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Corticosteroids in Hospice and Palliative Care (Reading & Sharing)

  • Corticosteroids may be used to treat a variety of conditions and symptoms in the palliative care patient, including cerebral edema, spinal cord compression, pain, nausea/vomiting, malignant bowel obstruction, fatigue, and loss of appetite.
  • Although steroids can be very effective, they are associated with frequent and significant adverse effects, particularly with prolonged used. Common effects of even short-term steroid use include disturbed sleep, hyperglycemia, delirium or agitation, fluid retention, gastric ulceration, and increased susceptibility to infection. Prolonged steroid use may lead to osteoporosis, myopathy, and cataracts.
  • Corticosteroids such as prednisone and methylprednisolone are associated with important adverse cardiovascular effects such as sodium and fluid retention, expanded extracellular fluid volume, hypokalemia, and increased BP (possibly associated with an increase in peripheral vascular resistance), all of which increase the risk of cardiac decompensation. However, dexamethasone has some mineralocorticoid activity with less risk of sodium retention, which may make it a safer alternative than some of the other drugs in this class. Additional concerns with corticosteroids include the risk of interaction with anticoagulants and gastrointestinal side effects in the patient taking aspirin.
  • To be CONT. and Modify…
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When the Movies Promoted Smoking (Piece of History – Reading & Sharing)

When Columbus landed in the New World in 1492, he and his men were astonished to find the native Indians smoking rolled-up tobacco leaves, the forerunners of present-day cigars. In the 16th century, Sir Walter Raleigh set London on its ear by puffing away on an elaborate pipe that he brought back from America. Soon tabacco smoking spread to Europe, and the craze was on. Doctors, noting its soothing effects, prescribed tobacco for all sorts of ailments, including lockjaw. In time, the craze was taken up by America’s new settlers. By the 1800s, cigarettes, which were really tiny cigars wrapped in paper, were a major industry, with billions being sold each year.

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Venlafaxine – Effexor (Selective Serotonin-Norepinephrine Reuptake Inhibitor /SNRI)

Venlafaxine is a selective serotonin-norepinephrine reuptake inhibitor (SNRI) used in the palliative care setting for concurrent treatment of depressive disorders and neuropathic pain. (Neuropathic chronic pain is often resistance to standard opioid therapy and is best treated with a secondary amine tricyclic antidepressant (nortriptyline, desipramine), a selective serotonin or norepinephrine reuptake inhibitor (SSNRI) (venlafaxine, duloxetine), or a calcium channel alpha2 delta lignd (anticonvulsants) (gabapentin or pregabalin).

In the United States, there are three SNRIs that have been approved by the FDA: venlafaxine (Effexor and Effexor XR), desvenlafaxine (Pristiq), and duloxetine (Symbalta). Venlafaxine and duloxetine both block the serotonin and norepinephrine transporters, thereby inhibiting and availability to bind with the postsynaptic receptors. At lower doses, venlafazine predominantly affects serotonin reuptak, contributing to greater anxiety reduction more so than depressive symptom reduction. Duloxetine, however, appears to be a more potent and equal serotonin and norepinephrine reuptake inhibitor than venlafaxine is. These drugs are rapidly absorbed after oral intake and metabolized extensively in the liver. Time needed to reach maximum plasma concentration is 2 hours for both venlafaxine and duloxetine. Venlafaxine has a half-life of 5 hours and the active metabolite is 11 hours. Steady state is achieve in 3 to 4 days. Duloxetine has a half-life of 12 hours, reaching steady state in 3 days. Both drugs are excreted mostly in urine.

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All About Nursing · Hospice & Palliative Care · Uncategorized

Predicting Prognosis: Activities of Daily Living (Reading & Sharing)

The most common method of assessing the functional status of patients with diagnoses other than cancer is by the evaluation of the activities of daily living (ADLs).

The original six activities, defined by Katz in the 1960s were bathing, dressing, toileting, transfer, continence, and feeding.

A patient’s ability to perform each of these activities, the evaluation of ADLs on a serial basis has been found to be an important indicator of patient prognosis.

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