October is American Pharmacists Month and we are excited to present to you a series of videos throughout the month by our very own, Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Hospice of Southern Illinois is very proud to have the honor of hosting the only PGY-2 (post-graduate, year 2) in Pain and Palliative Care Pharmacy Residency Program fully funded a hospice, in the United States. So, we present to you our next video in the series on Common Questions pertaining to a pharmacists specialty, hospice medications.
Bradlee Rea, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care
Hospice of Southern Illinois
Being a pharmacist on a healthcare team is as fulfilling as it is rewarding. Since pharmacists have training not many other healthcare professionals have, often they receive questions pertaining to their specialty, medications.
The questions receiving vary from patient to patient. Often pain control is a question I am asked to assess and fix. The management of the pain a patient is experiencing is multi-faceted. The first assessment that should be completed is the root cause of their pain. Different types of pain have different mechanisms on how they develop, leading to a variety of optimal treatment options. For example, most times people think the best option for treatment of pain would be an opioid like hydrocodone. However, if the patient is experiencing neuropathic pain, such as stinging, tingling, and burning, then opioids are not first line agents. There are a multitude of medications that can be used to treat pain outside the world of opioids. As with any medication it is important to assess the entire patient and factors which may influencing the efficacy or toxicity of a medication. Such factors typically include other medications that could cause a drug interaction, a patient’s organ function (particularly renal and liver), body fat percentage of a patient, swallowing capability and allergies. All of these must be assessed not only when making recommendations for pain medications, but also for any other medication.
Other questions commonly asked are the use of medication outside their typical or expected use. For example medications are much like a teeter-totter. On one side you have the beneficial effects of a medication, and on the other you have the adverse effects that are possible. Sometimes when all typical treatments have failed, the next step is to use the possible adverse effects of a medication as a treatment. One example would be the use of opioids. Most people think the primary use of them is for treatment of pain, which is correct. But in some settings, especially in hospice, we use the adverse effect of opioids to help with breathing in patients who are short of breath. Another example of this is the use of trazodone. Trazodone was produced originally as an antidepressant, but was also found to cause sedation at lower doses. More often than not, when patients are prescribed trazodone now-a-days it is for the adverse effect of drowsiness helping with sleep, and not for the treatment of depression. The possibilities of medication use are endless and new indications for use are described in literature often. Keeping up to date with medications and their potential uses is important in maintaining competence as a pharmacist.