Prescribing and Deprescribing Flashcards
1
Q
Why do we need to supply Anticipatory Medication?
A
“Just in case” medication
- stress and worry can be avoided as patient can receive what they need, when they need it without delay
- one of the most challenging situations for pts is access to meds “ out of hours”
- discomfort for patient if lack of symptom control
- distress for loved ones trying to get Rx dispensed
- difficult for patient if suffering whilst medication is delayed
2
Q
What common symptoms are seen towards the end of life and how to treat them?
A
Pain - Morphine or Diamorphine
Nausea and Vomitting - Cyclizine
Restless / Agitation - Midazolam
Secretions “Death Rattle” - Hyoscine Hydrobromide
3
Q
Legal Requirements of a CD Prescription
A
- Name
- Form
- Strength
- Dose
- Total quantity (both words and figures)
4
Q
Problems with Polypharmacy
A
- interactions
- tablet burden
- on medications with little or no benefit
- side effect profile
- complications
5
Q
What circumstances should be considered before deprescribing?
A
- life expectancy
- treatment target (slow disease progression, prevent decline, symptom control)
- how long does it take to see benefit of drug
6
Q
Barriers to Deprescribing
A
- limited time available
- lack of clarity over whos “job” it is to deprescribe
- concern around stopping meds initiated by a specialist
- uncertainty about the ongoing benefits of a medication
- withdrawal effects
- worsening of symptoms
- unclear prognosis and goals of care
- concern that pt and family may see it as a sign of “giving up hope”
- unwillingness or reluctance from the pts to change their meds
7
Q
Process of Deprescribing
A
- Ensure a complete medication history is obtained
- Identify the indication for each drug
- Consider the potential for harm for each drug, for example the age of the patient, the number and types of medication and the patients comorbidities
- Consider the ‘risk versus benefit’ for each medication
- Identify medication suitable for deprescribing
- Discuss and explain changes with patient
- Deprescribe one medication at a time if possible
- Reassess the effects of deprescribing
- Continue deprescribing as appropriate
8
Q
Reasons to consider deprescribing in palliative care
A
- reduced adverse events
- reduced cost
- reduced tablet burden
- enhanced quality of life
- prioritisation of most essential medications
9
Q
Reasons for deprescribing
- Antihypertensives
- Cardiac Drugs
- Diabetic Meds
A
- antihypertensives: body weight reduces and metabolism slows down, common for BP to fall
- cardiac drugs: some drugs e.g. aspirin and statin treat risk rather than symptom
- diabetic meds: weight loss and reduced metabolism reduces the need
10
Q
Reasons for staying on chemotherapy
A
- lengthen life
- symptomatic relief
11
Q
When should you stop steroids in palliative care?
A
- stop when unable to swallow because of decreased consciousness or profound weakness
