[henrysmom]

I am actually posting this for a friend, a hospice nurse who sadly has to work with a doctor who is not real knowledgable or savvy about hospice. She has heard that some docs prescribe Decadron for it's euphoria and appetite stimulating effects, even if the patient doesn't have bone pain, brain mets, etc. Anyone know about this? Doses? Typical patient responses? Thanks for any help, and I will forward this on to her (and encourage her to join!). Kim

[traumaRUs]

I thought decadron helped to dry up secretions so that as people progress through the stages of death - they wouldn't sound so rattly? Anyone else?

[henrysmom]

Originally Posted by traumaRUs

I thought decadron helped to dry up secretions so that as people progress through the stages of death - they wouldn't sound so rattly? Anyone else?

No you are thinking of atropine drops or scopalomine patches. Decadron is a steroid often used for people with brain tumors, etc..Kim

[earle58]

decadron's main uses are to suppress inflammatory responses which includes swelling.

it is a drug not to be casually used.

[hospicenurse]

I occasionally see Decadron or Prednisone used as an appetite stimulant in terminally ill patients. It can improve appetite, but usually the effect does not last long. Some patients and families are so upset about anorexia that it is worth a try, even with the side effects. Megace is also used sometimes, but is much more expensive. These are often meds that have come along for the ride from chemo or radiation and nobody has stopped them even though they probably aren't doing much good by the time hospice steps in. I personally feel that emotional support and instructing to accept the changes brought about by the disease process is a more appropriate hospice type treatment. However, many physicians continue to offer drug panaceas rather than have those uncomfortable conversations. Leaving the mess, of course, to be sorted out at the end by the hospice nurse.

BTW, before ordering steroids, you should look causes of anorexia that can be fixed, like oral thrush, nausea, constipation, hypercalcemia, or psychological issues.

Gail

[earle58]

decadron or other forms of steroid could cause euphoria BUT can also cause psychosis, confusion, paranoia, agitation.

i very much agree with hospicenurse in that if this patient is in hospice, it's time to start having some realistic discussions and making decisions accordingly.

decadron would not be a first line drug unless it was used to decrease any swelling, inflammation or sensitivity/allergic responses.

is this doctor the medical director of the hospice????

leslie

[Franemtnurse]

Originally Posted by earle58

decadron or other forms of steroid could cause euphoria BUT can also cause psychosis, confusion, paranoia, agitation.

i very much agree with hospicenurse in that if this patient is in hospice, it's time to start having some realistic discussions and making decisions accordingly.

decadron would not be a first line drug unless it was used to decrease any swelling, inflammation or sensitivity/allergic responses.

is this doctor the medical director of the hospice????

leslie

Aaaaaah the memories of what decadron did for me one time. Changed my personality completely. Made me as agressive as all get out. I even told my doctor Almighty off. Heh heh. He calmed right down like a whimpering puppy, he did, and he asked me, "What type of steroid would you like to be sent home on Mrs LeMay?" What a change in the boy. Precious memories, how they linger.:hatparty:

[earle58]

Originally Posted by Franemtnurse

Aaaaaah the memories of what decadron did for me one time. Changed my personality completely. Made me as agressive as all get out. I even told my doctor Almighty off. Heh heh. He calmed right down like a whimpering puppy, he did, and he asked me, "What type of steroid would you like to be sent home on Mrs LeMay?" What a change in the boy. Precious memories, how they linger.:hatparty:

thank you for sharing your personal experience, franemtnursegoddessguardianangelpreacherohstubborn one.

henrysmom, this is a valuable piece of information here and would strongly discourage the use of the decadron if it's only being used for mood and appetite.

[aimeee]

From the HPNA website:

"A group of drugs that are important are the glucocorticoids and I think they are widely used. One study has shown limited effect of up to four weeks on symptoms such as appetite. They also give a sensation of well being and performance status and I think that they have a significant antinausea effect and they improve pain control. The studies really failed to show a beneficial effect though on body weight and certainly those of us who have been around recognize that prolonged treatment with steroids leads to weakness and delirium, osteoporosis and depression all of which are commonly present in cancer patients so we use the glucocorticoid with caution. Prednisone as a dose with maybe 5mg three times a day or maybe Decadron 3-6mg every day have improved appetite to a greater extent than a placebo has. So again, not so great but it is kind of an option we have. There is really no indication that only one glucocorticoid is superior in it’s ability to stimulate appetite. So I think we look at group of drugs certain not as a benign group of drugs and use them with caution because there are some side effects that are significant to us."

http://www.hpna.org/webconf_June02.asp

[Gompers]

Originally Posted by Franemtnurse

Aaaaaah the memories of what decadron did for me one time. Changed my personality completely. Made me as agressive as all get out. I even told my doctor Almighty off. Heh heh.

I believe you! When we put our babies on Decadron to heal their lungs, they get "roid rage" really badly! BP's go through the roof, the kids are absolutely NUTTY. The ones that are extubated scream their lungs out, and the intubated ones usually self-extubate because they're flipping around their beds, turning their heads, pulling their own tubes, etc. NEVER see a kid in a good mood while on Decadron.