Palliative care is an approach that focuses on improving the quality of life of patients facing life-threatening illnesses. The goal is to relieve symptoms such as pain, nausea, and anxiety and address the patient’s and their family’s social and spiritual needs. Palliative care can be provided alongside curative treatments in hospitals, hospices, or at home.
Pharmacy medicines can play an important role in palliative care by effectively managing symptoms and improving the patient’s overall well-being. In this article, we will discuss how pharmacy medicines for palliative care and provide some useful tips to help you manage symptoms safely and effectively.
It is important to note that pharmacy medicines should only be used under the guidance of a healthcare professional and that patients should always follow the dosing instructions provided by their doctor or pharmacist.
Pain Management
Pain is one of the most common symptoms experienced by patients in palliative care. Pharmacy medicines can be used to manage different types of pain, including nociceptive pain (caused by tissue damage) and neuropathic pain (caused by nerve damage).
The World Health Organization) has developed a pain ladder that guides the use of different pain medications depending on the severity of the pain. The first step is to use non-opioid medications such as paracetamol or NSAIDs. If the pain is moderate to severe, weak opioids such as codeine or tramadol can be used. If the pain is still not controlled, strong opioids such as morphine or fentanyl can be considered>
It is important to start with the lowest effective dose and to titrate the dose upwards gradually until adequate pain relief is achieved. Patients should be monitored for side effects such as constipation, sedation, or respiratory depression.
Nausea and Vomiting
Nausea and vomiting are common symptoms experienced by patients in palliative care. The underlying illness, treatments, or other factors such as anxiety or constipation can cause them.
Pharmacy medicines such as antiemetics can be used to manage nausea and vomiting. These medications block specific receptors in the brain that trigger the vomiting reflex. Commonly used antiemetics include metoclopramide, haloperidol, and ondansetron. Patients should be monitored for side effects such as drowsiness, restlessness, or extrapyramidal symptoms. In addition to medication, non-pharmacological interventions such as relaxation techniques or distraction can also manage nausea and vomiting.
Constipation
Constipation is a common side effect of opioid use and can cause discomfort and pain for patients in palliative care. Pharmacy medicines such as laxatives can be used to manage constipation.
Laxatives can be classified into different groups depending on their mechanism of action. Bulk-forming laxatives such as psyllium or methylcellulose work by increasing the bulk of the stool and stimulating peristalsis. Osmotic laxatives such as lactulose or magnesium hydroxide work by drawing water into the colon and softening the stool. Stimulant laxatives such as bisacodyl or senna work by stimulating the nerves in the colon and increasing motility. Home health supplies such as bulk-forming and osmotic laxatives can be found at your local pharmacy or through online retailers.
Patients should be advised to drink plenty of fluids and to increase their fiber intake to prevent constipation. It is important to start with the lowest effective dose of laxatives and to titrate the dose upwards gradually until regular bowel movements are achieved.
Anxiety and Depression
Anxiety and depression are common emotional symptoms experienced by patients in palliative care. The underlying illness, fear of death, or other factors such as pain or social isolation can cause them.
Pharmacy medicines such as anxiolytics and antidepressants can be used to manage anxiety and depression. Anxiolytics such as lorazepam or diazepam work by reducing anxiety and promoting relaxation. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) increase neurotransmitters such as serotonin or norepinephrine.
Patients should be monitored for side effects such as sedation, confusion, or falls. It is important to start with the lowest effective dose and to titrate the dose upwards gradually until adequate symptom relief is achieved.
Dyspnea
Dyspnea, or shortness of breath, is a common symptom experienced by patients in palliative care. An underlying illness, anxiety, or other factors such as infection or heart failure can cause it.
Pharmacy medicines such as bronchodilators or opioids can be used to manage dyspnea. Bronchodilators such as salbutamol or ipratropium dilate the airways and improve airflow. Opioids such as morphine or fentanyl reduce the sensation of breathlessness and promote relaxation.
Patients should be monitored for side effects such as sedation, constipation, or respiratory depression. It is important to start with the lowest effective dose and to titrate the dose upwards gradually until adequate symptom relief is achieved.
Fatigue
Fatigue, or tiredness, is a common symptom experienced by patients in palliative care. It can be caused by an underlying illness, treatments, or other factors such as anxiety or depression.
Pharmacy medicines such as stimulants or antidepressants can be used to manage fatigue. Stimulants such as methylphenidate or modafinil work by increasing alertness and reducing fatigue. Antidepressants such as SSRIs or TCAs work by improving mood and energy levels.
Patients should be monitored for side effects such as insomnia, agitation, or hypertension. It is important to start with the lowest effective dose and to titrate the dose upwards gradually until adequate symptom relief is achieved.
Oral Care
Oral care is an important aspect of palliative care as it can help prevent discomfort and infections. Pharmacy medicines such as mouthwashes or analgesics can be used to manage oral symptoms.
Mouthwashes such as chlorhexidine or sodium bicarbonate can reduce the risk of infections and promote oral hygiene. Analgesics such as benzocaine or lidocaine can be used to manage oral pain. Patients should be advised to brush their teeth regularly and to use a soft toothbrush to avoid injuring the gums. They should also avoid using alcohol-based mouthwashes or toothpaste, which can cause dryness and irritation.
Skin Care
Skincare is another important aspect of palliative care, as it can help prevent discomfort and infections. Pharmacy medicines such as moisturizers or analgesics can be used to manage skin symptoms.
Moisturizers such as emollients or humectants can hydrate skin and prevent dryness. Analgesics such as lidocaine or capsaicin can be used to manage skin pain. Patients should be advised to avoid using harsh soaps or hot water and to moisturize their skin regularly. They should also avoid exposing their skin to direct sunlight or extreme temperatures.
Conclusion
Pharmacy medicines can play an important role in palliative care by effectively managing symptoms and improving the patient’s overall well-being. It is important to use these medicines under the guidance of a healthcare professional and to follow the dosing instructions provided. Patients should also be monitored for side effects, and their symptoms should be reassessed regularly to ensure they receive the most appropriate care.