Symptoms and Medicines.

Palliative Care South East has a palliative care physician and several nurse practitioners who can provide consultancy, support and advice to GPs.

The classes of medication most commonly used in palliative care for symptom relief are:

• analgesics
• antiemetics
• laxatives
• analgesic adjuvants
• steroids
• antidepressants
• neuroleptic agents
• anxiolytics
• sedatives

Standard medications may be used differently in the palliative care setting, based on well-established practices with varying degrees of evidence. Examples include the use of antipsychotic medications to treat nausea, anticonvulsants to treat pain, and opioids to treat dyspnoea. Where these indications are unlisted in the product information this is termed ‘off-license’ prescribing. Sometimes it may be difficult to access these medications for patients in the community. There are also cost implications as they are unable to be subsidised through the Pharmaceutical Benefits Scheme (PBS).

Many palliative care patients develop symptoms such as pain, vomiting or terminal restlessness that cause discomfort and distress. The timing of these symptoms can be difficult to predict. Best practice suggests that proactive prescribing and supply of medications for patients in the community enables symptoms to be managed rapidly. This avoids crises at home and reduces both patient suffering and unwanted, unnecessary admissions in the last days of life. We request from the GP, scripts for emergency medications so that the visiting palliative care nurses or the doctor has a supply of common oral and injectable medication kept in the home to administer for emergency use.