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Pharmacologic pain management at the end of life

doi: 10.1097/01.NPR.0000483074.69005.a2
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INSTRUCTIONS Pharmacologic pain management at the end of life

TEST INSTRUCTIONS

  • To take the test online, go to our secure website at www.nursingcenter.com/ce/NP.
  • On the print form, record your answers in the test answer section of the CE enrollment form on page 38. Each question has only one correct answer. You may make copies of these forms.
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  • You will receive your CE certificate of earned contact hours and an answer key to review your results.There is no minimum passing grade.
  • Registration deadline is May 31, 2018
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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 3.0 contact hours for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.5 contact hours. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida CE Broker #50-1223.

Your certificate is valid in all states. This activity has been assigned 2.5 pharmacology credits.

Pharmacologic pain management at the end of life

General Purpose: To provide information about the pharmacologic approaches to treat pain at the EOL. Learning Objectives: After completing this continuing-education activity, you should be able to: 1. Describe the types of pain and their management at the EOL. 2. Analyze how to use opioids for pain management at the EOL. 3. Identify adverse reactions to opioids and potential interactions with other drugs.

  1. Which statement about the EOL is accurate?
    1. EOL is limited to the last few days of a terminal illness.
    2. It is linked to worsening pain in both cancer and noncancer diagnoses.
    3. A study of opioid prescriptions in patients with cancer found that pain was only a prominent symptom in the last few days of life.
  2. Pain involving which tissue is nociceptive/somatic pain?
    1. liver
    2. colon
    3. muscle
  3. Why should pain assessments include myofascial pain and trigger points?
    1. They may call for higher opioid doses.
    2. They may reflect pain sources that do not respond to opioids.
    3. These areas do not cause significant pain.
  4. Which of the following is not correct about morphine?
    1. It is the gold standard for treating cancer pain.
    2. It has no maximum dose or ceiling effect.
    3. It can be safely prescribed for patients with kidney and hepatic impairment at the EOL.
  5. Which medication has limited use in severely cachectic patients?
    1. TD fentanyl
    2. SL oxycodone
    3. methadone
  6. Oxycodone
    1. causes hyperalgesia more often than other opioids.
    2. should not be administered with acetaminophen.
    3. should be used with caution in kidney impairment.
  7. Which statement about opioid therapy is correct?
    1. Hydromorphone can be administered rectally.
    2. Methadone has a short half-life.
    3. Oxymorphone is inexpensive and regularly used in hospice.
  8. Which statement about methadone is correct?
    1. It carries a low risk of accidental overdosing.
    2. It has few drug interactions.
    3. It has a long and variable half-life.
  9. The fentanyl TD patch
    1. should be reapplied every 24 hours.
    2. should not be exposed to heat sources.
    3. requires 4-6 hours to take effect at first application.
  10. Which statement is not correct regarding TIRF?
    1. It is approved for breakthrough cancer pain in opioid-tolerant patients.
    2. Prescribers and patients must be enrolled in a REMS program.
    3. Its various formulations are equianalgesic and interchangeable.
  11. Tramadol is a dual-action drug that
    1. is typically used for advanced pain in hospice.
    2. has a maximum dose ceiling.
    3. needs higher doses in the older patient.
  12. Which drug would be a best first-choice opioid for cancer pain?
    1. codeine
    2. morphine
    3. meperidine
  13. Which statement is correct regarding subQ opioid administration?
    1. SubQ administration is recommended for immunocompromised patients.
    2. The subQ route is not an effective route for opioid administration.
    3. SubQ infusions or intermittent injections are a good option for opioid administration in patients who can no longer swallow oral medication.
  14. Which statement concerning the use of opioids is correct?
    1. Hydrocodone is poorly absorbed by the SL route.
    2. ER formulations should be initiated in opioid-naive patients.
    3. The rectal route is not used for opioid administration.
  15. When rotating an opioid for uncontrolled pain, keep in mind that
    1. there is complete cross-tolerance of opioids.
    2. there is minimal genetic variability from opioid polymorphisms.
    3. providing the equianalgesic dose of the new drug is needed.
  16. For patients who are opioid tolerant, which adverse reaction is most likely to be a problem?
    1. respiratory depression
    2. constipation
    3. fatigue and drowsiness
  17. Which medication is most likely to help alleviate pruritus?
    1. diphenhydramine
    2. hydroxyzine
    3. gabapentin
  18. Which medication is commonly used in palliative care to improve appetite, mood, and feelings of well-being?
    1. dexamethasone
    2. lorazepam
    3. pamidronate
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