Cuidados Paliativos no Domicílio: Vias Alternativas para a Administração de Fármacos

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DOI:

https://doi.org/10.24950/rspmi.432

Palavras-chave:

Cuidados paliativos, Vias de administração de medicamentos

Resumo

Os cuidados paliativos têm como intuito a melhoria da qualidade de vida dos doentes que se defrontam com doenças graves e/ou avançadas, incuráveis ou progressivas. A gestão sintomática (farmacológica e não farmacológica) é uma das suas áreas de atuação já que o seu descontrolo influencia negativamente a qualidade de vida do doente e da sua família.
A via oral é a via terapêutica preferencial em cuidados paliativos, contudo, existem situações em que a sua utilização não é possível. Assim torna-se importante ter vias terapêuticas alternativas para cumprir o objetivo de manter o doente confortável no seu domicílio. O objetivo deste trabalho é apresentar as vantagens e desvantagens das vias alternativas mais utilizadas e as opções terapêuticas possíveis dentro de cada uma delas para os diferentes sintomas.

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Referências

World Health Organization. Palliative Care [Internet]. 2020. [consultado a 02/02/2022] Disponível em: https://www.who.int/news-room/fact-sheets/detail/palliative-care

Merino MTGB. Palliative care: Taking the long view. Front Pharmacol. 2018; 9:1–5.

Freire E, Fernandes R, Pires C, Gonçalves E, Saavedra M, Rocha MC, et al. Guia Prático de Controlo Sintomático. 2a edição. NEMPal – SPMI; 2021

Neto IG. Utilização da via subcutânea na prática clínica. Med Interna. 2008; 15:277–83.

Silva R, Paiva M, Vital F, Moura MJ, Lourenço J, Lopes JM. Plano Estratégico para o Desenvolvimento dos Cuidados Paliativos 2021-2022 2 Comissão Nacional de Cuidados Paliativos: Com o contributo dos Coordenadores Regionais: Ordem dos Médicos, Ordem dos Enfermeiros, Ordem dos Psicólogos. Lisboa: OM, OE, OP: 2022.

Gomes B, Sarmento VP, Ferreira PL. Estudo Epidemiológico dos Locais de Morte em Portugal em 2010 e Comparação com as Preferências da População Portuguesa. Acta Med Port. 2013; 26:327–34.

Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013; 12:7.

Ferreira RCC, Capelas ML. Morrer no domicílio: fatores associados à satisfação da preferência do doente. Rev Port Clínica Geral. 2021; 37:90–8.

Kestenbaum MG, Vilches AO, Messersmith S, Connor SR, Fine PG, Murphy B, et al. Alternative Routes to Oral Opioid Administration in Palliative Care: A Review and Clinical Summary. Pain Med. 2014; 15:1129–53.

Hofmeister M, Memedovich A, Dowsett LE, Sevick L, McCarron T, Spackman E, et al. Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis. BMC Palliat Care. 2018; 17:41.

NHS Scotland. Scottish Palliative Care Guidelines - Alternatives to regular medication normally given via a syringe pump condensed [Internet]. 2020. [consultado a 02/02/2022] Disponível em: https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/alternatives-to-regular-medication-normally-given-via-a-syringe-pump-when-this-is-not-available.aspx

Manganaro AM. Review of transmucosal drug delivery. Mil Med. 1997; 162:27–30.

Lam JKW, Cheung CCK, Chow MYT, Harrop E, Lapwood S, Barclay SIG, et al. Transmucosal drug administration as an alternative route in palliative and end-of-life care during the COVID-19 pandemic. Adv Drug Deliv Rev. 2020; 160:234–43.

Sutherland AE, Presland M, Harrop E, Carey M, Miller M, Wong IC. Orodispersible and transmucosal alternative medications for symptom control in adults. BMJ Support Palliat Care. 2020;bmjspcare-2020-002784. doi: 10.1136/bmjspcare-2020-002784

Lam JKW, Xu Y, Worsley A, Wong IC. Oral transmucosal drug delivery for pediatric use. Adv Drug Deliv Rev. 2014; 73:50–62. doi: 10.1016/j.addr.2013.08.011.

Patel VF, Liu F, Brown MB. Advances in oral transmucosal drug delivery. J Control Release. 2011; 153:106–16. doi: 10.1016/j.jconrel.2011.01.027.

Barosa M, Gonçalves T, Neto I. Guia Sintético Abordagem Da Agonia Últimos Dias E Horas De Vida. 2021. [consultado a 02/02/2022] Available from: https://ordemdosmedicos.pt/wp-content/uploads/2021/06/Guia-sintético-abordagem-da-agonia.pdf

Brigo F, Nardone R, Tezzon F, Trinka E. Nonintravenous midazolam versus intravenous or rectal diazepam for the treatment of early status epilepticus: A systematic review with meta-analysis. Epilepsy Behav. 2015; 49:325–36. doi: 10.1016/j.yebeh.2015.02.030.

Keller LA, Merkel O, Popp A. Intranasal drug delivery: opportunities and toxicologic challenges during drug development. Drug Deliv Transl Res. 2022;12:735-7. doi: 10.1007/s13346-020-00891-5.

Corrigan M, Wilson SS, Hampton J. Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings. Am J Health Pharm. 2015; 72:1544–54. doi: 10.2146/ajhp140630.

Prommer E. Midazolam: an essential palliative care drug. Palliat Care Soc Pract. 2020; 14:2632352419895527.

Dietrich E, Gums JG. Intranasal fentanyl spray: a novel dosage form for the treatment of breakthrough cancer pain. Ann Pharmacother. 2012; 46:1382–91.

Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16:48–61.

Lowry M. Rectal drug administration in adults: how, when, why. Nurs Times. 2016; 112:12-4.

Warren DE. Practical use of rectal medications in palliative care. J Pain Symptom Manage. 1996; 11:378–87.

León Ruiz M, Rodríguez Sarasa ML, Sanjuán Rodríguez L, Pérez Nieves MT, Ibáñez Estéllez F, Arce Arce S, et al. Guía para el manejo de las crisis epilépticas en cuidados paliativos: propuesta de un modelo actualizado de práctica clínica basado en una revisión sistemática de la literatura. Neurología. 2019; 34:165–97. doi: 10.1016/j.nrl.2016.11.010.

German Guideline Programme in Oncology (German Cancer Society, German Cancer Aid, AWMF): Palliative care for patients with incurable cancer, short version 1.1, 2015; 1–98 AWMF-registration number 128/001OL, consultado a 02/02/2022. Disponível em: http://leitlinienprogramm- onkologie.de/Leitlinien.7.0.html

Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012; 13:e58–68.

1. Flores MP, Castro AP, Nascimento JS. Analgésicos tópicos. Rev Bras Anestesiol. 2012; 62:248–52.

Cachia E, Ahmedzai SH. Transdermal opioids for cancer pain. Curr Opin Support Palliat Care. 2011; 5:15–9.

Prausnitz MR, Langer R. Transdermal drug delivery. Nat Biotechnol. 2008; 26:1261-8.

Tassinari D, Poggi B, Fantini M, Tamburini E, Sartori S. Treating sialorrhea with transdermal scopolamine. Exploiting a side effect to treat an uncommon symptom in cancer patients. Support Care Cancer. 2005; 13:559-61.

Leppert W, Malec-Milewska M, Zajaczkowska R, Wordliczek J. Transdermal and topical drug administration in the treatment of pain. Molecules. 2018; 23:681. doi: 10.3390/molecules23030681.

Spiller JA, Fallon M. The use of Scopoderm in palliative care. Hosp Med. 2000; 61:782–4.

Argoff CE. Topical Analgesics in the Management of Acute and Chronic Pain. Mayo Clin Proc. 2013; 88:195–205.

Stanos SP. Topical Agents for the Management of Musculoskeletal Pain. J Pain Symptom Manage. 2007; 33:342–55.

Sawynok J. Topical analgesics for neuropathic pain: Preclinical exploration, clinical validation, future development. Eur J Pain. 2014; 18:465–81.

Sociedade Brasileira de Geriatria e Gerontologia. O uso da via subcutânea em geriatria e cuidados paliativos Vol. 1, Sociedade Brasileira de Geriatria e Gerontologia Academia Nacional de Cuidados Paliativos. Brasília: SBGGANCC; 2016.

Broadhurst D, Cooke M, Sriram D, Gray B. Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews. PLoS One. 2020;15:e0237572. doi: 10.1371/journal.pone.0237572.

Fürst P, Lundström S, Klepstad P, Strang P. Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center. BMC Palliat Care. 2020;19:172. doi: 10.1186/s12904-020-00681-3.

Negro S, Martín A, Azuara ML, Sánchez Y, Barcia E. Stability of tramadol and haloperidol for continuous subcutaneous infusion at home. J Pain Symptom Manage. 2005; 30:192-9.

Papa P, Oricchio F, Ginés M, Maldonado C, Tashjian A, Ibarra M, et al. Pharmacokinetics of Subcutaneous Levetiracetam in Palliative Care Patients. J Palliat Med. 2021;24:248–51. doi: 10.1089/jpm.2019.0525.

1. Furtado I, Gonçalves F, Gonçalves J, Neves J. Continuous subcutaneous levetiracetam in end-of-life care. BMJ Case Rep. 2018;2018:bcr2017222340. doi: 10.1136/bcr-2017-222340.

NHS Scotland. Scottish Palliative Care Guidelines - Dexametasone [Internet]. 2020. [consultado a 02/02/2022] Disponível em: https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/alternatives-to-regular-medication-normally-given-via-a-syringe-pump-when-this-is-not-available.aspx

Emma Husbands. St. Michael’s Hospice Clinical Care Guidelines - Use of Corticosteroids. [Internet] 2008. [consultado a 02/02/2022]. Disponível em: https://www.palliativedrugs.com/download/steroidguidelines.pdf

Mercadante S, Spoldi E, Caraceni A, Maddaloni S, Simonetti MT. Octreotide in relieving gastrointestinal symptoms due to bowel obstruction. Palliat Med. 1993; 7:295–9.

Imamura S, Maehara S. Octreotide for the treatment of symptoms of bowel obstruction in advanced cancer. J Clin Oncol. 2007; 25:19626–26.

Hsu K, Prommer E, Murphy MC, Lankarani-Fard A. Pharmacologic management of malignant bowel obstruction: When surgery is not an option. J Hosp Med. 2019; 14:367–73.

Glare P, Miller J, Nikolova T, Tickoo R. Treating nausea and vomiting in palliative care: a review. Clin Interv Aging. 2011;6:243-59. doi: 10.2147/CIA.S13109.

Afari ME, Aoun J, Khare S, Tsao L. Subcutaneous furosemide for the treatment of heart failure: a state-of-the art review. Heart Fail Rev. 2019; 24:309–13. doi: 10.1007/s10741-018-9760-6.

Thomas B. Malignant bowel obstruction symptoms: subcutaneous bolus esomeprazole—retrospective case series. BMJ Support Palliat Care. 2022; bmjspcare-2021-003510.

Hernández-Ruiz V, Forestier E, Gavazzi G, Ferry T, Grégoire N, Breilh D, et al. Subcutaneous Antibiotic Therapy: The Why, How, Which Drugs and When. J Am Med Dir Assoc. 2021; 22:50-55.e6. doi: 10.1016/j.jamda.2020.04.035.

Andrew Wilcok, Paul Howard SC. Palliative Care Formulary. London: Pharmaceutical Press; 2020.

Sánchez-Sánchez E, Ruano-Álvarez MA, Díaz-Jiménez J, Díaz AJ, Ordonez FJ. Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review. Nutrient. 2021; 13:1562. doi: 10.3390/nu13051562.

Gilbar PJ, Pract DHCP. A Guide to Enteral Drug Administration in Palliative Care. J Pain Symptom Manage. 1999; 17:197–207.

Wright D, Chapman N, Founding-Miah M, Greenwall R, Griffith R, Guyon A, et al. Guideline on the medication management of adults with swallowing difficulties. Guidel Pract. 2008; 11:2.

Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT. Recommendations for the use of medications with continuous enteral nutrition. Am J Heal Pharm. 2009; 66:1458–67.

Madden A. Handbook of drug administration via enteral feeding tubes. J Hum Nutr Diet. 2007; 20:136–6.

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22-09-2022

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1.
Martins de Brito S, Bertão M, Freire E. Cuidados Paliativos no Domicílio: Vias Alternativas para a Administração de Fármacos. RPMI [Internet]. 22 de Setembro de 2022 [citado 18 de Dezembro de 2024];29(3):207-14. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/432

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