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Drug Formulary

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Essentials of Palliative Care

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Abstract

The development of a formulary specific for use in palliative medicine requires an understanding of the most common symptoms. Pharmacologic therapies offer the most rapid and efficient means of treating common symptoms. In order to reduce the risks of excessive polypharmacy that is often required when treating multiple symptoms, the goal is to maintain a regimen using the most effective agents, with favorable side effect profile, and optimal use of multipurpose agents. International organizations have provided lists for commonly used drugs in the treatment of symptoms. The chapter highlights the beneficial traits of drugs that are frequently indicated in palliative medicine.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Angèle Ryan M.D.

Authors
  1. Angèle Ryan M.D.
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Corresponding author

Correspondence to Angèle Ryan M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Advantages of methadone use in palliative medicine include all the following except:

    1. (a)

      High-potency opioid-tolerant patients

    2. (b)

      Anti-neuropathic mechanism via N-methyl-d-aspartate (NMDA) receptor antagonism

    3. (c)

      Short half-life

    4. (d)

      No active metabolites

    5. (e)

      Ease of administration

  2. 2.

    Which of the following medications are effectively administered by ­transmucosal route:

    1. (a)

      Olanzepine

    2. (b)

      Morphine

    3. (c)

      Fentanyl

    4. (d)

      Tramadol

    5. (e)

      Amitriptyline

  3. 3.

    All of the following medications offer benefit for the treatment of neuropathic pain with the exception of

    1. (a)

      Gabapentin

    2. (b)

      Buprenorphine

    3. (c)

      Carbamazepine

    4. (d)

      Codeine

    5. (e)

      Amitriptyline

  4. 4.

    Drug interactions are most likely with which of the following drugs

    1. (a)

      Acetaminophen

    2. (b)

      Diclofenac

    3. (c)

      Gabapentin

    4. (d)

      Haloperidol

    5. (e)

      Methadone

  5. 5.

    Which of the following benefits is not provided by octreotide in the care of terminally ill patients

    1. (a)

      Reduction of secretions and gut motility in inoperable bowel obstruction

    2. (b)

      Cost effective

    3. (c)

      Management of fistulas

    4. (d)

      Enhancement of diuretic therapy in treatment of ascites

    5. (e)

      Treatment of diarrhea

Answers

  1. 1.

    (c). A disadvantage of methadone is the prolonged and variable half-life which limits rapid titration. It remains a viable opioid option for patients who are highly tolerant or exhibit a neuropathic component of pain. Liquid formulation allows for creative administration in patients with compromised swallowing.

  2. 2.

    (c). Fentanyl has high lipid solubility making it an excellent choice for transdermal absorption. Although morphine, in concentrated liquid formulation, is often placed sublingually for patients with impaired swallowing, it is essentially ­swallowed with saliva. Similarly, an orally dissolving olanzepine disk is ­formulated for ease of swallowing. Tramadol is rapidly absorbed by oral route.

  3. 3.

    (d). The common classes of medication for treatment of neuropathic pain are anticonvulsants and antidepressants. Codeine is a weak opioid without ­antineuropathic effect. Buprenorphine has unique non-opioid mechanisms of action suggesting a role in treating neuropathic pain.

  4. 4.

    (e). Methadone is involved in numerous drug interactions as a result of metabolism via the cytochrome system.

  5. 5.

    (b). Despite the effectiveness of octreotide in symptom management, the cost remains an impediment to its use.

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Ryan, A. (2013). Drug Formulary. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_14

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_14

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

  • eBook Packages: MedicineMedicine (R0)

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