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WorksheetsOpioids in Cancer Pain Management
Total questions: 10
Worksheet time: 5mins
According to the ASCO guideline, what is the recommended initial approach for starting opioid therapy in adults with moderate-to-severe cancer pain?
Initiate with a high dose of an extended-release opioid to ensure rapid pain control
Begin with transdermal fentanyl for its stable blood levels and convenience
Prescribe methadone as the first-line agent due to its low cost and potency
Start with as-needed (PRN), immediate-release opioids at the lowest effective dose
The guideline states that certain opioids have limitations that may make them less desirable.
Which two opioids are specifically mentioned as being prodrugs with potential limitations?
Morphine and Meperidine
Fentanyl and Methadone
Tramadol and Codeine
Oxycodone and Hydromorphone
For a patient with significant renal impairment, which opioid is specifically recommended as an option because it is primarily excreted fecally?
Oxycodone
Codeine
Morphine
Methadone
What is the recommended dose for an immediate-release opioid prescribed for breakthrough pain in a patient receiving around-the-clock opioids?
5% to 20% of the total daily regular morphine equivalent dose
A fixed dose of 10mg, regardless of the daily opioid total
Exactly 50% of the total daily dose
Less than 2% of the total daily regular dose
Under which circumstances should opioid rotation be offered to a patient with cancer pain?
As a mandatory step every 3 months to prevent tolerance
Exclusively for patients who have developed substance use disorder
When pain is refractory to dose titration or side effects are poorly managed
Only when a patient requests for a different medication due to preference
What is a major barrier cancer patients face when trying to access prescribed opioids?
Misinterpretation of CDC guidelines, leading to limits on doses and dispensing
Patient refusal to take opioids due to complete absence of side effects
Lack of evidence that opioids are effective for cancer pain
Over-prescription of opioids by primary care physicians for cancer patients
What does the ASCO guideline recommend for patients with a known substance use disorder who require opioids for cancer pain?
Allowing the patient to self-titrate their opioid dose without clinical oversight
Treating the pain with non-opioid analgesic only, regardless of pain severity
Withholding all opioids to prevent the risk of misuse
Collaborating with palliative care, pain and/or substance use disorder specialists
What stance does the guideline take on the use of genetic testing (e.g., for CYP2D6 polymorphism) to guide opioid selection and dosing?
It is strongly recommended for all patients before initiating opioid therapy
It is strongly recommended against, as it is proven ineffective
It is recommended for patients only of Asian descent due to higher polymorphism rates
Evidence is insufficient to recommend for or against its use
When managing opioid-induced constipation, what initial prophylactic strategy is suggested?
Advise an increase in dietary fiber and water intake only
Using a mu-opioid antagonist like methylnaltrexone from the start
Waiting for constipation to develop before initiating any treatment
Prescribing stimulant laxatives
The guideline discusses patient concerns and stigma related to opioid use.
What is a described consequence of this stigma?
Patients skipping doses or taking lower doses than prescribed
Patients reporting higher satisfaction with their pain management
Patients request higher doses than prescribed
A decrease in the number of cancer pain-related emergency department visits
