Which medications carry risk for delirium, constipation, or sedation, and what is recommended?

Study for ELNEC 4: Symptom Management in Palliative Care Test with flashcards and multiple choice questions. Hints and explanations included! Get ready for your exam!

Multiple Choice

Which medications carry risk for delirium, constipation, or sedation, and what is recommended?

Medications with anticholinergic effects, along with CNS depressants such as benzodiazepines and opioids, are the ones most likely to contribute to delirium, constipation, and sedation in palliative care. Anticholinergic drugs can impair cognition by blocking acetylcholine in the brain, which increases confusion and delirium risk. Benzodiazepines further sedate the patient and can precipitate or worsen delirium, especially in older adults or those with advanced illness. Opioids slow gastrointestinal motility, leading to constipation, and also cause sedation. When these classes are used together or in polypharmacy, the risk compounds. The recommended approach is to review the entire medication list and deprescribe when possible. This means trimming nonessential anticholinergic load, using the lowest effective doses, and substituting safer alternatives or nonpharmacologic strategies for symptom control whenever feasible. Proactive dose optimization and regular monitoring for signs of delirium, constipation, or excessive sedation are essential, with a plan to adjust therapy in collaboration with the patient, family, and the care team.

Medications with anticholinergic effects, along with CNS depressants such as benzodiazepines and opioids, are the ones most likely to contribute to delirium, constipation, and sedation in palliative care. Anticholinergic drugs can impair cognition by blocking acetylcholine in the brain, which increases confusion and delirium risk. Benzodiazepines further sedate the patient and can precipitate or worsen delirium, especially in older adults or those with advanced illness. Opioids slow gastrointestinal motility, leading to constipation, and also cause sedation. When these classes are used together or in polypharmacy, the risk compounds.

The recommended approach is to review the entire medication list and deprescribe when possible. This means trimming nonessential anticholinergic load, using the lowest effective doses, and substituting safer alternatives or nonpharmacologic strategies for symptom control whenever feasible. Proactive dose optimization and regular monitoring for signs of delirium, constipation, or excessive sedation are essential, with a plan to adjust therapy in collaboration with the patient, family, and the care team.

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