1. As other comments pointed out, since she has metastatic breast cancer she likely has a poor prognosis and pain management becomes the most important aspect of her care.

2. 1mg SubQ morphine q3h is less morphine than she is receiving currently with 5mg morphine q4h PO.

Morphine equivalents for PO:IV morphine is 3:1. Let's assume IV and subQ are equivalent so the ratio remains 3:1. (Idk if they are or not, but IV would definitely be the most potent)

5mg PO morphine q4h = 30mg daily orally. So you would need 10mg daily either IV or subQ to match her current pain regimen.

1mg subQ morphine q3h = 8mg daily via subQ.

Thus, **the only answer choice that increases her morphine dose is increasing the frequency of her PO dosign to q3h.

I assume the sticking a needle into her every three hours is excessive. The syrup might be easier. We don;t care about her liver anymore.

• Key idea: While physicians should be on the look-out for signs of opioid addiction in patients receiving pain medications, in patients with metastatic cancer to bone it is common for them to develop tolerance and for the pain to progress, so their requests for increased pain management are valid and should be managed through a palliative care lens
• Mild cancer pain: Acetaminophen, NSAIDs
• Moderate cancer pain: Weak opioids (codeine, hydrocodone, tramadol)
• Severe cancer pain: Strong short-acting opioids (morphine, hydromorphone) –> Long-acting opioids (fentanyl, oxycodone) and short-acting opioids for breakthrough pain

https://step-prep.org/tutoring/

i dont think it said she was on NSAIDs anywhere in the question stem and i thought that they had a synergistic effect with opioids, thus should be tried prior to changing opioid management.

i dont think it said she was on NSAIDs anywhere in the question stem and i thought that they had a synergistic effect with opioids, thus should be tried prior to changing opioid management.