I have seen firsthand the benefits and drawbacks of different medications for managing pain and in terminally ill patients. Fentanyl patches and Ativan gel are two commonly used medications, but their effectiveness can vary depending on a patient's build and weight, particularly for very thin or cachexic individuals.

Fentanyl Patches

Fentanyl is a potent opioid medication used for in hospice and palliative care. It is often prescribed in patch form, applied to the skin, and releases the medication over 72 hours.

Now, let's talk about why fentanyl patches might not be effective for thin and cachexic patients. When we talk about thin and cachexia patients, we're referring to patients who have lost a significant amount of weight and muscle mass, often due to advanced illness.

One of the main reasons that fentanyl patches might not be effective for these patients is that they rely on a certain amount of fat to be absorbed properly. Specifically, fentanyl is absorbed through the skin and into the bloodstream, and fat cells in the skin help to store the medication and release it slowly over time. Thin and cachexia patients have less fat, meaning the medication may not be absorbed consistently or consistently.

It is also crucial to educate patients and their families on the proper use and disposal of fentanyl patches. Accidental exposure or misuse can lead to respiratory , coma, and even death.

Ativan Gel

Ativan (lorazepam) is a benzodiazepine medication commonly used for and in hospice and palliative care. Ativan gel is a topical medication that can be applied to the wrists or soles of the feet for faster onset of action.

However, for very thin or cachexia patients, Ativan gel can also be less effective due to decreased subcutaneous tissue and blood flow. This can result in slower absorption and reduced anxiety relief. It is essential to closely monitor the patient's medication response and adjust the dosage as needed.

It is also important to note that benzodiazepines can cause respiratory and should be used with caution in patients with compromised lung function.

Overall Considerations

When managing pain and anxiety in very thin or cachexia patients, it is vital to consider the following:

  • Monitor the patient's weight and build when prescribing medications
  • Educate patients and their families on the proper use and disposal of medications, particularly opioids like fentanyl
  • Monitor the patient's response to medications closely and adjust the dosage as needed
  • Use caution when prescribing medications that can cause respiratory depression in patients with compromised lung function.

Communication between the healthcare team, patient, and family is crucial for effective pain and symptom management in hospice and palliative care.

Conclusion

Topicals such as fentanyl patches and Ativan gel are commonly used medications for pain and anxiety management in hospice and palliative care. Still, their effectiveness can vary depending on a patient's build and weight. Very thin or cachexia patients may have less fat and blood flow, which can affect the absorption and consistency of the medications. Therefore, it is crucial to monitor the patient's condition and response to the medications and adjust the dosage as needed. It is also essential to educate patients and their families on the proper use and disposal of drugs and use caution when prescribing medications that can cause respiratory depression. Topicals are not a one-size-fits-all solution, and they should be tailored to each patient's individual needs and preferences. By doing so, we can provide optimal pain and symptom relief for our patients in hospice and palliative care.

Resources

Discomfort vs Pain — they can be treated the same for hospice patients

Assessing Pain in Nonverbal Patients

Managing Pain in the Dying Patient

WebMD — Topical Pain Relievers

Cleveland Clinic — Topical Pain Relief: How It Works

Medical News Today — Pain Management Techniques

National Prescribing Service (NPS) — Pain Management Hub

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