Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2021
ReviewThe Risk of QTc Prolongation with Antiemetics in the Palliative Care Setting: A Narrative Review.
Nausea and vomiting are common within the palliative care population. Antiemetic agents may help control symptoms, but may also place patients at risk for QTc prolongation. This article reviews pharmacotherapy agents including anticholinergics, antihistamines, antidopaminergics, 5-HT3 receptor antagonists, dronabinol, and medical marijuana and their associated risk of QTc prolongation. A clinical treatment pathway is provided to help guide clinicians in choosing the most appropriate antiemetic based upon patient specific factors for QTc prolongation.
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J Pain Palliat Care Pharmacother · Jun 2021
ReviewSubstance Abuse Risk and Medication Monitoring in Patients with Advanced Lung Cancer Receiving Palliative Care.
Oncology and Palliative Medicine lack guidance on routine opioid risk screening and compliance monitoring. This study explored relationships among risk screening and aberrant medication related behaviors in patients with advanced lung cancer receiving embedded palliative care. This was a single center, prospective study and data was collected from December 2018 to March 2020. ⋯ After pharmacist review, aberrant baseline UDS results were confirmed for 5/11 (45.5%) positive-risk and 4/23 (17.4%) negative-risk patients (p = 0.11). Overall, the SOAPP-R alone may be inadequate in this population and clinical pharmacists play an important role in comprehensive UDS result interpretation. Future studies are needed to validate this risk-screening tool in palliative cancer populations.
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J Pain Palliat Care Pharmacother · Jun 2021
Case ReportsSingle Subcutaneous Ketamine Dose Followed by Oral Ketamine for Depression Symptoms in Hospice Patients: A Case Series.
Management of depression symptoms in hospice patients is complicated by the fact that an appropriate trial of antidepressant therapy requires 4-6 weeks and most hospice patients receive hospice services for less than 8 weeks. Intravenously administered ketamine has been shown to produce rapid improvement in depression symptoms but is not an ideal route for hospice patients and oral ketamine appears to have a slower onset of antidepressant activity. We present a case series that illustrates the use of a single subcutaneous dose of ketamine (0.5 mg/kg) followed by daily oral ketamine (0.5 mg/kg daily) therapy to manage depression symptoms in three hospice patients. ⋯ A single subcutaneous dose of ketamine followed by oral therapy presents itself as an option to quickly reduce depression symptoms in hospice patients that do not also require additional pain management. Combining the use of the subcutaneous and oral routes takes advantage of the possibly faster onset, home administration, and milder side effects than intravenous dosing. Prospective studies are needed to determine which dosing strategy would be the most beneficial for hospice patients.
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J Pain Palliat Care Pharmacother · Jun 2021
Letter Case ReportsPost Laparoscopy Neuropathic Pain Treated by Capsaicin 8% Dermal Patch.
We report a case of chronic left flank neuropathic pain after a renal cyst removal in a 54-year old female. The patient was treated with a single application of capsaicin 8% dermal patch, with satisfactory results at an eight week follow up visit. Capsaicin 8% dermal patch could be a suitable alternative in the conservative management of post laparoscopy neuropathic pain, as it can be effective and has a well-tolerated safety profile.
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J Pain Palliat Care Pharmacother · Jun 2021
Case ReportsSpiritual Healing in a Hospice Veteran Led to a Successful Opioid Taper: A Case Report.
Addressing "total pain" is a concept commonly practiced in palliative care. Spiritual healing in a Navy Veteran led to a significant improvement in pain allowing a voluntary taper of opioid medication. ⋯ A reduction in opioid morphine equivalent daily doses (MEDD) were 87.5% without any symptoms from the clinical opioid withdrawal scale (COWS). The Veteran died peacefully during an opioid taper in hospice care.