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:Opioid use at end-of-life is often neglected due to unfounded fears about hastening
death. Which of the following statements is FALSE regarding opioid use at end-of-life? -
CORRECT ANSWER: )
Morphine has been found to cause death within 24 hours of initiation.
:The patient is a 63 year old female with chronic low back pain. She is prescribed
hydromorphone 4 mg four times a day. The maximum daily dose (MDD) is 4 tablets per
day and she has been given 120 tablets for a 30-day period for the last 6 months.
Substance use history is positive for marijuana and alcohol use in early adolescence.
She is also prescribed diazepam 5 mg 1-2 tablets as needed for sleep. Today, she
admits to overusing her prescription medications and running out consistently 1-2
weeks early. She admits to borrowing money and medications from "friends" to "make it
through." She would like help as she is now having difficulty paying her bills. Which of
the following is INAPPROPRIATE? - CORRECT ANSWER: d)
Increase the dose of hydromorphone as pain is not adequately controlled
:Which of the following would be the MOST reasonable opioid regimen for a hospice
patient with cancer and less than 3 months to live? - CORRECT ANSWER: a)
Low-dose morphine is an appropriate choice for an opioid-naïve patient.
A patient is a 20 year-old man with a medical history of "PTSD, depression, and ADHD."
He claims that he only drinks "socially." He is prescribed hydrocodone-acetaminophen
10-325 that he can take every 4 hours as needed for chronic pain in his left foot after
falling off a ladder at work and breaking several metatarsals. The maximum daily dose
(MDD) is 6 tablets per day and he is given 180 tablets for a 30-day period. He is also
prescribed extended-release amphetamines (Adderall ER) 20 mg daily and fluoxetine
(Prozac) 20 mg. The Prescription Monitoring Program reveals his last hydrocodone refill
was 3 weeks ago. A report from the Emergency Department (ED) reveals he was seen
there 2 days previously (over a weekend) and requested pain medication for migraine
, headache. Urine toxicology in the ED was positive for cocaine and amphetamines and
negative for opiates. Which is the next course of action? - CORRECT ANSWER:
Answer:Patient is likely suffering from substance use disorder. Using the "FRAMES"
approach, refer the patient for Substance Use Disorder evaluation.
A patient is a 57 year-old man with a history of a work-related shoulder injury with 2
previous surgical procedures. He is currently attending physical therapy. He is
prescribed oxycodone-acetaminophen 5-325 every 6 hours as needed for pain. The
maximum daily dose (MDD) is 4 tablets per day and he is given 120 tablets for a 30-day
period. He states he uses this less than once per day and his prescription monitoring
program and office records indicate he does fill this about every 4 months. He states his
last dose was 4 days ago. Witnessed urine toxicology is negative. Which of the
following is TRUE at this point in time? - CORRECT ANSWER: Pill counts should be
performed at visits and the patient may be called in at random between visits to confirm
how much the patient is using.
All of the following are patient scenarios which include risk factors for Substance Use
Disorder EXCEPT - CORRECT ANSWER: A patient who took prescribed
acetaminophen with codeine (Tylenol #3) for 3 days following a surgical procedure
earlier this year
All of the following should be included in an electronic prescription EXCEPT -
CORRECT ANSWER: prescriber social security number
How often should pain severity and quality be evaluated by prescriber? - CORRECT
ANSWER: every visit
Immediate release opioids used AS NEEDED for pain should be dosed... - CORRECT
ANSWER: Every 3 hours to effectively treat pain.
In New York State, initial opioid prescribing is limited to a 7-day supply for which of the
following conditions? - CORRECT ANSWER: a)Acute pain