Top 5 Clinical Case Studies in 2019 from Enclara Pharmacia


Enclara Pharmacia’s clinical management and educational teams collaborate on a variety of educational resources for the hospice community. These include clinical news alerts, webinars for CE credits, and our monthly newsletter, Palliative Pearls.

The newsletter offers a variety of content but its most valuable element may be the representative case studies. Each case study presents evidence-based medication management recommendations through the lens of a real-life Enclara patient. They are ideal for self-study or as discussion prompts for interdisciplinary team meetings.

As 2019 draws to a close, we are revisiting the year’s top 5 most popular case studies:

1. Pulmonary Hypertension in Hospice Care

Should life-extending hypertension medications continue in hospice? PM is a 66-year-old woman with a primary diagnosis of pulmonary arterial hypertension (PAH), history of scleroderma, and no known drug allergies. Upon review of PM’s medications, it is noted she is prescribed Letairis® (ambrisentan) 10mg by mouth daily and Adcirca® (tadalafil) 40mg by mouth daily to manage PAH. These medications are indeed related to the patient’s primary diagnosis of PAH, but it is not clear to the home hospice nurse if the medications should be continued on hospice care.

2. Palliative Management of Sweating at End-of-Life

What pharmacological and non-pharmacological interventions are recommended for hyperhidrosis? SL is a 66-year-old male admitted to hospice with a primary diagnosis of Non-Hodgkin Lymphoma. In the 6 months prior to hospice admission, SL has lost 25 lbs. (baseline 210 lbs.) and has experienced drenching night sweats as well as excessive sweating in the daytime. SL is frustrated with the multiple changes of clothes daily and the additional laundry it is producing and is also embarrassed engaging with others at his grandsons’ sporting events.

3. Methadone Conversion: Revisiting a Prior Case

When and how can methadone supplement other pain medications? What about antifungals? CT is a 62-year-old woman with metastatic breast cancer experiencing aching pain in her chest and shooting pains down her arm that have become increasingly uncontrolled over the past 2 weeks. She also has oral thrush that developed a few days ago. She has a history of asthma (exacerbated by her breast cancer) and recently completed a 6-day steroid taper. She was also treated with fluconazole 2 months ago for oral thrush.

4. Symptom Management of Rheumatoid Arthritis

What are the risks and benefits of restarting a biologic DMARD after stopping chemotherapy? RJ is a 60-year-old male admitted to hospice with a primary diagnosis of Hodgkin Lymphoma. Co-morbid conditions include COPD, hyperlipidemia, hypertension, and rheumatoid arthritis. He has no drug allergies and lives at home with his partner. Rheumatoid arthritis was diagnosed 6 years ago and RJ responded well to the combination of oral methotrexate and subcutaneous etanercept (Enbrel®). When RJ was diagnosed with lymphoma, both medications were discontinued while he underwent palliative chemotherapy, resulting in renewed RA symptoms.

5. Nausea and Vomiting, Sources and Palliative Management

How should a clinician choose from the many options for pharmacological and non-pharmacological treatment of nausea? AN is a 67-year-old male admitted to hospice 2 weeks ago. He has a primary diagnosis of prostate cancer with probable bone metastases, no other medical conditions, and no drug allergies. He lives at home with his wife. AN is experiencing new-onset persistent nausea and abdominal discomfort. He has tried ginger ale and a bland diet but neither have been effective. The nausea is not associated with any smells, tastes, events or time of day. AN reports bowel movements every other day and feeling content and not full after eating.

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Additional Enclara Pharmacia Educational Resources

We strive to provide clinical resources and evidence-based tools to help deliver the highest quality care to patients. Our educational resources include the opportunity to obtain free CE credits through the Enclara Learning Academy, free webinars, access to clinical alerts, and more.