Nausea and vomiting are common in palliative care but they are not diagnoses in themselves.

In this episode, we look at how to work backwards from the symptom and ask what is actually causing it. Gastric stasis, opioids, constipation, metabolic disturbances, vestibular problems, raised intracranial pressure and bowel obstruction can all cause nausea and they do not all need the same treatment.

We unpack where commonly used antiemetics such as metoclopramide, haloperidol, ondansetron, prochlorperazine and cyclizine fit, why metoclopramide can be helpful in gastric stasis but problematic in complete bowel obstruction, and why route of administration matters when oral medicines are no longer reliable.

As always, we finish with reflective questions for clinicians using the episode as part of their CPD.

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Why can someone feel profoundly breathless even when their oxygen levels are normal? And why might morphine help more than oxygen?

In Episode 4 of our palliative care series, we unpack the difference between breathlessness and hypoxaemia, why oxygen is not always the answer, and how low-dose opioids can reduce the distress and sensation of struggling to breathe.

We also cover reversible causes of breathlessness, the surprisingly useful role of a handheld fan, non-drug strategies, COPD and carbon dioxide retention, benzodiazepines, oxygen in the final days of life, and one of the biggest fears families have: does giving morphine for breathlessness hasten death?

For clinicians, pharmacists and anyone wanting a deeper understanding of palliative medicines, with reflective questions at the end to support CPD.

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Opioids are some of the most important medicines in palliative care and some of the most misunderstood.

In this episode, we take a practical deep dive into morphine, oxycodone, hydromorphone, fentanyl, buprenorphine and methadone, including how their potency differs, what changes in renal impairment, and why opioid conversion is never just simple arithmetic.

We also look at opioid rotation, breakthrough dosing, fentanyl and buprenorphine patches, rapid-onset fentanyl products such as Abstral and Actiq, and the important safety distinction between morphine and the much more potent hydromorphone.

Plus, we unpack the difference between tolerance, physical dependence and addiction and why fear of opioids can sometimes become a barrier to good symptom control.

A practical episode for clinicians who want to prescribe, supply and discuss opioids with more confidence.

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