Self-Assessment Answers for Section 1: Evidence-Based Guidance on Responsible Prescribing, Effective Management, and Harm Reduction
1 . In the United States, approximately how many non-medical users of pain relievers, tranquilizers, stimulants, and sedatives got their prescription drugs from a friend or relative for free? 2 . What two competing needs must the CSA and regulators attempt to balance? 3 . Which of the following factors might be used to determine into which schedule a drug or other substance should be placed? 4 . Into how many classes does the CSA assign drugs or other substances? 5 . Which attribute of some drugs with legitimate therapeutic uses increases their likelihood of being abused? 6 . Heroin, LSD, MDMA, and cannabis are currently listed in which CSA schedule? 7 . Drugs in which schedule are deemed to have a high potential for abuse or dependence but also have a currently accepted medical use in the US? 8 . The duration of action of ER/LA opioids is typically ______________. 9 . Uncomfortable or unpleasant side effects (aside from constipation) may potentially be reduced by which two approaches? 10 . What drug class has largely replaced barbiturates as treatment for anxiety and muscle spasms? 11 . Any person who handles or intends to handle controlled substances must obtain what? 12 . If a physician is filling in for another physician in another state as part of a locum tenens arrangement, the substitute physician can legally prescribe controlled substances as long as he or she is legitimately registered with the DEA in his or her home state. 13 . In an emergency, a prescriber may phone or electronically submit a prescription for a Schedule II drug to a pharmacy but must follow up with a written prescription within 7 days. 14 . Which of the following items does not need to be contained in any prescription for a controlled substance? 15 . Which of the following might suggest inappropriate prescribing of controlled stances by a clinician? 16 . The Ryan Haight Act made it illegal to _________________. 17 . Which of the following is not a potential benefit of urine drug screening? 18 . How frequently are the data in most prescription drug monitoring programs updated? 19 . Drugs with the highest risk for subsequent addiction slowly elicit dopamine release in the midbrain. 20 . Although initially thought to be less prone to induce tolerance and dependence than barbiturates, benzodiazepines are now recognized to be just as liable to diversion and abuse. 21 . Little evidence supports the assertion that long-term use of opioids provides clinically significant pain relief or improves quality of life or functioning. 22 . Roughly what percent of patients reported that they increased their dose of an opioid without talking to the prescribing physician in one study? 23 . When opioid treatment is initiated, it should be viewed by both patient and clinician as _____________________? 24 . Opioid tolerance must be demonstrated before prescribing any strength of _____________________. 25 . What level of opioid dose is widely considered a red flag warranting more intense monitoring and/or referral to an interdisciplinary treatment team? 26 . What relatively new development may reduce the incidence of death from accidental overdose of an opioid medication? 27 . For patients at the end of life, optimal pain management may mean lower doses of an analgesic, and higher levels of pain, in order to allow the patient mental alertness sufficient for interactions with loved ones. 28 . Medication-Assisted Treatment is primarily used for treating 29 . Which of the following is NOT a practice that clinicians can use to minimize diversion of controlled substances? 30 . Acamprosate is a medication that can be used in the treatment of
Self-Assessment Answers for Section 2: CDC Opioid Prescribing Guidelines for Chronic Pain
31 . What percentage of patients presenting to physician offices with non-cancer pain symptoms or pain-related diagnoses currently receive an opioid prescription in
the US? 32 . The CDC guidelines (and others) define chronic pain as pain lasting more than ___________ or past the time of normal tissue healing. 33 . Although the terms “abuse,” “dependence,” and “addiction,” have been used in the past to describe a problematic pattern of opioid use leading to clinically significant impairment or distress, which term is now generally favored? 34 . Which statement best summarizes the CDC finding about opioids for chronic pain? 35 . How soon after starting a patient on opioid therapy should a clinician evaluate the risks and benefits of the treatment? 36 . What is one suggestion for a way to augment opioid treatment in order to help improve a patient’s pain and function? 37 . Which statement accurately describes a challenge clinicians face when considering initiating treatment with an opioid? 38 . Which of the following is not a key point for clinicians to discuss with patients when an opioid is prescribed? 39 . Why should ER/LA opioids be avoided when starting opioid therapy for chronic pain? 40 . At which level of opioid dosing should a clinician carefully reassess the evidence of benefits and risks for the patient? 41 . Most experts agree that opioid dosages should not be increased to _______ without careful justification based on diagnosis and on an individualized assessment of benefits and risks. 42 . In general, the amount of opioids prescribed for acute pain should be limited to a ____ day supply: 43 . Long-acting (LA) and extended-release (ER) formulations of opioids should typically not be used for treating which kind of pain? 44 . What is the initial suggested rate of taper for weaning patients safely off of an opioid? 45 . What do the CDC guidelines suggest regarding the prescription of opioids to pregnant women? 46 . For the treatment of chronic pain in patients with depression, which two classes of antidepressants are recommended? 47 . The DAST and AUDIT tools are examples of which kind of assessment? 48 . Which of the following is not a possible reason for prescribing naloxone to a patient who has been prescribed an opioid analgesic? 49 . How frequently should PDMP data be reviewed for patients on long-term opioid therapy? 50 . Which of the following is not a potential benefit of urine drug testing?
Self-Assessment Answers for Section 3: Compassionate Care at the End of Life
51 . Roughly how many American adults have created an advance directive? 52 . How accurate are physicians, generally, in predicting patient preferences for end-of-life care? 53 . In the United States, what term is generally used for care of people who are not expected to live more than 6 months? 54 . The Karnofsky Scale may be useful for what clinical task? 55 . Which statement is true about the typical role of a referring physician relative to patients in hospice care? 56 . What condition do many older well adults consider as being “worse than death”? 57 . The opioids butorphanol, nalbuphine, and pentazocine, are not recommended in cancer pain management because ____________. 58 . Unwarranted fear of what potential side effect of opioid analgesics can lead to underprescribing by clinicians and/or under use by patients? 59 . Which class of adjuvant analgesic has received increasing attention in recent years as a possible way to control neuropathic pain? 60 . Which class of medications are first-line for treating dyspnea in end-of-life settings?
Self-Assessment Answers for Section 4: Managing Acute Pain
61 . Roughly how many people every year are at risk for opioid misuse or addition due to their being prescribed opioid analgesics for acute pain conditions? 62 . Opioid-induced hyperalgesia is most likely the result of _______________? 63 . DIRE, ORT, and SOAPP are examples of tools for assessing what patient characteristic? 64 . A study found that surgeons prescribed a mean of 24 pills (standardized to 5 mg oxycodone) for post-surgical pain. How many pills did patients actually use? 65 . What amount of opioid analgesic has been recommended by the Centers for Disease Control and Prevention as appropriate for most painful conditions? 66 . During which phase of healing from acute conditions are non-pharmacologic methods most appropriate? 67 . Combination products for pain control join an opioid with a _________________. 68 . Which of the following is not an example of multimodal therapy for acute pain? 69 . For which type of pain should long-acting or extended-release opioid analgesics not be used for __________________? 70 . Which of the following is not a topic that should be routinely covered as part of patient education about opioid analgesics?