COCN Palliative and End-of-Life Care Flashcards

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

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

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

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

Answer: Stimulant laxatives (senna) with or without stool softeners

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

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

Answer: Methylnaltrexone (Relistor)

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

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

Answer: Low-dose systemic opioids

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

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

Answer: Durable power of attorney for healthcare (DPAHC)

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

Palliative sedation for refractory symptoms at end of life requires that other symptom management options have been:

Answer: Exhausted or deemed inappropriate before sedation is initiated

Palliative sedation is ethically justified only when all other reasonable symptom-relief options have failed or are inappropriate.