The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jun 2011
ReviewReview article: dexmedetomidine: does it have potential in palliative medicine?
Dexmedetomidine, is a α( 2) adrenergic agonist approved by the Food and Drug administration for sedation and analgesia. A highly potent α(2) adrenergic agonist, it has quick onset of action, with peak effects within 1 hour of administration. It is metabolized in the liver and eliminated in the urine as a glucuronide. ⋯ Clinical trials suggest efficacy for the treatment of delirium in the intensive care unit setting with efficacy comparable to haloperidol and benzodiazepines. Dexmedetomidine also has an opioid-sparing action and can act to enhance analgesia. The purpose of this article is to review the pharmacodynamics and pharmacology of dexmedetomidine, and examine its potential use in the palliative care population, especially with regard to the management of delirium.
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Am J Hosp Palliat Care · Jun 2011
The use of high doses of oxycodone in an acute palliative care unit.
A retrospective study of patients who were prescribed controlled-release oxycodone (CRO) in a period of 3 years (2006-2008) was performed. A total of 212 patients were prescribed at discharge CRO for background analgesia; 129, 43, and 40 patients were prescribed doses of oxycodone of less than 120 mg/day (group L), 120 to 240 mg/day (group M), and more than 240 mg/day (group L), respectively. ⋯ At discharge, adverse effects were mild and only a minority of patients were switched to other opioids. This study demonstrated that CRO administered in larger doses was safe and effective, showing versatility and flexibility similar to morphine.
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Prevalence of treatable depression is as high as 25% among terminally ill patients. The incidence of antidepressant use was ascertained at the Mayo Hospice Program in Rochester, Minnesota, from June 1, 2007, to December 31, 2008. ⋯ Survival was the main predictor to receive an antidepressant with an odds ratio of 2.71 (95%CI: 1.60-4.60) for each additional day in hospice. Proper diagnostic tools for this population, education about the benefits of antidepressants in palliative care, and clear guidelines about antidepressant class and dosages are needed.
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Am J Hosp Palliat Care · May 2011
ReviewReview of cancer pain management in patients receiving maintenance methadone therapy.
Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. ⋯ Two patients had documented ''drug-seeking'' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.