CHPN CHPN Pharmacology & Medication Management 1 — Questions and Answers
Question 1: Which opioid is considered first-line for moderate-to-severe pain in hospice patients with normal renal function?
- Morphine (Correct answer)
- Meperidine
- Codeine
- Tramadol
Correct answer: Morphine
Morphine is the gold-standard first-line opioid for moderate-to-severe pain in hospice patients with intact renal function.
Question 2: A hospice patient is experiencing opioid-induced constipation. Which medication is specifically FDA-approved for this indication?
- Methylnaltrexone (Correct answer)
- Bisacodyl
- Docusate sodium
- Lactulose
Correct answer: Methylnaltrexone
Methylnaltrexone (Relistor) is a peripherally acting mu-opioid receptor antagonist FDA-approved specifically for opioid-induced constipation.
Question 3: When converting from oral morphine to subcutaneous morphine, what is the standard conversion ratio?
- 3:1 (oral to subcutaneous) (Correct answer)
- 1:1
- 2:1 (oral to subcutaneous)
- 4:1 (oral to subcutaneous)
Correct answer: 3:1 (oral to subcutaneous)
The standard oral to subcutaneous morphine conversion is 3:1, meaning 30 mg oral morphine equals 10 mg subcutaneous morphine.
Question 4: Which benzodiazepine is most commonly used in hospice care to manage refractory dyspnea and anxiety at end of life?
- Lorazepam (Correct answer)
- Diazepam
- Alprazolam
- Clonazepam
Correct answer: Lorazepam
Lorazepam is preferred in hospice for its short-to-intermediate half-life, multiple routes of administration, and efficacy for dyspnea and anxiety.
Question 5: A hospice nurse notes a patient on fentanyl patches is febrile. What is the most important medication concern?
- Fever increases fentanyl absorption through the patch, risking overdose (Correct answer)
- Fever decreases fentanyl effectiveness
- The patch should be removed immediately and oral opioids started
- No medication adjustment is needed
Correct answer: Fever increases fentanyl absorption through the patch, risking overdose
Elevated body temperature increases transdermal fentanyl absorption significantly, which can lead to opioid toxicity.
Question 6: Which medication is used to reduce respiratory secretions ('death rattle') in a dying patient?
- Glycopyrrolate (Correct answer)
- Furosemide
- Dexamethasone
- Haloperidol
Correct answer: Glycopyrrolate
Glycopyrrolate is an anticholinergic agent that reduces salivary and bronchial secretions without crossing the blood-brain barrier.
CHPN CHPN Pharmacology & Medication Management 1
Which opioid is considered first-line for moderate-to-severe pain in hospice patients with normal renal function?