Pain & Symptom Management Flashcards

A hospice patient on scheduled morphine reports breakthrough pain occurring 4-5 times daily. What is the most appropriate intervention?

Answer: Increase the scheduled around-the-clock morphine dose

Frequent breakthrough pain (>3-4 episodes/day) indicates the scheduled baseline dose is inadequate and should be titrated upward.

Which adjuvant analgesic is first-line for neuropathic pain in hospice patients who can tolerate oral medications?

Answer: Gabapentin

Gabapentin (and pregabalin) are first-line adjuvants for neuropathic pain due to their efficacy and relative tolerability.

A patient with hepatic metastases has ascites causing severe dyspnea and abdominal discomfort. Which intervention most directly addresses both symptoms?

Answer: Perform therapeutic paracentesis

Therapeutic paracentesis removes ascitic fluid, directly reducing intra-abdominal pressure and relieving both dyspnea and abdominal pain.

When converting a patient from oral morphine 60 mg/day to IV morphine, what is the correct equianalgesic IV daily dose?

Answer: 20 mg IV

The oral-to-IV morphine ratio is approximately 3:1, so 60 mg oral ÷ 3 = 20 mg IV per day.

A hospice patient develops opioid-induced constipation. Which laxative regimen is most appropriate as first-line prophylaxis?

Answer: Stimulant laxative such as senna with or without a softener

Stimulant laxatives (senna) with or without docusate are recommended first-line prophylaxis for opioid-induced constipation in palliative patients.

A patient with end-stage COPD experiences refractory dyspnea despite optimized bronchodilators. Which pharmacologic intervention has the strongest evidence for relieving dyspnea in this setting?

Answer: Systemic opioids

Low-dose systemic opioids have the strongest evidence base for relieving refractory dyspnea in end-stage lung disease.

Which of the following best describes the concept of 'total pain' as introduced by Dame Cicely Saunders?

Answer: The combined physical, psychological, social, and spiritual dimensions of suffering

Dame Cicely Saunders coined 'total pain' to describe suffering as an integration of physical, emotional, social, and spiritual components, foundational to hospice philosophy.