prescribing and deprescribing in palliative care Flashcards
what is anticipatory medication
‘just in case medication’- much stress and worry can be avoided and the patient can receive what they need when they need it and without unnecessary delay. don’t have to ring out of hours eg bank holiday weekend. means symptoms can be treated promptly, relatives won’t have to leave a very sick loved one in order to try and access some medication
what are the 4 symptoms experiences in palliative care
pain, nausea and vomiting, agitation, excess secretion (death rattle)
how do you treat the 4 symptoms in palliative care
opioids, cyclone, midazolam, hyoscine hydrobromide or glycopyronium
what is a TTO
‘to take out’ - form can be printed to allow practice of prescription writing- write a prescription to obtain a supply of anticipatory medicines for the discharge of a hospital patient
define deprescribing
describes the process of identifying and discontinuing medications with little or no benefit and potential harm, in order to improve quality of life. this needs to balance the symptomatic benefits of treatment with the psychological adaption to having a terminal illness
what considerations need to be taken into account when deprescribing
what is the patients life expectancy, what is the treatment target. how long does it take to see a benefit from a given drug
what are the barriers to deprescribing
- lack of clarify over who’s job it is
- possible concerns around stopping medications that were initiated by a specialist
- uncertainty about the ongoing benefits of a medication
- concern over drug withdrawal effects and possible worsening of symptoms
- uncertainty on the timing of deprescribing discussions when prognosis is unclear
- may be seen as giving up hope
- reluctance from the patients to change their medications
process of deprescribing
1 ensure a complete medication history is obtained
2 identify indication of each drug
3 consider potential harm of each drug eg age of patient
4 consider risk vs benefit
5 identify medications suitable for deprescribing
6 discuss and explain changes with patients
7 deprescribing one medication at a time if possible
8 reassess the effects of deprescribing
9 continue deprescribing as appropriate
5 benefits of deprescribing in the palliative patient towards the end of life
reduced adverse events, prioritisation of the most essential medications, reduced tablet burden, reduced cost, enhanced quality of life
why are antihypertensives often deprescribed
body weight reduces and metabolism slows down and it is common for blood pressure to fall
why are cardiac drugs often deprescribed
some drugs treat risk rather that symptom eg statins and aspirin
why is chemotherapy often deprescribed
in the palliative care setting its used to lengthen life and provide symptomatic relief. constant review needed to ensure still appropriate
why are diabetic meds often considered to be deprescribed
weight loss and reduced metabolism may reduce the need. monitor blood sugar
why are steroids deprescribed in palliative care
reduce appropriately depending on indication. stop when unable to swallow because of decreased consciousness or profound weakness
why are anticoagulants deprescribed in palliative care
consider risk of significant haemorrhage outweighing risk of thromboembolism
