ec19 open session eml opioids and pc lukas 290313 v2.ppt · hiv / aids neurological diseases: mnd...

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Meet Gisela

50 years, cancer left eye 19 years agorecurrent cancer, metastases lung, liver, bone

Severe pain:radiotherapy, opioid

Readmission after 8 weeks

Severe pain: opioid fentanyl 400 µg/h, morphin 60 mg prn

Died in hospice after 3 weeks

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Meet William, Mulago Hospital, KampalaUganda

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Meet the Palliative Care TeamJinja Hospice, Uganda

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Meet Dr. Charmaine BlanchardChris Baragwanath Hospital, SowetoSouth Africa

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Soweto, South Africa

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Soweto, South Africa

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Soweto, South Africa

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

To identify the most important symptoms in palliative care, taking into account prevalence and associated distress

To identify appropriate pharmacological approaches for management of individual symptoms

To determine effectiveness and safety of identified pharmacological approaches

Essential Medicines in Palliative Care Objectives

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Palliative Care Priorities

ElderlyNursing Home

Dementia

Cancer

HIV / Aids

NeurologicalDiseases: MND

Rabies?

Developed Countries

Developing Countries

Pediatrics

Cardiac FailureLung FailureRenal Failure

MDR TB

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg Murray et al. BMJ 330 (2005) 1001-11

Trajectories

High function

Low functionDeath

Time

Cancer

MND, heart, lung disease

Frailty, dementia

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Drug Commission of German Medical Board series of systematic reviews commissioned

European Association for Palliative Care guidelines and expert papers from the research network

International Association for Hospice and Palliative Careworldwide expertise, including resource-poor settings

African Palliative Care Associationresearch collaboration

Essential Medicines in Palliative Care Resources

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

German guidelines, sys revs

IAHPC expertise

EAPC guidelines

APCA research collaborations

IAHPC Application for EMLMedicine IndicationAmitriptyline NEW: 75 mg tablet DepressionDexamethasone NEW: 4 mg tablet Anorexia

Fatigue Diazepam AnxietyDocusate Sodium ConstipationFluoxetine DepressionHaloperiodol Delirium Hyoscine butylbromide NEW: 10mg/mL injection Respiratory Tract

Secretions Ibuprofen PainLoperamide NEW: 2mg solid oral form DiarrhoeaLorazepam NEW: 1 mg, 2.5 mg tablet AnxietyMetoclopromide Nausea, vomitingMorphine Pain

Dyspnea Senna ConstipationSodium Picosulfate NEW: 7.5 mg/mL oral liquid Constipation

University Hospital Bonn, GermanyMalteser Hospital Bonn/Rhein-Sieg

Accept medicines for adults

Add medicines: hyoscine butylbromide, sodium picosulfate, loperamide

Add formulations

Separate section for palliative care for adults and children

Essential Medicines in Palliative Care Application