Talking Points on Deprescribing in Hospice Care

Deepak Shrivastava, MD is a board-certified Hospice Medical Director. In addition, he holds board certifications in Internal Medicine, Sleep Medicine, Pulmonary and Critical Care Medicine and Post-Acute and Long-Term Care. He is an academic and clinical faculty at the Sleep, Critical Care and Pulmonary division. He is a Clinical Professor at the University of California. He is an adjunct Professor of Pharmacy at the University of Pacific, School of Pharmacy. He is the recipient of many academic and service awards including the Medical Director of the Year award (2015) at the American Medical Directors Association. Dr. Shrivastava received his training at the State University of New York, University of California, Davis and Stanford. He is an active researcher with a keen interest in medical education. He is directly involved in health care quality and performance improvement. In addition to his active practice of Pulmonary, Critical Care and Sleep Medicine in an ACGME-accredited teaching program, he has been involved in Medicare Hospice Benefit Program since 1989. He is a member of the National Partnership for Healthcare and Hospice Innovation (NPHI). His areas of interest are clinical nursing and hospice physician education, and performance improvement in hospice care.

• IntroductionPhysiologic changes of terminal illnessFundamentals of deprescribingDeprescribing StatinsDeprescribing BenzodiazepinesDeprescribing AntipsychoticsDeprescribing SSRI and SNRIsDeprescribing Tricyclic AntidepressantsDeprescribing Anticholinergic drugs for parkinsonismDeprescribing Anticholinergic drugs for urinary incontinenceDeprescribing muscle relaxantsDeprescribing long-term OpioidsDeprescribing Proton Pump InhibitorsDeprescribing AllopurinolDeprescribing Antihyperglycemics OralDeprescribing Antihyperglycemics InjectableDeprescribing anti-hypertensivesDeprescribing AnticoagulantsDeprescribing Cholinesterase inhibitorsDeprescribing Glaucoma eye dropsDeprescribing Vitamin D and CalciumDeprescribing NSAIDsDeprescribing gabapentin and pregabalinDeprescribing long-acting Beta agonistDeprescribing VitaminsDeprescribing medications in childrenDeprescribing in Transgender and LGBTQCultural competency in deprescribingChaplain and medical social workerWhen to restart discontinued medications.Medicolegal aspects of deprescribing