NR565: WEEK 2: TEST QUESTIONS WTH ACCURATE
SOLUTIONS
1) Why not start with ER/LA opioids? -- Answer ✔✔ -Patients may experience
better pain control if they take opioids when needed rather than on a scheduled
basis.
- Taking opioids on a scheduled basis may contribute to tolerance & dose
escalations.
2) Medical conditions that may pose serious and life-threatening risks with opioid
use -- Answer ✔✔ - Sleep-disordered breathing such as sleep apnea
- Pregnancy
- Renal or hepatic insufficiency
- Age >= 65
- Certain mental health conditions
- SUD
- Previous nonfatal overdose
3) Titrating Opioids to >=50 MME/day -- Answer ✔✔ When considering increasing
dosage to >=50 MME/day:
- Carefully reassess individual benefits and risks for such a dosage increase,
including whether opioids are meeting the patient's treatment goals
- Increase follow-up intervals to every 1 to 4 weeks
, - Consider offering naloxone and overdose prevention education to both patient
and the patient's household members
4) Avoid Titrating Opioids to ________ -- Answer ✔✔ >=90 MME/Day
5) Providers should reevaluate benefits and harms with patients within _______
weeks of starting opioid therapy or a dose escalation. -- Answer ✔✔ 1 to 4
weeks
- Provides an opportunity to minimize risks of long-term opioid use by
discontinuing opioids among patients not receiving a clear benefit from these
medications.
6) Providers should reevaluate benefits and harms of continued therapy with
patients every ________ or more frequently. -- Answer ✔✔ 3 months
7) Initiating ER/LA Opioids -- Answer ✔✔ -risks for opioid overdose are greatest
during the first 3-7 days after opioid initiation or an increase in dosage,
particularly when ER/LA opioids are initiated
• Also includes methadone & transdermal fentanyl
- Follow-up within 3 days is appropriate when initiating or increasing the dosage
of methadone
- Follow-up within 1 week is appropriate when initiating or increasing the dosage
of other ER/LA opioids
8) If the patient's dosage is increased to 5/325 mg oxycodone/acetaminophen QID
PRN, what would the daily maximum MME be, assuming the patient takes the full
four doses each day? Select the best answer.
A) 15 MME/day
B) 50 MME/day
C) 30 MME/day
D) 20 MME/day -- Answer ✔✔ 30 MME/day
, Rationale:
5 mg oxycodone QID is 20 mg/day. When you multiply 20 by the conversion
factor of 1.5, the result is 30 MME/day.
9) A follow-up visit within two weeks is appropriate for which of the following
reasons? Select all that apply.
A) Providers should reevaluate benefits and harms with patients within 1
to 4 weeks of starting opioid therapy or a dose escalation
B) This patient's new dosage is above the 50 MME/day threshold and
therefore should be closely monitored
C) It is less likely that continued opioid therapy will be effective for this
patient if she is not receiving relief 1 month after starting an opioid
D) Reassessment of pain and function within 1 month of initiating opioids
provides an opportunity to minimize risks of long-term opioid use --
Answer ✔✔ a c d
10) High-Dosing Risks -- Answer ✔✔ add risk without clear benefit. Furthermore,
benefits of high-dose opioids for chronic pain have not been established. A
randomized controlled trial found no difference in pain or function between
liberal dose escalation and maintenance of current opioid dosage
- Increase risk of serious harm, including fatal and nonfatal overdose
11) Dosage and Overdose Risk -- Answer ✔✔ -Dosages >=50 MME/day increase the
risk of overdose by at least two-fold compared with dosages 20 MME/day.
- Dosages greater than 100 MME/day increase overdose risk up to nine times.
12) Considerations for the Use of ER/LA Opioids -- Answer ✔✔ reserved for
severe, continuous pain
- Considered only for patients who have received IR opioids daily for at least 1
week without improvement
- Used when treating end-of-life pain
SOLUTIONS
1) Why not start with ER/LA opioids? -- Answer ✔✔ -Patients may experience
better pain control if they take opioids when needed rather than on a scheduled
basis.
- Taking opioids on a scheduled basis may contribute to tolerance & dose
escalations.
2) Medical conditions that may pose serious and life-threatening risks with opioid
use -- Answer ✔✔ - Sleep-disordered breathing such as sleep apnea
- Pregnancy
- Renal or hepatic insufficiency
- Age >= 65
- Certain mental health conditions
- SUD
- Previous nonfatal overdose
3) Titrating Opioids to >=50 MME/day -- Answer ✔✔ When considering increasing
dosage to >=50 MME/day:
- Carefully reassess individual benefits and risks for such a dosage increase,
including whether opioids are meeting the patient's treatment goals
- Increase follow-up intervals to every 1 to 4 weeks
, - Consider offering naloxone and overdose prevention education to both patient
and the patient's household members
4) Avoid Titrating Opioids to ________ -- Answer ✔✔ >=90 MME/Day
5) Providers should reevaluate benefits and harms with patients within _______
weeks of starting opioid therapy or a dose escalation. -- Answer ✔✔ 1 to 4
weeks
- Provides an opportunity to minimize risks of long-term opioid use by
discontinuing opioids among patients not receiving a clear benefit from these
medications.
6) Providers should reevaluate benefits and harms of continued therapy with
patients every ________ or more frequently. -- Answer ✔✔ 3 months
7) Initiating ER/LA Opioids -- Answer ✔✔ -risks for opioid overdose are greatest
during the first 3-7 days after opioid initiation or an increase in dosage,
particularly when ER/LA opioids are initiated
• Also includes methadone & transdermal fentanyl
- Follow-up within 3 days is appropriate when initiating or increasing the dosage
of methadone
- Follow-up within 1 week is appropriate when initiating or increasing the dosage
of other ER/LA opioids
8) If the patient's dosage is increased to 5/325 mg oxycodone/acetaminophen QID
PRN, what would the daily maximum MME be, assuming the patient takes the full
four doses each day? Select the best answer.
A) 15 MME/day
B) 50 MME/day
C) 30 MME/day
D) 20 MME/day -- Answer ✔✔ 30 MME/day
, Rationale:
5 mg oxycodone QID is 20 mg/day. When you multiply 20 by the conversion
factor of 1.5, the result is 30 MME/day.
9) A follow-up visit within two weeks is appropriate for which of the following
reasons? Select all that apply.
A) Providers should reevaluate benefits and harms with patients within 1
to 4 weeks of starting opioid therapy or a dose escalation
B) This patient's new dosage is above the 50 MME/day threshold and
therefore should be closely monitored
C) It is less likely that continued opioid therapy will be effective for this
patient if she is not receiving relief 1 month after starting an opioid
D) Reassessment of pain and function within 1 month of initiating opioids
provides an opportunity to minimize risks of long-term opioid use --
Answer ✔✔ a c d
10) High-Dosing Risks -- Answer ✔✔ add risk without clear benefit. Furthermore,
benefits of high-dose opioids for chronic pain have not been established. A
randomized controlled trial found no difference in pain or function between
liberal dose escalation and maintenance of current opioid dosage
- Increase risk of serious harm, including fatal and nonfatal overdose
11) Dosage and Overdose Risk -- Answer ✔✔ -Dosages >=50 MME/day increase the
risk of overdose by at least two-fold compared with dosages 20 MME/day.
- Dosages greater than 100 MME/day increase overdose risk up to nine times.
12) Considerations for the Use of ER/LA Opioids -- Answer ✔✔ reserved for
severe, continuous pain
- Considered only for patients who have received IR opioids daily for at least 1
week without improvement
- Used when treating end-of-life pain
