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1. If a decision is made to initiate LOT:
A. A careful assessment of benefits and risks should be made to ensure that the benefits are expected to outweigh the well-documented risks.
B. A multimodal treatment plan should be integrated into the patient’s care prior to LOT consideration.
C. Both (A) and (B).
D. None of the above.
2. The underlying concepts of the biopsychosocial model of pain includes the idea that pain perception and its effects on the patient’s function is mediated by biology alone.
A. True
B. False
3. In light of the low harms associated with exercise and psychological therapies when compared with LOT these treatments are preferred over LOT, and should be offered to all patients with chronic pain including those currently receiving LOT.
A. True
B. False
4. A retrospective cohort study found that even greater than opioid dose, _____ was the strongest predictor of developing OUD.
A. Co-occurring depression
B. Duration of OT
C. Having an acute psychiatric instability
D. Having a history of overdose
5. Long-term opioid therapy for pain is recommended against in patients with all of the following untreated substance use disorders, except for:
A. Alcohol
B. Tobacco
C. Both (A) and (B)
D. None of the above
6. Concurrent benzodiazepine and LOT use is a serious risk factor for unintentional overdose death, however, abrupt discontinuation of benzodiazepines should be avoided as it can lead to serious adverse effects including seizures and death.
A. True
B. False
7. Concomitant use of benzodiazepines is considered a contraindication to initiation of OT.
A. True
B. False
8. All patients who take opioids chronically are at risk for OUD and overdose, but especially those who are younger than _____ years of age.
A. 18
B. 26
C. 30
D. 65
9. When their pain is aggressively managed starting soon after injury, hospitalized patients recovering from battlefield injuries are known to have less of all of the following, except for:
A. Anxiety
B. Chronic pain
C. Depression
D. PTSD
10. Studies indicate that developing brains are at increased risk of abnormalities and addiction when exposed to substance use early in life.
A. True
B. False
11. Patients may decline which of the following?
A. Offered treatment such as OT.
B. Risk mitigation strategies such as urine drug testing and pill counts.
C. Both (A) and (B).
D. None of the above.
12. Studies have shown that naloxone administration has been efficacious if given by:
A. Medical personnel
B. Lay people
C. Either (A) or (B)
D. None of the above
13. Fentanyl analogs that may be used to create counterfeit opioid analgesic pills can cause a toxidrome characterized by significant CNS and profound respiratory depression requiring multiple naloxone doses for reversal.
A. True
B. False
14. Returning unused opioid medications has been explored as a strategy to reduce the amount of opioids in the community, as it has been estimated that _____% of opioid prescriptions are left unused.
A. 90
B. 70
C. 50
D. 30
15. For those patients who develop OUD and progress to intravenous drug use, the first recommendation is:
A. Medication-assisted treatment.
B. Educating the patient regarding sterile injection techniques and community-based needle exchange programs.
C. Both (A) and (B).
D. None of the above.
16. Continuing LOT to “prevent suicide” in someone with chronic pain is recommended as an appropriate response only if suicide risk is high or increases.
A. True
B. False
17. Which of the following may change the risk/benefit calculus for LOT?
A. Lab abnormalities
B. Alcohol use
C. Nursing of infants
D. All of the above
18. What is considered to be a safe dose of opioids?
A. Below 20 mg morphine equivalent daily dose
B. Below 50 mg morphine equivalent daily dose
C. Below 100 mg morphine equivalent daily dose
D. None of the above
19. Although it is widely accepted that progressively higher doses of prescribed opioids result in correspondingly higher risks of opioid overdose, patients using any dose of opioids can still experience life-threatening respiratory or CNS depression, especially when opioid-naive. This risk begins to increase with MEDD as low as:
A. 20 - 50 mg
B. 40 - 50 mg
C. 60 - 80 mg
D. 80 - 100 mg
20. In patients receiving LOT, evidence indicates that women are 50% more likely to escalate to high-dose opioids and twice as likely to experience an opioid-related death compared to men.
A. True
B. False
21. Healthcare workers need to be especially aware of the risk associated with a fentanyl transdermal delivery system, including its:
A. Continuous delivery, even after the patch is removed
B. Increased rate of delivery
C. Unpredictable variation in rate of delivery
D. All of the above
22. Transdermal fentanyl should not be used in opioid-naive patients.
A. True
B. False
23. Which method continues to be the most common method of abuse?
A. Chewing, crushing, cutting, grating, and/or grinding.
B. Consumption of a large number of intact capsules or tablets.
C. Extraction of the opioid with use of a common solvent.
D. Taking an agent intended for oral use nasally or parenterally.
24. Due to the partial mu agonist activity of _____ and its demonstrated safety profile when used in connection with acetaminophen in elderly patients, it may be a preferred agent in that patient group.
A. Tramadol
B. Tapentadol
C. Both (A) and (B)
D. None of the above
25. All of the following are properties that make buprenorphine potentially desirable as an analgesic, except for:
A. It is a synthetic opioid analgesic with partial mu opioid agonist and kappa opioid antagonist properties.
B. It can be added to patients that are on a full mu agonist without precipitating withdrawal.
C. It has high affinity to the opiate receptor and a long duration of action.
D. It is a partial agonist agent and as such may be associated with less euphoria and easier withdrawal.
26. All of the following require consideration of monotherapy (buprenorphine without naloxone), except for:
A. Pregnancy
B. Liver disease
C. Kidney disease
D. All of the above require monotherapy
27. All of the following are unique pharmacologic properties of methadone that make it particularly risky to prescribe, except for:
A. Methadone caries a risk of cardiac arrhythmia, and risk assessment for QT prolongation and electrocardiographic monitoring is essential.
B. Methadone has a variable half-life with peak respiratory depressant effect occurring sooner and lasting a shorter time that peak analgesic effect.
C. The metabolism of methadone varies by dose and individual, making dosing unpredictable.
D. There are medications that interact with methadone and should not be prescribed concurrently.
28. At least _____ should pass on a particular dose of methadone before increasing dosage of methadone to make sure that the full effects of the previous dosage are evident.
A. 1 month
B. 14 days
C. 1 week
D. 3 days
29. OT should be tapered when patients voice their preference to reduce dosage and/or discontinue LOT.
A. True
B. False
30. Patients on LOT with OUD are at increased risk of overdose when opioids are _____ without appropriate treatment for OUD.
A. Continued
B. Discontinued
C. Either (A) or (B)
D. None of the above
31. Patients should be strongly cautioned that it takes as little as _____ to lose tolerance to their prior opioid dose and that they are at risk of an overdose if they resume their prior dose.
A. 1 month
B. 1 week
C. 3 days
D. 1 day
32. Long-acting opioids may be associated with higher overdose, overdose death, and all-cause mortality rates when compared to short-acting opioids, therefore, long-acting opioids should always be tapered first and never simultaneously with short-acting opioids.
A. True
B. False
33. When determining the pace of opioid tapering, which factors would suggest the need for a more gradual taper?
A. Higher opioid dose and longer duration of OT.
B. Non-adherence to the treatment plan.
C. Escalating high-risk medication-related behaviors.
D. All of the above.
34. Which high-risk medication-related behavior suggests the presence of an SUD?
A. Early refills
B. Lost or stolen medications
C. Problematic findings on urine tests
D. Any of the above
35. By far, the most powerful risk factor for developing OUD is:
A. Long-term opioid analgesics use
B. Other substance use
C. Co-occurring mental illness
D. Age
36. Which factor increases overdose risk when opioids are used for acute pain?
A. High prescribed dose
B. History of SUD
C. History of mental health concerns
D. All of the above
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