A patient with moderate to severe chronic pain has been taking ...

[madam-professor]

A patient with moderate to severe chronic pain has been taking oxycodone (OxyContin) 60 mg every 6 hours PRN for several months and tells the nurse that the medication is not as effective as before.
 
  The patient asks if something stronger can be taken. The nurse will contact the provider to discuss:
  a. administering a combination opioid analgesic/acetaminophen preparation.
  b. changing the medication to a continued-release preparation.
  c. confronting the patient about drug-seeking behaviors.
  d. withdrawing the medication, because physical dependence has occurred.

Question 2

A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient?
 
  a. PRN dosing of the drug may be more effective.
  b. The risk of respiratory depression increases over time.
  c. The patient should discuss increasing the dose with the provider.
  d. The patient should request the addition of a benzodiazepine to augment pain relief.

[trampas]

Answer to Question 1

ANS: B
Oxycodone is useful for moderate to severe pain, and a continued-release preparation may give more continuous relief. Dosing is every 12 hours, not PRN. A combination product is not recommended with increasing pain, because the nonopioid portion of the medication cannot be increased indefinitely. This patient does not demonstrate drug-seeking behaviors. Physical dependence is not an indication for withdrawing an opioid, as long as it is still needed; it indicates a need for withdrawing the drug slowly when the drug is discontinued.

Answer to Question 2

ANS: C
This patient is developing tolerance, which occurs over time and is evidenced by the need for a larger dose to produce the effect formerly produced by a smaller dose. This patient should be encouraged to request an increased dose. PRN dosing is less effective than scheduled, around-the-clock dosing. The risk of respiratory depression decreases over time as patients develop tolerance to this effect. Benzodiazepines are CNS depressants and should not be given with opioids, as they increase the risk of oversedation.

[madam-professor]

Excellent

[mcarey591]

Gracias!