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WorksheetsCase Study & Conversion examples for Integration of Pharm
Total questions: 16
Worksheet time: 16mins
1) Pt has been prescribed Hydromorphone 2 mg PO Q1h PRN.
Is this appropriate on top of his scheduled (around the clock) 2mg PO Q4h (Explain)
a) Yes.
Rationale: Breakthrough doses can be 50–100% of the scheduled Q4h dose.
b) No.
The PRN dose should not exceed 25–50% of the scheduled dose.
c) No.
Administering the same dose hourly will cause dose stacking and toxicity.
d) No. PRN breakthrough dosing must match the scheduled interval (Q4h)
2 A) List the 3 medications that are considered first line therapy for management of constipation according to the WRHA constipation algorithm? (Select all that apply).
a) Polyethylene Glycol (PEG) 3350
b) Psyllium Fibre
c) Bisacodyl
d) Sennosides (Senna glycosides)
2 B) Which classes do those 3 laxatives (Polyethylene Glycol 3350, Sennosides and Bisacodyl) belong to? (Select all that apply).
a) Osmotic Laxative
b) Stool Softeners
c) Stimulant Laxative
d) Enemas
3 A) List the 2 medications that Mr. G is on that belong to the class of medications indicated as first line therapy to treat delirium in Palliative care? (Select all that apply).
a) Haloperidol
b) Metoclopramide
c) Methotrimeprazine
d) Hydromorphone
3 B) These 2 medications from the aforementioned question have an indication to manage another common symptom in palliative care patients. What other symptom can be treated by these 2 medications? (Select the Correct response).
a) Constipation
b) Nausea and Vomiting
c) Pain
d) Dyspnea
4 A) Metoclopramide 10 mg is administered ac (before meals) and at hs (bedtime). What common palliative symptom is being managed by this drug? (Select the Correct response).
a) Pain
b) Nausea & Vomiting
c) Constipation
d) Delirium
4 B) Why do you think metoclopramide is so commonly used in palliative care?
(Hint: Explanation should refer specifically Mr. G’s case study)
a) It is preferred because it provides deep sedation, which is often required in end-stage palliative patients.
b) It is commonly used because it reduces gastric acid secretion, preventing opioid-induced gastritis.
c) Opioids can cause nausea; constipation can cause nausea; this drug works on the CTZ which is the common trigger area.
d) It is favored because it directly counteracts opioid receptors, reversing opioid-induced side effects without affecting analgesia.
Conversion Example Questions:
Do not consider incomplete cross tolerance. Please use the equivalency table for opioids provided in the class notes, and use the Equianalgesic Guide Morphine → Fentanyl Patch also provided in the class notes.
1) Morphine 20mg IV: mg Morphine PO?
(a)
2) Oxycodone 60mg PO: mg Morphine PO?
(a)
3) Hydromorphone 2.25mg IV: mg Morphine PO?
(a)
4) J.S. is a terminally ill lung cancer patient. J.S.’s current pain medication is oxycodone 40mg q 8 hours. Please convert it into an equianalgesic dose of hydromorphone subcut mg.
(a)
5) A client receives 50 mg po of Morphine q4h. What is an appropriate breakthrough dose?
a. Morphine 5 mg po q1h prn
b. Morphine 10 mg po q1h prn
c. Morphine 50 mg po q3h prn
d. Morphine 30 mg po q1h prn
6). Mrs. B is a 50 yo woman with metastatic breast cancer. She receives Hydromorphone 15 mg subcut q4h. What is an appropriate dose of Hydromorphone to give for breakthrough pain?
a. Hydromorphone 5 mg subcut q2h prn
b. Hydromorphone 9 mg subcut q1h prn
c. Hydromorphone 10 mg po q1h prn
d. Hydromorphone 15 mg po q1h prn
7 A) Your client has Stage IV Pancreatic cancer, and his pain has been now stabilized and controlled for the past week on Hydromorphone CR 36mg PO Q12H. The doctor has decided to start the pt. on a Fentanyl Patch.
Using the Equianalgesic guide for Morphine to Fentanyl patch how many Mcg/hr patch would you expect to be ordered for this patient mcg/hr?
(Hint: Follow the rules in your class handouts for opioid conversions and check the equivalency tables provided in class notes).
(a)
7 B) How many mg of Hydromorphone po Q1h would be expected for the doctor to order as breakthrough pain medication for the above Fentanyl mcg/hr patch? (Hint: Follow the rules for breakthrough pain medication orders)
(a)
