Medication Used in Hospice
If you have a relative or other loved one possibly entering into hospice, you likely do have an array of questions. This particularly can be the case if you are the adult child of an aging parent who has reached what medical professionals consider the final days or weeks of his or her life. Understanding where you may find yourself and realizing getting solid answers to questions about hospice care is crucial, we present this article for your consideration. This article specifically addresses the types and purposes of medications used in hospice.
What Is Hospice?
Before diving into the medications used in hospice, we provide you an overview of this type of care. If you are like most people, you certainly may have a general understanding of the concept of hospice care but really may need a bit more in the way of an explanation of what hospice is all about.
Overview of Medications in Hospice
A couple of key notes about medications in hospice are necessary before considering individual drugs commonly given to hospice patients. First and foremost, medications provided to hospice patients are determined on a case by case basis. There is no broad ranging template that is utilized for all hospice patients in all situations. With that said, time and again hospice patients are in rather similar circumstances. This results in the fact that many of the same medications are indeed provided from one hospice case to another.
Second, the bulk of medications provided to hospice patients are associated with pain management. Underpinning hospice is palliative care. The National Institute of Nursing Research defines palliative care as:
Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. You receive palliative care at the same time that you’re receiving treatments for your illness.
Palliative care provides relief from symptoms including pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, problems with sleep, and many other symptoms. It can also help you deal with the side effects of the medical treatments you’re receiving. Perhaps most important, palliative care can help improve your quality of life and provide help to your family as well.
We now turn to a consideration of various medications that commonly are utilized in caring for a person in hospice. These medications include over the counter drugs as well as prescriptions.
The most widely utilized medication in hospice is acetaminophen. There are both over the counter and prescription derivations of this medication. It is best known by the brand name Tylenol. Acetaminophen is used to reduce fever and to assist in easing mild to moderate pain. Acetaminophen can be taken in a pill by mouth or via a rectal suppository.
Side effects of acetaminophen are rare. With that said, uncommon reactions can include:
- Pain in the upper stomach
- Loss of appetite
- Dark urine
- Clay-colored stools
Acetaminophen is not to be taken with certain drugs due to potentially dangerous interactions. These include:
Lorazepam is the second most widely used drug by patients in hospice. Lorazepam many times is prescribed along with morphine for comfort. This medication is designed to address a number of issues that include:
- Shortness of breath
Lorazepam can cause dangerous interactions with other drugs. Alcohol should not be consumed when taking Lorazepam. Symptoms of a dangerous drug interaction include:
- Unusual dizziness
- Extreme sleepiness
- Slowed or difficult breathing
Long-term use can make Lorazepam less effective. Suddenly going off Lorazepam can cause worsening anxiety as well as other issues.
There are side effects of Lorazepam that include:
- Dry mouth
- Changes in appetite
- Difficulty urinating
- Frequent urination
- Blurred vision
- Changes in sex drive
- Changes in sex ability
Morphine is regularly used in hospice but it is not the most widely prescribed medication. There are a number of misconceptions about morphine use in hospice care that warrant correction.
Morphine is an opioid and has the potential for addiction. However, in hospice the prospect of a patient becoming addicted to morphine is not a real issue for a number of reasons. First, morphine tends to be utilized when an individual is at the final stages of life. As will be discussed in a moment, it is designed to address a number of symptoms associated with the last days of an individual’s life.
Second, morphine is not used to hasten death. Morphine is used to ease the transition of a hospice patient from life to death.
Third, morphine typically does not stop working for a hospice patient. It is possible to increase the dosage or morphine incrementally in order to maintain effectiveness. Moreover, there are alternate medications that can be utilized should morphine lose its effectiveness or not be well tolerated by a particular patient.
Morphine is designed to address three primary issues associated with people in hospice, the trio of which can be particularly prevalent during a person’s last days:
- Dyspnea (or air hunger)
Most hospice patients, especially those who have dementia, lung disease and cancer are treated with antidepressants. Antidepressants assist hospice patients with:
- Anxiety disorders
- Seasonal Affective Disorder
Examples of antidepressants used in hospice are Prozac and Zoloft. Side effects of these medications can include:
- Weight loss
Bisacodyl is used to treat constipation suffered by a hospice patient. Constipation is quite common among hospice patients. When they begin to eat and drink less as they approach the last days of their lives, they can suffer constipation. In addition, other medications begin taken while in hospice can have side effects that include constipation.
Bisacodyl is an over the counter medication that comes in a number of different brands:
- Carter’s Little Pills
Bisacodyl stimulates a person’s intestines in order to cause a bowel movement. The medication normally takes effect within six to 12 hours. As a consequence, it oftentimes is given before bedtime to stimulate a bowel movement in the morning.
There are some side effects of taking Bisacodyl that include:
- Stomach cramps
- Stomach discomfort
- Rectal bleeding (if that occurs, a doctor should be notified immediately)
Dexamethasone is a steroid that is used in hospice for a number of different reasons. It is available under prescription brand names that include:
In hospice, Dexamethasone is used to:
- Relieve pain
- Reduce swelling
- Increase appetite
- Relieve nausea
On a more long-term basis, Dexamethasone is used to treat:
- Certain types of arthritis
- Skin disorders
- Blood disorders
- Kidney disorders
- Eye disorders
- Thyroid disorders
- Intestinal disorders, including colitis
- Severe allergies
- Certain types of cancer
Dexamethasone is taken orally in pill or liquid form. It is recommended that it be taken with milk or food.
Potential side effects of Dexamethasone include:
- Skin rash
- Swollen face
- Swollen lower legs
- Swollen ankles
- Vision problems
- Long-lasting cold
- Long-lasting infection
- Muscle weakness
- Black stool
- Upset stomach
- Easy bruising
Anticholinergic represents another type of medication used in hospice care. A commonly used brand is Benadryl. Anticholinergic is used to treat:
- Muscle spasms
- Breathing problems
- Movement disorders
Side effects might include:
- Blurred vision
- Dry mouth
Anticholinergic generally is not recommended for people with dementia.
Anxiolytic primarily is used in hospice to address anxiety. Anxiolytic can also be used to treat:
- Panic disorder
Side effects of Anxiolytic can include:
- Sexual dysfunction
A hospice care team works closely with a patient as well as family members or other loved ones to ensure that a person in hospice receives appropriate medications as part of an overall course of care. The hospice team typically is readily available to answer any questions or to address any concerns regarding medications.