Pain Management and Regulatory

1. 57-year-old female with widely metastatic breast cancer and intractable pain on Oxycodone Extended Release 80 mg P.O. Q6H ATC with Oxy-IR 30 mg P.O. Q3H PRN (taking ATC). You determine the patient could benefit from rotation to methadone. Which is the most appropriate new regimen? (Hint: do not calculate for cross-sensitivity, as worsening pain accounts for this; use 10:1 morphine-to-methadone conversion.)
2. 38-year-old female with cervical CA has prior history of substance abuse on Hydromorphone PCA with basal 18 mg/hr with Gabapentin as adjuvant, pain poorly controlled, primarily neuropathic. You determine patient could benefit from methadone PCA. Which of the following would be the most appropriate basal rate for methadone PCA? (Hint: do not account for cross-sensitivity given severity of pain, use 20:1 morphine-to-methadone ratio. Additional hint: IV methadone is twice as strong as oral.)
3. Palliative care is the same as hospice care.
4. Morphine is the strongest opiate.
5. Hydromorphone, methadone, and buprenorphine are strong opiates. True or false?
6. Dyspnea is defined by pulse ox.
7. Agitation in dementia is best treated with non-pharmacologic interventions.
8. In order to be eligible to elect hospice care, an individual must:
9. Hospice currently underserves which of the following populations in the U.S.?
10. Hospice regulatory areas facing increased scrutiny do not include which of the following?
11. When is the best time to document hospice eligibility?
12. Which of the following is correct regarding the initial 6-month hospice certification?
13. Which of the following is not a required member of the interdisciplinary group or interdisciplinary team?
14. Which of the following anti-depressants is not effective in treating neuropathic pain?
15. How often must a patient be seen by an RN to maintain hospice eligibility?
16. Which of the following is not part of the hospice item set?
17. Hospice should cover medications utilized for symptom management.
18. The PEPPER Report is public information.
19. The PEPPER Report includes areas of hospice scrutiny.
20. Business associates and business associate subcontractors are directly subject to applicable HIPAA rules including the HIPAA Security Rule and certain provisions of the Privacy Rule.