HP Newsletter - Hospice Pharmacia

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2 Passionate for the Appropriate Use of Medication Education Corner - Jillian N. Prusakowski, PharmD, Education Manager The excelleRx Institute is committed to collaborating with hospices to enhance pharmacotherapy outcomes for patients through education, research and participation in public policy. As a benefit to hospices, we provide palliative care educational programs to enhance practice and career growth for health care professionals. “Introduction to Non-opioid and Opioid Pain Therapy” was offered as a web teleconference in February. There were 173 hospices registered for this program. Over 440 health care professionals received credit for this continuing education session. This program is now available online as an independent study. “Beyond Opioids: Adjuvant Drug Therapy” was conduced in May. There were 116 hospices registered and over 312 health care professionals received continuing education credit for the program! Most recently in August, we presented “Pharmacotherapy for the Anxious and Agitated Patient.” Approximately 200 hospices registered and roughly 900 health care professionals requested to participate! Other CNE modules available online are listed below. Please visit the recently updated CNE website www.hospicepharmacia.com. The programs available include: Palliative Sedation in Hospice Patients Palliative Care in Amyotrophic Lateral Sclerosis Palliative Care in Patients with Dementia Palliative Care in Huntington’s Disease Palliative Treatment of Dyspnea Management of Seizures in End of Life Care The Palliative Management of Insomnia Introduction to Non-opioid and Opioid Pain Therapy Beyond Opioids: Adjuvant Drug Therapy Pharmacotherapy for the Anxious and Agitated Patient “Management of Common Gastrointestinal Complaints at the End of Life,” will be held on: • November 8, 2005 at 9:00am EST • November 9, 2005 at 12:00pm EST • November 10, 2005 at 3pm EST Laura Scarpaci, PharmD is the speaker. She is the Palliative Care Pharmacy Practice Resident at the University of Maryland, School of Pharmacy. This CE program is designed to equip nurses with the tools needed to manage common gastrointestinal symptoms encountered at the end of life such as nausea, vomiting and diarrhea. An overview of recent advances will be provided in addition to a review of pharmacological agents and nonpharmacological techniques typically used in the management of these troubling symptoms. The presentation will also incorporate several cases to demonstrate how the material can be applied to real-life situations. After participation in the program, the audience will be able to: 1. Identify common etiologies associated with nausea, vomiting, and diarrhea at the end of life. 2. Differentiate between the available pharmacological agents for the treatment of common end-of-life gastrointestinal symptoms with regards to their mechanism of action, side effects, and indications. 3. Create an appropriate drug regimen based on patient-specific factors and clinical appropriateness for managing common end-of-life gastrointestinal symptoms. If you would like to learn more about the excelleRx Institute educational programs, please contact Dr. Jill Pfeiffenberger, Director of Education for the excelleRx Institute, by calling 877.882.7822, ext 1677 or by emailing jillp@excellerx.com. Register now for education regarding HP’s Seventh Edition of the Medication Use Guidelines! www.hospicepharmacia.com
Passionate for the Appropriate Use of Medication 3 HP’s Seventh Edition of the Medication Use Guidelines - Douglas J. Weschules, PharmD, BCPS, VP of Clinical Services HP announces the release of the seventh edition of the Medication Use Guidelines (MUGs)! excelleRx has been hard at work for the past twelve months creating this new volume, and we cannot wait to place it in your hands. The workload assumed by the MUGs committee was the most aggressive in excelleRx’s history, with over 500 hours spent in the authorship of guidelines, protocols and monographs alone. Over 40 different topics were included in the development of this seventh edition of the MUGs, 28 of which were suitable for external review. HP sincerely thanks each of the 34 development clinicians and 11 internal review editors and staff for rising to this challenge. The changes associated with the seventh edition of the MUGs are not limited to just the review topics themselves, however. The process associated with MUGs development also continues to mature every year. Noteworthy examples of this evolution this year include the development and use of guideline templates for Development Clinicians (authors) to follow, as well as the grading of evidence associated with these documents. So, what will you see in this new edition? Completely new guidelines include: • Urinary Incontinence • Bowel Obstruction • Failure to Thrive/Debility, Unspecified New medications and therapy options for existing guidelines include: • Roxicodone tablets, 15 and 30 mg • Valproic acid-based SeizureKit Additional detail and enhancements have also been added to the following guidelines: • Alzheimer’s Disease • Anxiety • Agitation • Congestive Heart Failure • COPD • Nociceptive Pain • Urinary Tract Infections Many medications were reviewed but not added to the seventh edition of the MUGs, either because of a lack of evidence to support their use in the hospice population or because MUG alternatives exist that are comparable and/or more cost effective. Medications included in the external review process that were not added to the MUGs are outlined below by reason: Not enough evidence to support their addition to the MUGs: • Antihypertensives for the palliation of end stage CVA • Donepezil (Aricept®) • Galantamine (Razadyne®) • Hydromorphone sustained-release (Palladone®) • Memantine (Namenda®) • Nebulized dexamethasone for COPD or dyspnea • Nebulized lidocaine for cough • Pregabalin (Lyrica®) • Tiagabine (Gabitril®) • Tiotropium (Spiriva®) • Valproic acid for the management of agitation associated with dementia A comparable MUG medication already exists and/or is more cost-appropriate: • Albuterol sulfate/ipratropium bromide (DuoNeb®) • Citalopram (Celexa®) • Clopidogrel (Plavix®) • Dalteparin (Fragmin®) • Enoxaparin (Lovenox®) • Levetiracetam (Keppra®) • Morphine sulfate sustained-release capsule (Avinza®) • Olanzapine (Zyprexa®) • Torsemide (Demadex®) • Tramadol (Ultram®) In addition, the following medications were reviewed internally, but were not part of the external review process: • Acetylcysteine (Mucomyst®) • Carvedilol (Coreg®) • Magnesuim oxide (Mag Ox®) • Oral ketamine (Ketalar®) • Quinine sulfate As you can see, the external review process was robust. Many clinicians from partnering hospices and programs participated in this process. The vast majority of external reviewers agreed that each document they reviewed provided a thorough analysis of each topic, a complete literature review, and agreed with the findings of the author. A few questions and concerns were highlighted throughout this process, all of which helped to influence the MUGs committee’s ultimate decisions for the seventh edition of the MUGs. If you are interested in participating in the external review process in the future, please let us know! The Seventh Edition of the MUGs will be mailed to Hospice Pharmacia partners in the next several weeks and will be effective on November 1st, 2005. Information regarding the preparatory teleconferences is available on our website. If you have any questions regarding the release of the MUGs, or about any of its content, please contact the MUGs committee at MUGs@excellerx.com. www.hospicepharmacia.com
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HP Newsletter - Hospice Pharmacia

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