Contents:
Apomorphine
Apomorphine is a dopamine agonist. Due to extensive hepatic 1st-pass metabolism, it can only be administered subcutaneously, either as intermittent injections (APO-go® Pen), or a continuous infusion (APO-go® Pump). Despite its name, it is neither an opioid derivative, nor a controlled drug.
Apomorphine is used (uncommonly) in some PD patients with complex disease including disabling motor fluctuations which have not responded to other pharmacological measures. Apomorphine is not initiated in the dying patient. If the patient is already on Apomorphine, continue the same dose and do not stop treatment.
Patients and/or carers will be trained in the use and maintenance of APO-go® pumps. If the patient lacks capacity or is too unwell and there is no support from trained care-givers, contact their regular APO nurse in normal working hours. Alternatively, call the manufacturer’s dedicated 24 hour helpline on 0844 880 1327.
Duodopa Intestinal Gel
This is rarely used ‘advanced therapy’ for those with complex stage PD and severe motor fluctuations. Levodopa/Carbidopa gel is administered via a portable pump into the duodenum or upper jejunum by a percutaneous endoscopic transgastric jejunostomy (PEG-J).
Patients who are established on Duodopa need to continue the infusion at the normal rate. If the PEG-J tube is blocked or the bowel is not working, discontinue the infusion, commence a rotigotine patch and obtain a specialist opinion as soon as possible. The Duodopa manufacturer’s dedicated 24hour helpline is available on 0844 880 1327.
Deep Brain Stimulation (DBS)
DBS involves stimulation of target sites within the brain which are affected by Parkinson’s. Electrodes are connected to a subcutaneous neurostimulator, usually in the chest area (similar to a cardiac pacemaker).
DBS settings can only be altered by an external handheld device and are not changed routinely in the dying patient.
After death the DBS device does not need to be switched off. If the patient is to be cremated, alert the bereavement team, as the funeral directors need to be informed.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.