Pharmacotherapy Considerations for Challenging Symptoms in Serious Illness: The Goldilocks Guide

Abstract

Outcomes

1. At the conclusion of this presentation the participant will be able to: 1. Describe best practices for symptom management in patients with end-stage renal disease and end-stage liver disease.

2. Describe best practices for managing symptoms such as malignant bowel obstruction, and terminal secretions. 3. Describe pharmacotherapy strategies to control symptoms. 4. Describe best practices in dosing buprenorphine.

Patients living with a serious illness frequently rely on medications to palliate their symptoms (pain and non-pain). Drug therapy at this stage of a patient's life is a balancing act – clinicians need to be knowledgeable about when, what, and how to deprescribe, and how to critically select new medications to add to the mix. This pre-conference will cover a variety of topics that will illustrate precision pharmacotherapy – referred to as “The Goldilocks Guide.”

Topics will include management of challenging non-pain symptoms such as malignant bowel obstruction, nausea/vomiting, terminal secretions, fatigue and more. We will also address symptom management in end-stage renal disease and end-stage liver disease. We will discuss essential techniques of kidney supportive care focusing on several key areas. We will explore various approaches to treating fatigue, constipation, itching/pruritus in renal disease, and nausea, confusion, and ascites in liver disease. We will emphasize the importance of proper selection and dosing for medications such as opioids, gabapentin, and, dare we say, maybe even NSAIDs (in renal disease)! As a special treat, we will discuss a practical real-world approach to managing agitation in the hospice and palliative care patient. This content will focus on the thoughtful use of pharmacology to relieve the highly distressing symptoms of delirium our patients often experience. As if that weren't enough, this presentation will cover the use of buprenorphine for patients receiving palliative or hospice care. This will include candidate selection, and dosing considerations. And as a special treat, each speaker will review two recent and impactful studies on the appropriate use of pharmacotherapy in serious illness.