Q: Out of following which medicine should be avoided at end of life care?

A) Morphine
B) Dexmedetomidine
C) Glycopyrrolate
D) Cisatracurium 
E)  Ondansetron



Answer:  D

Cisatracurium is a neuromuscular blockade and it provides no beneficial effect  at end of life. Rather it can mask patient's symptoms, hasten and make death more painful and may prevent providers from effectively deliver comfort care. 

Another objective of above question is to bring in light the role of sedatives in palliative care (Choice B). More and more literature now favours comforting sedation for patient's at end of life.


Recommended Reading:

Palliative Sedation in End-of-Life Care - Susan D. Bruce, RN, BSN, OCN; and coll. - Journal of Hospice and Palliative Nursing. 2006;8(6):320-327.