Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Jun 2021
Case ReportsThe Hunger for Mirtazapine: A Discontinuation Syndrome.
While mirtazapine is primarily prescribed for major depressive disorder, it is less commonly prescribed for anorexia related to various disease states. Mirtazapine is associated with few adverse events but potential for a discontinuation syndrome does exist. ⋯ Mirtazapine was restarted at the same dose after 14 days of ongoing symptoms and his symptoms subsided immediately. Scant literature exists to highlight the potentially serious adverse events associated with abrupt mirtazapine discontinuation, even at low doses, and this case contributes to advocating for the need of mirtazapine taper when medication cessation is being considered.
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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
Characterizing Patients after Opioid Taper in a VA Medical Center.
To identify potential areas for intervention and gain insight on current practice in patients who are tapered to zero morphine equivalent daily doses (MEDD) through the Pharmacy Pain E-Consult at a Veterans Healthcare System. This was done by describing the types of follow-up care and resources utilized by patients. This project is a retrospective chart review of Veterans with non-cancer pain on chronic-opioid therapy consulted to the pharmacy e-consult service and tapered to 0 MEDD. ⋯ Follow-up with mental health and pain management clinical pharmacy specialists decreased post-taper. Tapering to zero MEDD did not lead to a significant increase in pain one-year post-taper; however, approximately 33% of patients were re-started on opioids within one year post-taper. Average MEDD scores decreased post-taper as expected but with effects on mental health being largely unknown, we believe that further study in this area will help us better support patients.