Test User got 22 of 22 possible points on the Risk Reduction Strategies for ER/LA Opioids Post-Test. Total score: 100 %

Transcription

1 Published on OpioidRisk ( Home > Results Test User got 22 of 22 possible points on the Risk Reduction Strategies for ER/LA Opioids Post-Test. Total score: 100 % Question Results Question #1 of 22: Add new comment 21 reads Scott is a 49 year old new patient who has tried first line treatment for his back pain and, after a complete evaluation, you decide he needs chronic opioid therapy. He has mild hypertension, elevated triglycerides and LDL/low HDL, occasional constipation, and occasional insomnia. He takes no medications for these conditions. Question: Which pre-existing medical condition is likely to result in the most side effects from chronic opioid therapy? Mild hypertension Poor serum lipid profile Constipation Insomnia Mild hypertension Poor serum lipid profile Constipation

2 Correct. Constipation is a very common side effect of chronic opioid therapy and to have pre-existing constipation makes it even more likely that this will be a problem. He should receive medication to prevent this side effect. Insomnia Question #2 of 22: 22 reads Darius was prescribed an immediate release opioid while you titrated the dose to get adequate pain control. But while attempting to achieve a stable dose, he ran out of his medication early. Question: Which of the following is the most common reason for aberrant drug-related behavior like this (most frequently occurring reason)? Diversion of the drug by a relative Inadequate pain relief or misunderstood directions Chemical coping Recreational use by the patient Diversion of the drug by a relative. Inadequate pain relief or misunderstood directions Correct. Combined, these are the most common reasons for running out of pain medication early. Chemical coping Recreational use by the patient

3 Question #3 of 22: 27 reads After achieving a stable dose of his new extended release opioid for several months, and complying with all office policies, Mr. Alfred informs you at his monthly visit that he will be unable to return to pick up his prescription next month. So he requests that you write him two prescriptions and give them both to him today. Question: Which of the following responses meet Federal Regulations? Refuse to do this because it is not permitted by the Drug Enforcement Administration (DEA). Tell him you will phone in the second prescription at the appropriate time. Write two prescriptions today and date the second one for one month from now. Write "Do not fill until (specific date)" for the second prescription in the body of the prescription. Refuse to do this as it is not permitted by the DEA Federal regulations allow for up to a 90 day supply as described below. Tell him you will phone in the second prescription at the appropriate time Incorrect. Prescriptions for controlled substances may not be phoned in unless it is a true emergency, in which case the written prescription must be issued to the pharmacist within seven days. Write two prescriptions today and date the second one for one month from now.

4 Incorrect. If you choose two write two prescriptions at once, the second one should be dated with the current date. Write "Do not fill until (specific date)" for the second prescription in the body of the prescription. Correct. This is allowed for up to a 90 day supply. Question #4 of 22: 21 reads Mrs. Winters seems discouraged during her interview and expresses frustration at how her activities are now limited due to her knee pain. Her affect does seem low. Question: Which of the following is a good approach in primary care to screen her for depression? MMPI CAGE Over the past 2 weeks, have you felt little interest or pleasure in doing things? Over the past 2 weeks, have you felt down, depressed, or hopeless? Ask, "Have you been feeling depressed lately?" MMPI CAGE Over the past 2 weeks, have you felt little interest or pleasure in doing things? Over the past 2 weeks, have you felt down, depressed, or hopeless?

5 Correct. These two questions together are the PHQ-2 (Patient Health Questionnaire- 2), which is a quick test with some evidence supporting its use as a screening tool for depression in primary care. Ask, "Have you been feeling depressed lately?" Question #5 of 22: 7 reads Question: Which of these phrases is recommended for use during a patient interview in order to detect substance use disorders? You haven't ever abused an illegal substance, have you? How many times a week do you use drugs? Why did you start abusing drugs? All of the above You haven't ever abused an illegal substance, have you? How many times a week do you use drugs? Correct. During a patient interview, use quantifiable questions which focus on the who, what, where, and how rather than why the individual is using drugs. Why did you start abusing drugs? All of the above Question #6 of 22:

6 11 reads Question: Assessment of any patient whom you suspect may have a substance use disorder includes which of the following components? Laboratory testing Medical history assessment Physical exam Mental status check All of the above A, B and C only Laboratory testing Medical history assessment Physical exam Mental status check All of the above Correct. All of these components are part of a full assessment of any patient that may have a substance use disorder. A, B and C only

7 Question #7 of 22: 18 reads Question: A substance use history should be obtained from the following patients: Patients who you suspect may have a substance use problem Patients who have aberrant behavior All patients Patients who you suspect may have a substance use issue Patients who have aberrant behavior All patients Correct. There is no typical individual suffering from substance use disorder, so it is recommended that clinicians gather a substance use history from all patients. Question #8 of 22: 16 reads True or False: Patients who use opioids to treat pain over an extended period of time can become physically dependent without developing opioid use disorder. True False

8 True Correct. It may be difficult to distinguish physical dependence from opioid use disorder in patients with pain. Physicians should screen all patients for substance use disorder and risk before beginning opioid treatment for pain. False Question #9 of 22: 12 reads Question: The CAGE assessment is a 4 item instrument used to detect substance abuse problems. The acronym CAGE represents which of the following keywords in the assessment instrument? Cut down, annoyed, guilty, eye-opener Caring, annoyed, guilty, eye-opener Caring, amount, guilty, eye-opener Cut down, amount, guilty, every day Cut down, annoyed, guilty, eye-opener Correct. C- cut down (Have you ever felt you ought to cut down on your drinking or drug use?), A- annoyed (Have people annoyed you by criticizing your drinking or drug use?), G- guilty (Have you ever felt bad or guilty about your drinking or drug use?), E- eye-opener (Have you ever had a drink or used drugs first thing on the morning to steady your nerves or get rid of a hangover?). Caring, annoyed, guilty, eye-opener

9 Caring, amount, guilty, eye-opener Cut down, amount, guilty, every day Question #10 of 22: 21 reads Question: Once a referral of a patient being treated for chronic pain is made to a mental health professional, which of these services is included in the primary care provider's role: Regular follow-up appointments Treatment adherence promotion Coordination with other treating clinicians All of the above Regular follow-up appointments Treatment adherence promotion Coordination with other treating clinicians All of the above Correct. All of these are recommended after primary care physicians have made a patient referral. Question #11 of 22: Add new comment 65 reads

10 Patient: Vishnu Singh, age 32 Presentation/Chief Complaint: Mr. Singh is seen in your family medicine practice complaining of severe pain in his foot which he broke in several places 3 months ago in a motorcycle accident. He specifically requests a prescription for oxycodone. Relevant Case Details: He has been on immediate-release oxycodone since the accident. After further evaluation, you determine Mr. Singh meets indications for chronic opioid therapy. However, his risk for opioid abuse using a standard screening tool, is evaluated as being high. Question: Which of the following is an ideal treatment? Prescribe extended-release opioids and manage in the primary care setting with additional treatment structure. Provide a prescription for two weeks of extended-release oxycontin and refer him to another family medicine provider. Tell him his pain cannot be fully evaluated and treated safely in this practice, refer him to an orthopedist and pain/addiction specialist, prescribing medication only until that appointment. Refuse treatment because of his high risk, with or without referral. Prescribe extended release opioids and manage in the primary care setting with additional treatment structure Provide a prescription for two weeks of immediate release oxycontin and refer him to another family physician. Tell him his pain cannot be fully evaluated and treated safely in this practice and refer him to an orthopedist and a specialist in pain and addiction for the treatment of his pain, prescribing just enough medication to cover the interval until that appointment.

11 Patients who are at high risk for opioid addiction or abuse are best treated by someone specializing in pain and addiction. Also, the underlying pain condition is not one that is best evaluated in Family Medicine alone, so specialty referrals are indicated. Refuse treatment because of his high risk, with or without referral. Question #12 of 22: Add new comment 28 reads Question: Regarding the use of written agreements between providers and patients about opioid therapy, which of the following is correct? It is best to avoid requesting signatures on these agreements. It is best to avoid calling these agreements "contracts." Use these agreements only in high risk patients so as to not risk losing rapport with other patients. These agreements are basically the same thing as "informed consent." It is best to avoid requesting signatures on these agreements It is best to avoid calling these agreements "contracts" Patient-provider agreements are signed but they are not contracts. Use these agreements only in high risk patients so as to not risk losing rapport with other patients These agreements are basically the same thing as "informed consent"

12 Question #13 of 22: Add new comment 14 reads Estelle Adams is a 47 year old patient who requires chronic opioid therapy for severe shoulder pain that has not responded to other treatments. Question: In considering whether or not to use urine drug testing with Ms. Adams, which of the following is true? Urine drug testing should be used only if there is a history of substance abuse Urine drug testing should be used only if she starts to show signs of drug addiction Urine drug testing should be used at baseline prior to treatment and periodically throughout treatment Urine drug testing should be offered only if the patient wants this additional support Urine drug testing should be used only if there is a history of substance abuse Urine drug testing should be used only if she starts to show signs of drug addiction Urine drug testing should be used at baseline prior to treatment and periodically throughout treatment Correct. Universal precautions are recommended for all patients on chronic opioid therapy, which include baseline and periodic, random urine drug testing, regardless of apparent risk. Urine drug testing should be offered only if the patient wants this additional support Question #14 of 22: Add new comment 31 reads

13 Question: Which treatment should be tried first for most common pain conditions? Different first line therapies for each pain condition Weak opioids if the pain is mild to moderate; stronger opioids if the pain is moderate to severe Non-steroidal anti-inflammatory drugs if the pain is mild to moderate; opioids if the pain is moderate to severe Non-steroidal anti-inflammatory drugs if the pain is due to an acute condition; opioids if the pain is due to a chronic condition Different first line therapies for each pain condition Correct. First line therapies should be tried first. Weak opioids if the pain is mild to moderate; stronger opioids if the pain is moderate to severe Non-steroidal anti-inflammatory drugs if the pain is mild to moderate; opioids if the pain is moderate to severe Non-steroidal anti-inflammatory drugs if the pain is due to an acute condition; opioids if the pain is due to a chronic condition Question #15 of 22: Add new comment 20 reads Lee Ann is being seen by a primary care provider, a psychologist, and a pain specialist for her chronic pain condition. Question: Which of the following is true regarding the role of her "medical home?"

14 The pain specialist should always be the medical home because he or she will likely be the one to prescribe pain medication. The pain specialist should always be the medical home since he or she needs to be the one most on top of things. The primary care provider could serve as the medical home. A medical home is not really needed in this case because they are only needed when five or more providers are involved. The pain specialist should always be the medical home since he or she will likely be the one to prescribe pain medication. The pain specialist should always be the medical home since he or she needs to be the one most on top of things. The primary care provider could serve as the medical home. Correct. The primary care provider could play the role of the medical home, even if they are not the one prescribing the pain medication. A medical home is not really needed in this case because they are only needed when five or more providers are involved Question #16 of 22: Add new comment 61 reads

15 Patient: Abby Winters, age 65 (New Patient) Presentation/Chief Complaint: Abby complains of moderately severe osteoarthritis pain in her knees for 10 years Relevant Details: Knee replacement therapy deferred due to financial limitations. History of severe gastritis with NSAID therapy Question: Which of the following is the most patient-centered approach to starting the pain history part of the patient interview? "I'm sorry to hear that you are having pain. Please tell me more about it." "On a scale of 1-10, with 1 being almost no pain to 10 being the worst kind of pain, can you describe to me your current level of pain?"

16 "How bad is your pain?" "What have you tried to alleviate your pain?" "I'm sorry to hear about your pain. Please tell me more about what it is like." This is the most patient centered approach. The expression of empathy followed by an open ended question is likely to develop rapport and yield information about what aspect of the pain matters most to her. "On a scale of 1-10, with 1 being almost no pain to 10 being the worst kind of pain, can you describe to me your current level of pain?" "How bad is your pain?" "What have you tried to alleviate your pain?" Question #17 of 22: Add new comment 59 reads Patient: Sam Blackton, age 43 Mr. Blackton is a new patient who has tried first-line treatment for his work-related back pain and, after a complete evaluation, you decide he needs chronic opioid therapy as part of his treatment. Relevant Case Details: He has mild hypertension, elevated triglycerides and high LDL/low HDL, occasional constipation, and occasional insomnia. He takes no medications for these conditions. Question: Which pre-existing medical condition is likely to result in the most side effects from chronic opioid therapy?

17 Mild hypertension Constipation Poor serum lipid profile Insomnia Mild hypertension Constipation Constipation is a very common side effect of chronic opioid therapy and to have preexisting constipation makes it even more likely that this will be a problem. He should receive medication to prevent this side effect. Poor serum lipid profile Insomnia Question #18 of 22: Add new comment 71 reads

18 Patient: Emily McRae, age 47 Presentation/Chief Complaint: Emily is new to the practice and is being converted from immediate-release opioid therapy to extended-release opioid therapy for severe shoulder pain related to her rotator cuff. Relevant Case Details: The pain has not responded to other treatments including surgery 8 years ago. Question: In considering whether or not to use urine drug testing with Ms. Mcrae, which of the following is true? Urine drug testing is indicated only if there is a history of substance abuse. Urine drug testing should be used only if she starts to show signs of drug addiction. Urine drug testing should be used at baseline prior to treatment and periodically throughout treatment. Urine drug testing should be offered only if the patient wants this additional support. Urine drug testing is indicated only if there is a history of substance abuse Urine drug testing should be used only if she starts to show signs of drug addiction Urine drug testing should be used at baseline prior to treatment and periodically throughout treatment. Universal precautions are recommended for all patients on chronic opioid therapy which include baseline urine drug testing and periodic, random, urine drug testing regardless of apparent risk. Urine drug testing should be offered only if the patient wants this additional support Question #19 of 22:

19 Add new comment 98 reads Patient: Abby Winters, age 65 (New Patient) Presentation/Chief Complaint: Abby complains of moderately severe osteoarthritis pain in her knees for 10 years Relevant Details: Knee replacement therapy deferred due to financial limitations. History of severe gastritis with NSAID therapy Question: Which of the following approaches is the most patient-centered approach for meeting Ms. Winters' and starting the patient encounter? "Abby, Good to see you! What brings you here today?" "Thanks for waiting. I'm Dr. Smith. How can I help you?"

20 "Hello Ms. Winters. I'm Dr. Smith. I read that you are having some problems with arthritis. Please tell me more about that." "So, Abby, I hear your arthritis is giving you some problems." "Abby, I'm sorry to hear about your pain. Can you tell me more about it?" The expression of empathy followed by an open ended question is likely to develop rapport and yield information about what aspect of the pain matters most to her. "Abby, on a scale of 1-10, with 1 being almost no pain to 10 being the worst kind of pain, can you describe to me your current level of pain?" "Abby, how bad is your pain?" "Abby, what have you tried doing to alleviate your pain and how well does it work?" Question #20 of 22: Add new comment 73 reads Patient: Darius Washington, age 34

21 Presentation/Chief Complaint: Chronic neck pain from spinal stenosis after a football injury caused a herniated disc 2 years ago. He is requesting opioids to relieve the pain, but has avoided taking opioids until now due to concerns about becoming addicted. Question: Which of the following will give you the best idea of Mr. Washington's risk for opioid addiction or misuse if you prescribe opioids? Ask him to fill out an Opioid Risk Tool screening. Ask him about his parents' history of drinking. Ask him if he was a victim of childhood sexual abuse. Ask if he has misused prescription drugs. Ask him to fill out an Opioid Risk Tool The other questions are good questions to ask, but the Opioid Risk Tool is best, because it asks a more complete set of questions that are validated. Ask him about his parents' history of drinking Ask him if he was a victim of childhood sexual abuse Ask if he has used prescription drugs for non-medical purposes Question #21 of 22: Add new comment 70 reads

22 Patient: La-Toya Johnson, age 35 Ms. Johnson is a new patient being evaluated for a long history of endometriosis that is now constant and severe unless treated with opioids. Relevant Case Details: Ms. Johnson has tried various first-line therapies to treat the underlying condition and the pain without success. Ms. Johnson is taking immediate release opioids for the past 6 months. She also has Type-II Diabetes and a BMI of 40. The treatment plan will include a weight loss program and an extended release opioid for her pain. Question: Which of the following are essential to determine before prescribing Ms. Johnson an ER/LA opioid? Opioid tolerance criteria as found on the product information If she has any children or pets Her use of alcohol All of the above Opioid tolerance criteria as found on the product information

23 It is essential to determine any requirement for opioid tolerance for the specific ERLA opioid being prescribed If she has any children or pets Safe storage of opioids is always important, but it is especially important to keep opioids stored in a place, preferably locked, where children and pets cannot find it and risk an accidental overdose. Her use of alcohol Complete abstinence from alcohol is recommended for many extended release opioids. Check product information. All of the above All of the above apply, as well as her current dose, which will give an idea of her current opioid tolerance. It will still be important to lower the dose before changing her to another opioid. Question #22 of 22: 21 reads Question: Which of the following types of pain usually fall under the category of nociceptive pain? Severe pain Chronic pain Neurological pain

24 Mechanical/compression pain Severe Chronic Neurological Mechanical/compression pain Mechanical/compression pain is typically nociceptive, as nociceptive is defined as the sensory reaction to stimuli that damage tissue. Source URL: