CHPN Pharmacology & Medication Management Flashcards

A continuous subcutaneous infusion is prescribed for a hospice patient. Which drug combination is considered compatible in the same syringe driver?

Answer: Morphine and midazolam

Morphine and midazolam are widely documented as compatible in subcutaneous syringe drivers for palliative symptom control.

A patient's family asks about the 'double effect' of increasing opioid doses. How should the hospice nurse respond?

Answer: Explain that appropriately titrated opioids do not hasten death and are intended to relieve suffering

Evidence supports that properly titrated opioids do not hasten death; the nurse should reassure the family that the goal is comfort, not hastening death.

Which route of opioid administration is preferred when a hospice patient can no longer swallow oral medications?

Answer: Subcutaneous

Subcutaneous administration is preferred for continuous opioid delivery in hospice because it is comfortable, effective, and avoids repeated injections.

A hospice patient develops myoclonus after morphine dose escalation. What is the most appropriate intervention?

Answer: Rotate to a different opioid such as hydromorphone or fentanyl

Opioid rotation to an alternative opioid reduces exposure to accumulated neuroexcitatory metabolites that cause myoclonus.

What is the purpose of a bowel protocol in hospice patients receiving opioids?

Answer: To proactively prevent opioid-induced constipation from the start of therapy

Opioids cause constipation in nearly all patients, and a prophylactic bowel regimen (typically a stimulant laxative) should begin with opioid initiation.

Which medication is used to treat opioid-induced pruritus in hospice patients?

Answer: Low-dose naloxone or nalbuphine

Low-dose naloxone or the mixed agonist-antagonist nalbuphine can relieve opioid-induced pruritus without reversing analgesia.