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Nurse Practitioner:
doi: 10.1097/01.NPR.0000450821.67133.c8
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Prescribing opioids in primary care: Avoiding perils and pitfalls

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INSTRUCTIONS Prescribing opioids in primary care: Avoiding perils and pitfalls

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Prescribing opioids in primary care: Avoiding perils and pitfalls

General Purpose: To provide information about and recommendations for safely prescribing opioids for chronic noncancer pain. Learning Objectives: After reading the article and taking this test, you should be able to: 1. Describe the significance of effective pain management. 2. Identify ways to decrease risk of opioid misuse. 3. State procedures for safely prescribing opioids.

  1. The 2001 Joint Commission pain standards addressed
    1. medical board policies on safe prescribing.
    2. abuse of pain medications.
    3. safety and efficacy of specific drugs.
    4. undertreatment of pain.
  2. The Office of National Drug Control Policy implemented strategies to
    1. expand prescribing privileges.
    2. treat pain more effectively.
    3. reduce prescription drug abuse.
    4. streamline pain medication distribution.
  3. The first step in pain management planning is
    1. nonpharmacologic intervention.
    2. patient education.
    3. comprehensive assessment.
    4. risk management.
  4. Chronic pain is usually defined as pain persisting
    1. despite treatment.
    2. past the period of expected healing.
    3. without provocation.
    4. for more than 2 months.
  5. It is estimated that 50% of people in chronic pain experience
    1. depression and anxiety.
    2. social isolation.
    3. addiction.
    4. undertreatment.
  6. Opioids should only be initiated after assessment, diagnosis, and
    1. a failed trial of NSAIDs.
    2. surgical intervention.
    3. exercise and rehabilitation.
    4. misuse risk evaluation.
  7. The FDA-approved REMS include
    1. information about all opioid formulations.
    2. a patient counseling document about safety.
    3. mandatory education for prescribers.
    4. manufacturer responsibility for monitoring drug distribution.
  8. Which of the following validated opioid risk assessment tools is considered to be superior?
    1. Diagnosis, Intractability, Risk, Efficacy Score
    2. Opioid Risk Tool
    3. Screener and Opioid Assessment for Patients with Pain–Revised
    4. Opioid Addiction Risk Assessment
  9. For patients with active substance use disorders, opioid therapy
    1. is always contraindicated.
    2. should not be undertaken in an outpatient setting.
    3. is recommended only for cancer or end-of-life care.
    4. should be managed by a pain management specialist.
  10. The PADT assesses all the followingexcept
    1. activities of daily living.
    2. risk of addiction.
    3. adverse reactions.
    4. aberrant behavior.
  11. Oral opioid therapy is discontinued by 22% of individuals due to
    1. lack of pain relief.
    2. adverse reactions.
    3. resolution of symptoms.
    4. cost.
  12. The gold standard choice for urine drug testing is
    1. gas chromatography/mass spectrometry.
    2. scheduled enzyme immunoassay.
    3. random dipstick immunoassays.
    4. urinalysis.
  13. Which resource helps identify patients who obtain medication from multiple sources?
    1. Current Opioid Misuse Measure
    2. PDMP
    3. Opioid Risk Tool
    4. REMS
  14. Moderate dose opioid therapy is a daily morphine equivalent of
    1. 10 to 30 mg.
    2. 31 to 40 mg.
    3. 41 to 90 mg.
    4. 91 to 120 mg.
  15. Which baseline test should be done before prescribing methadone?
    1. complete blood count
    2. urinalysis
    3. pulmonary function tests
    4. electrocardiogram
  16. Steps taken to safely prescribe opioids include all of the following
    1. checking the PDMP or pharmacy records.
    2. knowing and avoiding the opioids most commonly abused in the particular region.
    3. dispensing immediate release rather than extended release tablets.
    4. dispensing the smallest number of capsules possible to achieve the necessary dose.
  17. According to the article, 54% of the time, opioids used for nonmedical purposes were
    1. prescribed by primary care providers.
    2. obtained free from family and friends.
    3. taken from pain management clinics.
    4. purchased from “dealers.”
  18. Discontinuing opioid therapy should involve
    1. an individualized plan.
    2. adhering to a standardized taper protocol.
    3. tapering by 10% weekly.
    4. referral to a substance abuse treatment program.
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