Terminal patients

Prophylactic, continuous use of antibiotics has no effect on the frequency of exacerbations antibiotics should only be used for treating infectious exacerbations. Antitussives are contraindicated because cough has an important protective role. Opioids may be effective for dyspnea in advanced disease but may have serious adverse effects they may be used to manage symptoms in terminal patients. 

Pregnancy term/naf/on- Misoprostol has been used in combination with mifepristone for pregnancy termination. Patients taking mifepristone must take 400 meg misoprostol orally 2 days after taking mifepristone unless a complete abortion has already been confirmed before that time. 

Unfortunately, the inconvenience occasioned by these laws—and an unwarranted fear by medical professionals themselves regarding the risk of patient tolerance and addiction—continues to hamper adequate treatment of patients with terminal conditions. This has been shown to be particularly true in children and elderly patients with cancer. There is no excuse for inadequate treatment of pain in a terminal patient not only is addiction irrelevant in such a patient, it is actually uncommon in patients who are being treated for pain (see Chapter 31). 

To the amazement of observers, terminal patients given LSD changed in their attitudes from depression, apathy and anguish to sensitivity, poignancy and deep feeling for people. They movingly expressed gratitude for life itself. LSD seemed to enable many to face death with equanimity. 

The project team requires reports to track the progress of the study including patient enrollment data, discrepancy counts, outstanding CRF pages, and terminated patients (including dropouts). If the CRO already has adequate tracking systems, the reports should be evaluated and adapted as needed. 

Richards, W.A. Mystical and Archetypal Experiences of Terminal Patients in DPT Assisted Psychotherapy Journal of Religion and Health (1978) 17(2)117-126... 

A more recent innovation is the addition of local anesthetics to lowered doses of morphine by epidural infusion for intractable cancer pain involving nerve roots and bone. This has been reported to be useful in terminal patients where the tumor already involves the spine, long bones, or is growing into the nerve root. 

N,N-DMT is a naturally occuring alkaloid of many members of the legume family (Fish 1955) (Ghosal 1966) (lacobucci 1964) (Pachter 1959) and also occurs as an endogenous neurochemical in the brain (Christian 1976 1977). N,N-DMT is a hallucinogen. N,N-DPT is non-hallucinogenic, has been used in psychotherapy (Soskin 1973) and in terminal patients (Richards 1978). 

Morphine and oxycodone suppositories might be useful in terminal patients when oral therapy is difficult, but this therapy is often replaced by transdermal fentanyl. 

Arbuckle C. A Caregiver s Journey with a Terminal Patient. Los Angeles Milligan Books, 2004. Caposella C and Wamock S. Share the Cate How to Organize a Group to Care for Someone Who is Seriously HI. New York, NY Simon Schuster, 2006. 

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