Palliative care has different goals than curative care, particularly for hospice patients nearing the end of life. It can be difficult to find pharmacological guidance for the conditions and comorbidities encountered in hospice. Enclara Pharmacia’s Palliative Pearls series helps fill the gap. Inspired by real life clinical consultations between hospice clinicians and Enclara pharmacists, these clinical case studies and reviews are provided as a service to the entire hospice community.
You can sign up to receive Palliative Pearls in your inbox each month, plus Clinical Alerts and more. In the meantime, here are the five most popular Palliative Pearls articles of 2020:
Gastroparesis: Patient Case and Brief Review
Gastroparesis is a syndrome of delayed gastric emptying of solids, in the absence of an obstruction, with main symptoms of nausea, vomiting, early satiety, belching, bloating and/or upper abdominal pain. It can be a side effect of medications or occur independently. Dietary modifications and adequate hydration are first line interventions but changing or adding medications can also help. Find out more about managing this troublesome condition.
Principles of Pediatric Dosing
When it comes to medications, children are not mini adults. Often, labeled dosing recommendations do not include pediatrics. Palliative care literature specific to this population is scarce. This review covers some of the differences in pediatric physiology, dosing considerations and guidance for maintaining adherence. It’s a must-read for clinicians that serve this special population.
Recognizing Delirium in Home Hospice
Delirium can be distressing for both patients and caregivers. This review explores the myriad risk factors for delirium and some of the tools used to screen for it. It also covers pharmacological and non-pharmacological interventions, including the debate around the appropriateness and efficacy of antipsychotics. Don’t miss this opportunity to gain a better understanding of how to prevent, screen for and manage delirium.
Dyspnea and Opioid Use
Dyspnea covers a variety of breathing difficulties associated with late-stage COPD and several other life-limiting conditions. There are a variety of pharmacological interventions to reduce its severity, including oral, parenteral and inhaled opioids. Learn more about dosing and administration of opioids for patients with dyspnea.
Conversion from Transdermal Fentanyl Use to Oral Administration in Cachectic Patients.
Cachexia, or involuntary weight loss, is a syndrome of progressive and ongoing loss of skeletal muscle mass (with or without loss of fat mass). It’s often the result of an underlying disease such as cancer, AIDS or COPD. Cachexia can reduce the benefit of transdermal fentanyl administration, leaving patients with unresolved pain. This case study includes directions for converting patients from fentanyl patch to oral opioid administration.
Additional Resources
In addition to Palliative Pearls and Clinical Alerts, Enclara shares blog posts, whitepapers and other resources throughout the year. Here are a few you may find useful:
- Benefits of Deprescribing for Patients Nearing End-of-Life (whitepaper)
- Equity in Palliative Care and Hospice (whitepaper)
- Educational Resources for Respiratory Symptoms and Palliative Care
