1. Which of the following terms is correctly defined as “physical adaptation with chronic drug exposure where abrupt discontinuation or administration of an antagonist precipitates withdrawal symptoms”?
A. Physical dependence
B. Addiction
C. Pseudoaddiction
D. Tolerance
2. A patient calls the pharmacy immediately after leaving his prescriber's office to verify if his prescription for hydrocodone/acetaminophen 5/325 mg 4 times daily was received. The pharmacist tells the patient that the prescription is due to be filled in 5 days. The patient calls on the 3rd day to make sure the medication is in stock and calls on the 4th day to make sure the prescription will be filled the next day. On the 5th day, the patient is waiting outside the pharmacy 5 minutes before it opens to pick up the prescription. When the pharmacist counsels the patient, the patient reports taking the medication at 8 am, 1 pm, 6 pm, and 10 pm every day and watches the clock until it is time for his next dose because his medication stops working roughly 60 to 90 minutes prior to his next dose. The patient's behavior may be suggestive of which of the following phenomena?
A. Addiction
B. Chemical coping
C. Physical dependence
D. Pseudoaddiction
3. Mrs. Smith is prescribed oxycodone 5 mg every 4 hours as needed. She reports that the oxycodone 5 mg dose no longer works for her, so, instead, she has been taking 10 mg every 8 hours. She reports sometimes taking an additional dose at bedtime to help her sleep. Which of the following aberrant behaviors is Mrs. Smith exhibiting?
A. No aberrant behaviors; she does not exceed her prescribed maximum daily dose on most days
B. Misuse
C. Abuse
D. Addiction
4. Aberrant drug-related behaviors are divided into behaviors that are more suggestive of addiction and those that are less suggestive of addiction (i.e., more likely related to undertreated pain). Which of the following behaviors below is considered less suggestive of addiction?
A. Patient aggressively complains about needing a dose increase
B. Patient forges prescription to alter the quantity
C. Patient crushes oxycodone tablets and injects them
D. Patient has a comorbid marijuana use disorder
5. Which of the following are actions that people may attempt in order to abuse an extended-release opioid formulation?
A. Crush the tablet into a fine powder in order to snort it
B. Dissolve the tablet in an aqueous solution in order to liquefy it and inject it
C. Take a handful of opioids orally all at once
D. All of the above
6. Which of the following correctly pairs the federal classification of the abuse-deterrent property utilized by Xtampza ER with the specific technology used?
A. Agonist/antagonist classification: utilizes sequestered naltrexone molecules
B. Physical/chemical barrier classification: utilizes DETERx technology that contains microspherical particles consisting of fatty acid salts of opioid base with excess fatty acids and waxes, which increases overall lipophilicity
C. Aversion technology classification: utilizes sodium lauryl sulfate, which causes nasal burning and throat irritation when snorted
D. Physical/chemical barrier classification: utilizes RESISTEC technology that contains polyethylene oxide, which increases its molecular weight and increases its resistance to crushing
7. Which of the following correctly identifies the novel mechanism of action of NKTR-181, which is currently in phase 3 clinical trials?
A. NKTR-181 utilizes Trigger Lock technology that contains sustained-release Micropump particles that are resistant to crushing and resistant to drug extraction with aqueous solvents
B. NKTR-181 is a partial mu-receptor agonist/antagonist that has lower intrinsic activity toward the mu-receptor, which decreases the risk for euphoria and opioid-induced respiratory depression
C. NKTR-181 is a long-acting, mu-receptor agonist that has a pegylated structure, which decreases its permeability across the blood-brain barrier, minimizing euphoria and decreasing neuroplastic changes associated with the development of addiction
D. NKTR-181 is formulated with naloxone, which only antagonizes the mu-receptor to prevent abuse if the formulation is abused via intranasal or intravenous routes
8. Which of the following best explains the ultimate goal of the Food and Drug Administration's Extended-release and Long-acting Opioid Analgesic Risk Evaluation and Mitigation Strategy program?
A. To reduce serious adverse outcomes resulting from inappropriate prescribing, misuse, and abuse of extended-release or long-acting opioids while maintaining patient access to these medications
B. To deny legitimate pain patients opioid medications by only allowing them to receive a pre-specified amount of medication per month
C. To reduce the liability and responsibility of pharmacists when verifying prescriptions, as physicians have increased educational pain management continuing education requirements, which increases their reliability when prescribing opioids
D. To allow for easier access to opioid medications for patients, so that they may freely use opioids without having to follow-up with their prescriber/pharmacist
9. Mr. Tafton is a well-known patient who comes into your pharmacy with a prescription for a fentanyl 25 mcg/hr patch; the directions are to apply 1 patch every 3 days. To your knowledge, he has not been on any prior opioid medications, and you are concerned that starting at this dose would significantly increase the patient's risk for opioid-induced respiratory depression. Which of the following actions would be most appropriate for you to take?
A. Contact the physician who ordered the prescription to explain that fentanyl should not be used in opioid-naïve patients, especially at this dose
B. Fill the prescription and dispense to the patient with a fentanyl medication guide, as the patient is not at risk for respiratory depression
C. Ask the patient if he has been taking any opioids that he has received from other pharmacies to confirm whether he is truly opioid-naïve
D. A and C
10. What is the best course of action for a pharmacist to take if he or she suspects a prescription is forged? A search of the state prescription drug monitoring program found no results of previous prescriptions for the patient.
A. Ask the patient about the prescription in front of other patients
B. Ask the patient for the prescriber's phone number and call the clinic to verify the prescription
C. Deny all prescriptions when there is a suspicion of forgery, even if it is a small suspicion and no action has been taken to obtain more information or verify legitimacy
D. Look up the prescriber information and contact the clinic to verify the prescription
