In specialist palliative care, nausea and vomiting are common distressing and debilitating symptoms (Hamling, 2011). Prevalence in patients with advanced cancer is up to 70% and up to 50% in patients with non-malignant advanced disease, such as heart failure, chronic obstructive pulmonary disease and renal failure (Twycross and Back, 1998). Nausea and vomiting increase in prevalence as disease progresses (Keeley, 2009; Harris, 2010) and become more common as death approaches. The symptoms present as a result of many factors, which are most easily categorized as disease- or treatment-related. Pharmacological treatment of these distressing symptoms can produce undesirable extrapyramidal effects that mimic symptoms such as Parkinson's disease, depression and anxiety. Failing to recognize the causative agent of such symptoms could prolong a patient's suffering. Therefore, it is important that the nurse prescriber is aware of these side-effects when prescribing antiemetic drugs.

Deirdre Hickson - clinical nurse specialist, specialist palliative care team Roscommon, HSE West/Mayo Roscommon Hospice, Ireland