Palliative Care Flashcards
ASHP definition of pharmacists role in hospice and palliative care
cost-effective recs, reviewing med profiles, eliminating duplicate meds, alternative dosage forms, monitoring and educating
palliative care vs hospice care
palliative = improving quality of life for those with serious illness
hospice = end of life care
the dying experience- 1-3 months
withdrawal from the world and people, ↓ food intake, ↑ sleep, ↓ communication
the dying experience- 1-2 weeks
mental changes: disorientation, agitation, confusion, talking to the unseen
physical changes: ↓ BP, pale/bluish skin, ↑ perspiration
the dying experience- days - hours
surge of energy, ↓ BP, eyes glassy, irregular breathing, weak pulse, ↓ urine output
the dying process- minutes
“fish out of water” breathing, cannot be awakened
changes during the dying process
fatigue, weakness, cutaneous ischemia, ↓ appetite, cardiac dysfunction, renal failure, ↓ level of consciousness, ↓ ability to communicate, terminal delirium, resp. dysfunction, loss of ability to swallow, loss of sphincter control, pain, loss of ability to close eyes
portmanteau (7)
● multiple therapeutic effects
● minimal drug interactions
● multiple routes of admin
● wide therapeutic window
● cost effective
● convenient dosing schedule
● dose response and favorable ceiling effect
intensol
concentrated liquid- good for palliative care toolkit
N/V due to gut wall (gastric irritants, abd radiotherapy, intestinal distention, cytotoxic chemo) treatment
- H2RA/PPI
- metoclopramide
- ondansetron
N/V due to area postrema (morphine/digoxin, hypercalcemia/uremia, clonidine, cytotoxic chemo) treatment
- haloperidol/metoclopramide
- 1 + dexamethasone (pamidronate for hypercalcemia)
- ondansetron + dexamethasone
N/V due to cerebral cortex (fear/anxiety, raised intracranial pressure, hyponatremia) treatment
- dexamethasone
- amitriptyline, haloperidol, lorazepam
- limit free water + 3% saline + haloperidol
N/V due to vestibular nuclei (movement, vertigo) treatment
- Benadryl + dramamine (dimenhydrinate)
- meclizine or cyclizine
- glycopyrrolate, scopolamine
dyspnea treatment (based on cause)
- steroids (carcinomatous lymphangitis), bronchodilators (bronchospasm), diuretics (cardiac failure, gross ascites)
- ipratropium/albuterol (duoneb) + dexamethasone
- morphine + dexamethasone
opioids and dyspnea
help relieve SOB, generally requires lower doses
cough treatment
- treat underlying cause
- promote production (saline neb. and/or guaifenesin)
- suppress cough (morphine, hydrocodone, dextromethorphan)
anxiety treatment (worry, tense, unable to relax)
- non-pharm
- short term lorazepam, alprazolam, amitriptyline (with depression)
- long term buspirone, SSRI, mirtazepine (with depression/insomnia/anorexia)
delirium treatment (disorientation, hallucinations, aggressive)
- haloperidol
- haloperidol + lorazepam
- haloperidol + midazolam or chlorpromazine
constipation prevention
opioid induced 1. Senna or bisacodyl +/- docusate +/- metoclopramide
age/disease induced 1. fiber, fluids, docusate
2. sorbitol, lectulose, PEG
3. MOM, bisacodyl supp.
acute constipation treatment
r/o obstruction or impact
1. bisacodyl or Senna (stimulant)
2. double dose
3. sorbitol (osmotic lax)
bowel obstruction (early satiety, bloating) treatment
- metoclopramide +/- dexamethasone (not used if complete obstruction)
- glycopyrrolate +/- morphine +/- haloperidol
asthenia (fatigue, weakness, mental fatigue) treatment
- energy conserving measures
- methylphenidate or dexamethasone
depression treatment
> 4 week survival: escitalopram or sertraline +/- methylphenidate
<4 week survival: methylphenidate or ketamine
anorexia/cachexia underlying causes
anxiety, depression, N/V, stomatitis, constipation, dysphagia, PAIN
