario: COVID-19 | Management | Palliative care - cough | CKS | NICE Search CKS… Menu Scenario: COVID-19 Palliative care - cough: Scenario: COVID-19 Management Last revised in April 2020 Scenario: COVID-19 Management From birth onwards. How should my management vary when considering the possibility of COVID-19? Be aware that older people or those with comorbidities, frailty, impaired immunity or a reduced ability to cough and clear (...) issuing an 'acute' prescription with a limited supply. Advise the person of the risks of constipation and consider prescribing a regular stimulant laxative. Avoid cough suppressants in people who suffer from chronic bronchitis and bronchiectasis as this can cause sputum retention. Seek specialist advice for people aged under 18 years. Basis for recommendation These recommendations are based on the National Institute for Health and Care Excellence (NICE) COVID-19 rapid guideline: managing symptoms

2019 NICE Clinical Knowledge Summaries

92. Palliative care - cough: Scenario: Assessment

Palliative care - cough: Scenario: Assessment Scenario: Assessment | Management | Palliative care - cough | CKS | NICE Search CKS… Menu Scenario: Assessment Palliative care - cough: Scenario: Assessment Last revised in April 2020 Scenario: Assessment From age 16 years onwards. What should I ask about the cough? Ask about the: Impact on the person's quality of life. Severity, time of onset, and duration of the cough. Pattern and character of the cough, for example: Dry cough, persisting over (...) — large amounts (> 100 mL per day) are produced by people with bronchorrhoea, which can occur as a result of bronchiolo-alveolar cancer, asthma, or tuberculosis. Blood — haemoptysis from tumour, or tumour erosion. Dyspnoea — effusion, lung collapse, lymphangitis carcinomatosa. For more information on causes and management of dyspnoea, see the CKS topic on . Basis for recommendation These recommendations are based on expert opinion from palliative care and medical literature developed from clinical

2019 NICE Clinical Knowledge Summaries

93. Palliative care - cough: Pholcodine linctus BP

Palliative care - cough: Pholcodine linctus BP Pholcodine linctus BP | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Pholcodine linctus BP Palliative care - cough: Pholcodine linctus BP Last revised in April 2020 Pholcodine linctus BP If the person is already taking a strong opioid such as morphine, do not try a weak opioid such as pholcodine. Instead an 'as required' dose of morphine solution should be used to relieve cough. Pholcodine Linctus BP 5 to 10 mg

2019 NICE Clinical Knowledge Summaries

94. Palliative care - cough: Nebulized sodium chloride

Palliative care - cough: Nebulized sodium chloride Nebulized sodium chloride | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Nebulized sodium chloride Palliative care - cough: Nebulized sodium chloride Last revised in April 2020 Nebulized sodium chloride When nebulized 0.9% saline solution is used to ease cough associated with tenacious secretions [ ; ; ]: Initially use 2.5 mL to 5 mL four times a day as needed and before physiotherapy [ ]. If greater

2019 NICE Clinical Knowledge Summaries

95. Palliative care - cough: Mucolytics

Palliative care - cough: Mucolytics Mucolytics | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Mucolytics Palliative care - cough: Mucolytics Last revised in April 2020 Mucolytics Carbocisteine and mecysteine hydrochloride are options to reduce the viscosity of the secretions. If a palliative care patient does not demonstrate any convincing benefit after a week or two of using a mucolytic, then use of a mucolytic should be discontinued. For carbocisteine

2019 NICE Clinical Knowledge Summaries

96. Palliative care - cough: Morphine

Palliative care - cough: Morphine Morphine | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Morphine Palliative care - cough: Morphine Last revised in April 2020 Morphine Morphine should be titrated in the same way as for pain relief. The initial starting dose will depend on the person's previous exposure to opioids. For more information about the use of morphine in pain relief, see the Prodgiy topic on . For someone not already taking an opioid, a dose of 2.5

2019 NICE Clinical Knowledge Summaries

97. Palliative care - cough: Codeine

Palliative care - cough: Codeine Codeine | Prescribing information | Palliative care - cough | CKS | NICE Search CKS… Menu Codeine Palliative care - cough: Codeine Last revised in April 2020 Codeine If the person is already taking a strong opioid such as morphine, do not try a weak opioid such as codeine. Instead an 'as required' dose of morphine solution should be used to relieve cough and, if this is beneficial, continue to use in this way, or increase the regular morphine dose [ ]. Codeine

2019 NICE Clinical Knowledge Summaries

98. Palliative care - cough

Palliative care - cough Palliative care - cough | Topics A to Z | CKS | NICE Search CKS… Menu Palliative care - cough Palliative care - cough Last revised in April 2020 Cough is a defensive reflex that occurs in response to stimulation of irritant receptors which are found in the airways. Management Prescribing information Background information Palliative care - cough: Summary Cough is a defensive reflex that occurs in response to stimulation of irritant receptors which are found (...) obstructive pulmonary disease, and gastro-oesophageal reflux disease. When assessing someone with cough in palliative care, the following should be elicited: The impact on the person's quality of life. The severity, time of onset, and duration of the cough. The pattern and character of the cough. Any associated symptoms, such as nasal discharge, sputum, blood, or breathlessness. When examining someone with cough in palliative care, features to help determine the underlying cause should be identified

2019 NICE Clinical Knowledge Summaries

99. Palliative care - constipation: Which laxative should I prescribe?

Palliative care - constipation: Which laxative should I prescribe? Choice of laxative | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu Choice of laxative Palliative care - constipation: Which laxative should I prescribe? Last revised in October 2016 Which laxative should I prescribe? The final choice of laxative will often depend on individual preference, and what has previously been tried. Advantages and disadvantages of different laxatives are detailed (...) . Syrup is unpalatable. Sodium picosulfate 6–12 hours Licensed only for short-term use. Syrup is palatable. Bisacodyl 6–12 hours No syrup available. Licensed only for short-term use. Dantron(terminal care only) 6–12 hours Restricted to use in terminal care. Prolonged contact with the skin (e.g. faecal or urinary incontinence) can cause a dantron burn — an erythematous rash with a sharply demarcated border. Available only combined with a softener: Concerns about possible carcinogenicity (from high-dose

2019 NICE Clinical Knowledge Summaries

100. Palliative care - constipation: What doses of laxatives may be needed in palliative care?

Palliative care - constipation: What doses of laxatives may be needed in palliative care? Doses of laxatives | Prescribing information | Palliative care - constipation | CKS | NICE Search CKS… Menu Doses of laxatives Palliative care - constipation: What doses of laxatives may be needed in palliative care? Last revised in October 2016 What doses of laxatives may be needed in palliative care? Table 4 . Laxative doses that may be needed to manage constipation in palliative care. Laxative Licensed (...) dose (adults) Dose that may be needed in palliative care (off–label) Arachis (peanut) oil (retention enema) 1 enema (130 mL) at bedtime, as required Use maximum licensed dose Bisacodyl (tablets) 5–10 mg at night, increased if necessary to a maximum dose of 20 mg at night 20 mg three times a day Bisacodyl (suppositories) 1 suppository (10 mg) in the morning 20 mg daily Co-danthramer Strong (dantron/poloxamer 37.5/500 mg capsules or 75/1000 mg suspension) 1–2 capsules (or 5 mL only) at night 3

2019 NICE Clinical Knowledge Summaries