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Self-Assessment Answers for Section 1: Opioid Analgesics in the Management of Acute and ChronicPain

1 . Which type of pain is characterized by aberrant signal processing in the peripheral or central nervous system?

A.Nociceptive pain

B.Acute pain

C.Neuropathic pain

D.Chronic non-cancer pain

2 . What term describes the phenomenon of pain being caused by a normally innocuous stimulus such as light touch?

A.Allodynia

B.Hyperalgesia

C.Hypoalgesia

D.Referred pain

3 . What is the likely physiological basis for opioid-induced hyperalgesia?

A.Upregulation of nociceptive pathways in peripheral and central nervous systems

B.Downregulation of nociceptive pathways in dorsal horn neurons

C.Increased release of substance-P in neuronal synapses of peripheral and central nervous system neurons

D.Disinhibition of neuropathic pain pathways in central nervous system

4 . Which statement best summarizes the CDC finding about opioids for chronic pain?

A.Opioid analgesics should be confined to use in patients with neuropathic, as opposed to nociceptive, pain syndromes

B.Chronic non-cancer pain can be effectively treated with immediate-release opioid agents, but should not be treated with long-acting or extended-release formulations

C.No evidence shows a long-term benefit of opioids in pain and function versus no opioids although extensive evidence shows the potential harms of opioids

D.Evidence supports the use of opioid analgesics for long-term non-cancer chronic pain except in patients with pre-existing substance use disorders

5 . Opioid pain medications should not be combined with _______________?

A.Benzodiazepines

B.Stimulant medications

C.SSRI antidepressants

D.Anti-hypertensive medications

6 . Which of the following topics should be routinely covered as part of patient education about opioid analgesics?

A.Background information about acute vs. chronic pain

B.Criteria for Opioid Use Disorder

C.Safe medication disposal

D.Difference between nociceptive and neuropathic pain

7 . Although the absolute risk for inducing opioid misuse or addiction due to prescriptions of opioids for acute pain is low, the large number of such prescriptions means that approximately how many people are at risk each year?

A.260,000

B.160,000

C.60,000

D.6,000

8 . Non-pharmacologic methods for treating acute pain are appropriate for which phase of healing?

A.Immediately after tissue trauma

B.> 48 hours after tissue trauma

C.Late healing phase for recovery of function

D.Immediately after tissue trauma as well as in late healing phase

9 . Long-acting (LA) and extended-release (ER) formulations of opioids should not be used for __________________?

A.Treating acute pain

B.Treating cancer pain

C.Treating end-of-life pain

D.Treating chronic non-cancer pain

10 . What is one suggestion for a way to augment opioid treatment in order to help improve a patient’s pain and function?

A.Use an every-other-day dosing pattern for the opioid, alternating with an NSAID analgesic

B.Rotate the route of administration every 6 weeks

C.Add a long-acting opioid to a prescription for an immediate-release opioid

D.Try concurrent non-pharmacologic approaches such as exercise or cognitive behavioral therapy

11 . Which of the following is an example of a functional goal?

A.Reduced anxiety about pain

B.Reduced need for rescue analgesia

C.Reduced daily dose of opioid analgesic

D.Walking around the block

12 . According to the Centers for Disease Control and Prevention, what amount of opioid analgesic is appropriate for most painful conditions?

A.2-day supply

B.3-day supply

C.5-day supply

D.7-day supply

13 . Which class of patients might require more frequent or intense monitoring when prescribed an opioid analgesic?

A.Young adults

B.Older adults

C.Female patients

D.Patients with hypertension

14 . Which of the following characteristics is typical of patients who are addicted to a pain medication?

A.Medication use improves quality of life

B.Follows practitioner-patient agreement for opioid use

C.Medication use continues or increases despite adverse effects

D.Has left-over medication at each visit

15 . 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.

A.= 50 MMED

B.= 60 MMED

C.= 80 MMED

D.= 90 MMED

16 . The availability of naloxone was increased in 2019 by an FDA decision that ____________.

A.Allowed naloxone to be sold over the counter

B.Approved a generic formulation of nasal-spray naloxone

C.Allowed registered nurses to prescribe naloxone

D.Provided government subsidy to increase production of naloxone

17 . Which of the following medications is a full mu-receptor agonist used to treat Opioid Use Disorder?

A.Methadone

B.Buprenorphine

C.Extended-release naltrexone

D.Naloxone

18 . Which of the following medications can be self-administered by patients with a medication obtained from a regular pharmacy?

A.Methadone

B.Buprenorphine

C.Extended-release naltrexone

D.Naloxone

19 . For which of the following must clinicians obtain a special waiver from the DEA prior to being able to prescribe the medication?

A.Methadone

B.Buprenorphine

C.Extended-release naltrexone

D.Naloxone

20 . Which of the following is a possible reason for prescribing naloxone to a patient who has been prescribed an opioid analgesic?

A.The patient is taking a dose of an opioid < 50 MMED

B.The patient has recently been released from prison

C.The patient has history of hypertension

D.The patient has a concurrent prescription for an SSRI antidepressant

Self-Assessment Answers for Section 2: Managing Acute Pain

21 . Roughly how many people every year are at risk for opioid misuse or addiction due to their being prescribed opioid analgesics for acute pain conditions?

A.260,000

B.160,000

C.60,000

D.6,000

22 . Opioid-induced hyperalgesia is most likely the result of _______________?

A.Upregulation of pro-nociceptive pathways in peripheral and central nervous systems

B.Downregulation of nociceptive pathways in dorsal horn neurons

C.Increased release of substance-P in neuronal synapses of peripheral and central nervous system neurons

D.Disinhibition of neuropathic pain pathways in central nervous system

23 . DIRE, ORT, and SOAPP are examples of tools for assessing what patient characteristic?

A.Risk for opioid-induced hyperalgesia

B.Neuropathic pain levels

C.Risk for opioid misuse or addiction

D.Health-related quality of life

24 . 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?

A.4 pills

B.8 pills

C.16 pills

D.20 pills

25 . What amount of opioid analgesic has been recommended by the Centers for Disease Control and Prevention as appropriate for most painful conditions?

A.2-day supply

B.3-day supply

C.5-day supply

D.7 day supply

26 . During which phase of healing from acute conditions are non-pharmacologic methods most appropriate?

A.Immediately after tissue trauma

B.> 48 hours after tissue trauma

C.Late healing phase for recovery of function

D.Immediately after tissue trauma as well as in late healing phase

27 . Combination products for pain control join an opioid with a _________________.

A.Non-opioid co-analgesic

B.Non-opioid controlled substance

C.Opioid antagonist to prevent abuse

D.Caffeine

28 . Which of the following is not an example of multimodal therapy for acute pain?

A.Systemic NSAID plus systemic opioid

B.Systemic NSAID plus epidural opioid and local anesthetic

C.Immediate-release opioid plus extended-release opioid

D.Ketamine plus opioid

29 . For which type of pain should long-acting or extended-release opioid analgesics not be used __________________?

A.Treating cancer pain

B.Treating acute pain

C.Treating end-of-life pain

D.Treating chronic non-cancer pain

30 . Which of the following is not a topic that should be routinely covered as part of patient education about opioid analgesics?

A.Background information about acute vs. chronic pain

B.Safe storage

C.Safe disposal

D.Timing of medication use

2020 New Hampshire Medical Licensure Program

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