“Desprescrever” nos Doentes em Fim de Vida: Um Guia para Melhorar a Prática Clínica
DOI:
https://doi.org/10.24950/rspmi/Revisao/139/1/2018Palavras-chave:
Cuidados Terminais, Desprescrever, Polifarmácia, Prescrição InadequadaResumo
A desprescrição consiste numa avaliação sistemática dos
riscos e benefícios potenciais de cada fármaco para determinado doente, considerando a sua condição clínica e
prognóstico vital. Este processo deve integrar-se no plano
de cuidados de todos os doentes, mas sobretudo nos doentes em fim de vida, i.e., últimos 12 meses de vida, tratando-
-se assim de uma matéria de enorme pertinência no âmbito dos Cuidados Paliativos. Devem ser descontinuados os
fármacos cuja expectativa temporal para benefício excede
a sobrevida expectável do doente - geralmente fármacos
utilizados para prevenção primária, como é o caso das estatinas. A manutenção de outros grupos de fármacos, após
correta avaliação, poderá estar indicada, mas com a devida
adequação aos objetivos de cuidados nestes doentes (ex.:
antimicrobianos, anticoagulantes, inibidores da bomba de
protões e agentes hipoglicemiantes). O ato de desprescrever visa evitar ou reduzir a polifarmácia e, assim, minimizar
as potenciais iatrogenias medicamentosas e a sobrecarga
terapêutica que tomam especial relevância no fim de vida.
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