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Blog articles are provided as informational purposes only and are not intended to constitute medical advice. Medication protocols are subject to patient’s medical provider’s authorization.


The U.S. Food and Drug Administration (FDA) has identified that some ranitidine products, including those commonly known as the brand name drug, Zantac®, contain a nitrosamine impurity called N-nitrosodimethylamine (NDMA) at low levels. NDMA is classified by U.S. government organizations, such as the Environmental Protection Agency (EPA), as a probable human carcinogen (a substance that could cause cancer).



Methadone was first developed in Germany in the 1930s and was used extensively during World War II as an alternative to morphine during shortages. Over the past twenty years, methadone has experienced a revival due to its unique characteristics, versatile administration, and utility in managing nociceptive and/or neuropathic pain in hospice and palliative care (Figure 1).



Medications used to treat psychiatric conditions and symptoms are commonly used in the hospice setting. It has been reported that antipsychotics are in the top 20 most frequently prescribed pharmacological class of medications in hospice patients. Adverse effects of these medications can easily be overlooked but can have significant effects on the patient. This article will examine adverse events associated with common psychiatric medications, including serotonin syndrome, neuroleptic malignant syndrome, extrapyramidal symptoms, and tardive dyskinesia.

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Last month, a meta-analysis1 of 1,442 patients and 5 randomized controlled trials found cannabinoids did not reduce cancer pain any better than placebo, when these were added to stable doses of opioids. Change in pain score using the numeric rating scale (NRS) was the primary outcome. The analysis also found statistically significant increased frequencies of somnolence and dizziness as compared with placebo. The cannabinoids were administered in a pump oromucosal spray formulation (not currently available in the US), using equal parts CBD (cannabidiol) and THC (tetrahydrocannabidiol) mixture.


Benzodiazepines are used for a variety of indications in the hospice setting, including insomnia, breathlessness, agitation, seizures, nausea/vomiting, myoclonus, and palliative sedation (see details outlined below).

Although they share many class effects, unique properties of individual benzodiazepines have clinical implications. For example, benzodiazepines can be classified based on their half-life (short, intermediate, and long). The benzodiazepine with the shortest half-life is triazolam. The longest is diazepam. The terminal half-life may be affected by liver or kidney dysfunction, age, drug-drug interactions, gender, race, or even route of administration. For example, the half-life of diazepam may be up to 174 hours when administered intramuscularly.


ANCC Accreditation

ProCare HospiceCare is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.