RESTLESS LEGS SYNDROME | NOCTURNAL LEG CRAMPS …

[Pages:40]RESTLESS LEGS SYNDROME | NOCTURNAL LEG CRAMPS | SULFONAMIDES

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Issue 49 December 2012

Strong opioids in palliative care

bpac nz

better medicine

EDITOR-IN-CHIEF Professor Murray Tilyard

EDITOR Rebecca Harris

PROGRAMME DEVELOPMENT Gareth Barton, Lucy Broughton, Mark Caswell, Rachael Clarke, Peter Ellison, Dr Hywel Lloyd, Dr Lik Loh, Kirsten Simonsen, Dr Sharyn Willis

REPORTS AND ANALYSIS Justine Broadley, Todd Gillies, Andy Tomlin

DESIGN Michael Crawford

WEB Gordon Smith, Kyi Thant

MANAGEMENT AND ADMINISTRATION Kaye Baldwin, Tony Fraser, Kyla Letman

CLINICAL ADVISORY GROUP Professor John Campbell, Leanne Hutt, Dr Rosemary Ikram, Dr Cam Kyle, Dr Liza Lack, Dr Chris Leathart, Janet Mackay, Natasha Maraku, Dr Peter Moodie, Barbara Moore, Associate Professor Jim Reid, Associate Professor David Reith, Leanne Te Karu, Professor Murray Tilyard

ACKNOWLEDGEMENT We would like to acknowledge the following people for their guidance and expertise in developing this edition: Dr Alex Bartle, Christchurch Dr Kate Grundy, Christchurch Dr Rosemary Ikram, Christchurch Dr Dayna More, Wellington Dr Nikki Turner, Auckland

Issue 49 December 2012

Best Practice Journal (BPJ) ISSN 1177-5645 BPJ is published and owned by bpacnz Ltd Level 8, 10 George Street, Dunedin, New Zealand.

Bpacnz Ltd is an independent organisation that promotes health care interventions which meet patients' needs and are evidence based, cost effective and suitable for the New Zealand context. We develop and distribute evidence based resources which describe, facilitate and help overcome the barriers to best practice. Bpacnz Ltd is currently funded through contracts with PHARMAC and DHB Shared Services. Bpacnz Ltd has five shareholders: Procare Health, South Link Health, General Practice NZ, the University of Otago and Pegasus Health.

SOUTH LINK HEALTH

The information in this publication is specifically designed to address conditions and requirements in New Zealand and no other country. BPAC NZ Limited assumes no responsibility for action or inaction by any other party based on the information found in this publication and readers are urged to seek appropriate professional advice before taking any steps in reliance on this information.

Printed in New Zealand on paper sourced from well-managed sustainable forests using mineral oil free, soy-based vegetable inks

CONTACT US: Mail: P.O. Box 6032, Dunedin

Email: editor@.nz Phone: 03 477 5418 Free-fax: 0800 27 22 69

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CONTENTS Issue 49 December 2012

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8 Strong opioids for pain management in adults in palliative care

Pain is estimated to be the most prevalent symptom preceding all deaths occurring in a palliative care setting. Strong opioids are a safe and effective treatment for moderate to severe pain

in adults, if used appropriately. However, individual patient responses vary making dose titration an important aspect of

pain management. Constipation, nausea and other adverse effects are common and should be managed pre-emptively.

Switching between opioids should be undertaken with caution as the equivalent dose will vary between patients

18

18 The night time hustle: managing restless legs

syndrome in adults

Restless legs syndrome is a common neurological disorder that can significantly affect a patient's quality of life. Lifestyle modification is the mainstay of treatment for people with mild or infrequent symptoms. Pharmacological treatments, starting with dopamine agonists, should be reserved for people with more severe symptoms.

24 Nocturnal leg cramps: is there any relief?

Nocturnal leg cramps are common, particularly in older

24

people and in women who are pregnant. Is there an effective

treatment? Unfortunately, treatment options are limited, but

lifestyle modifications and gentle stretching may have some

effect. Pharmacological treatment may be considered for

people with frequent, severe leg cramps. Quinine is no longer

recommended for leg cramps, however, it appears to still be

used.

BPJ Issue 49 1

CONTENTS Issue 49 December 2012

29

4 Upfront

Recommended vaccinations for staff working in primary health care

29 Antibiotic series

Appropriate use of sulfonamide antibiotics

34 Using the New Zealand Formulary

Guide for switching antidepressants

36 Correspondence

Can tetracyclines and penicillins be used together? Recording of immunisations in Medtech. The catch-up period for immunisations has been extended.

2 BPJ Issue 49

bpacnz

All web links in this journal can be accessed via the online version:

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The week before Christmas

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