COCN COCN Palliative and End-of-Life Care 2

Question 1

Which opioid rotation (equianalgesic conversion) consideration is most important when switching a cancer patient from morphine to hydromorphone?

Accepted Answer

A 25–50% dose reduction from the calculated equianalgesic dose is recommended to account for incomplete cross-tolerance

Answer

Incomplete cross-tolerance between opioids means the calculated equianalgesic dose should be reduced by 25–50% to prevent overdose.

Question 2

A cancer patient on chronic opioids develops constipation. The first-line treatment is:

Accepted Answer

Stimulant laxatives (senna) with or without stool softeners

Answer

Stimulant laxatives are the recommended first-line treatment for opioid-induced constipation (OIC), as bulk agents may worsen the condition.

Question 3

Which medication is specifically FDA-approved for opioid-induced constipation in cancer patients who have not responded to standard laxatives?

Accepted Answer

Methylnaltrexone (Relistor)

Answer

Methylnaltrexone is a peripherally-acting mu-opioid receptor antagonist that relieves OIC without reversing central analgesia.

Question 4

A patient with advanced cancer is experiencing refractory dyspnea. The evidence-based pharmacologic treatment is:

Accepted Answer

Low-dose systemic opioids

Answer

Low-dose systemic opioids have the strongest evidence for reducing the sensation of dyspnea in advanced cancer.

Question 5

Which advance directive specifically designates a person to make healthcare decisions if the patient becomes incapacitated?

Accepted Answer

Durable power of attorney for healthcare (DPAHC)

Answer

A DPAHC appoints a healthcare proxy (surrogate decision-maker) to act on the patient's behalf when they cannot make decisions.

COCN Test Practice Test