Certified Hospice and Palliative Assistant (CHPNA) Practice Test

Which of the following describes a limitation of opioids?

1. They are safe at any dose

2. Only pure opioids can be used

3. They can have active metabolites requiring careful titration

4. All opioids have the same dosing guidelines

The correct answer is: They can have active metabolites requiring careful titration

Opioids are commonly used in hospice and palliative care for managing pain and discomfort. A significant limitation of these medications is that they can have active metabolites, which necessitates careful titration. Some opioids undergo metabolism in the liver and can produce active metabolites that may accumulate, especially in patients with impaired kidney or liver function. This can lead to increased effects and potential toxicity if not monitored closely. Therefore, healthcare providers must assess each patient's condition, existing organ function, and response to opioids, adjusting dosages accordingly to ensure safety and efficacy. The other options do not accurately reflect the complexities involved with opioid use. The idea that opioids are safe at any dose disregards the risk of overdose and individual variability in drug response. Relying solely on pure opioids ignores the therapeutic options provided by combination therapies and non-opioid analgesics. Additionally, it is not accurate to claim that all opioids share the same dosing guidelines, as individual drugs in this class can have vastly different potencies and appropriate dosing regimens tailored to specific circumstances and patient needs.