1. What is a typical duration of a prescription for opioid therapy in most cases of acute pain treated in an outpatient setting?
A. ≤ 3 days
B. 3 to 7 days
C. 7 to 10 days
D. ≥ 10 days
E. Unsure
2. Which opioid is most suited to a patient with concomitant neuropathic pain?
A. Buprenorphine
B. Oxycodone
C. Tapentadol
D. Fentanyl
E. Unsure
3. In a patient with chronic depression, neuropathic and musculoskeletal pain of the lower back with insufficient relief from oral oxycodone therapy, which of the following adjunctive therapy options is most appropriate, assuming no contraindications?
A. Adjunctive PAMORA therapy
B. Adjunctive SNRI therapy
C. Adjunctive NSAID therapy
D. Adjunctive methadone therapy
E. Unsure
4. What is the most appropriate recommendation for a patient with a Bowel Function Index score of 49?
A. No intervention; tolerance develops to constipation
B. Mobility and adequate food intake
C. Consider prophylactic stool softener
D. Consider methylnaltrexone
E. Unsure
5. When assessing the amount of monitoring that is likely needed for a patient on long-term opioid therapy, which scale should be used?
A. Clinical Opioid Withdrawal Scale
B. Subjective Opioid Withdrawal Scale
C. Pain, Enjoyment, General Activity Scale
D. Screener and Opioid Assessment for Patients with Pain-Revised
E. Unsure
6. In an opioid-naïve patient beginning long-term opioid therapy, which of the following regimens is most appropriate?
A. Oral morphine IR 10 mg every 4 hours
B. Oral hydromorphone IR 0.2 mg every 4 to 6 hours
C. Oral morphine ER 15 mg every 8 hours
D. Oral methadone 50 mg once daily
E. Unsure
7. A patient with chronic cancer-related pain has had their dose of around-the-clock oral hydromorphone ER increased to one 32-mg tablet once daily. What is an appropriate new breakthrough pain regimen that corresponds with this change?
A. Oral hydromorphone IR 4 mg tablet every 4 hours as needed
B. Oral hydromorphone ER 2 mg every 4 hours as needed
C. Oral oxycodone IR 5 mg every 4 hours as needed
D. Oral morphine IR 10 mg every 4 hours as needed
E. Unsure
8. A patient previously taking a TDD of 60 mg oral morphine is to be converted to a new opioid. The patient has had poor pain control, but no remarkable adverse events of morphine therapy. What dose reduction of the new opioid, if any, would be most appropriate to account for incomplete cross-tolerance?
A. No dose reduction
B. 25%
C. 50%
D. 75%
E. Unsure
9. A patient is converting therapy from oral oxycodone 40 mg TDD to transdermal buprenorphine. What is the most appropriate initial step for this conversion?
A. Taper oral oxycodone to 30 mg TDD prior to applying buprenorphine patch
B. Taper oral oxycodone to 20 mg TDD prior to applying buprenorphine patch
C. Apply buprenorphine 5 mcg/h patch at the next dosing interval after the last oxycodone dose
D. Apply buprenorphine 10 mcg/h patch at the next dosing interval after the last oxycodone dose
E. Unsure
10. Among the following patients, which is the best candidate for transition to transdermal fentanyl?
A. An obese patient whose chronic pain is well controlled with their current opioid regimen
B. A cachectic cancer patient with multiple recent changes to their current opioid regimen
C. A patient with severe post-operative pain anticipated to last 48 to 72 hours
D. A patient with severe renal impairment with inadequate pain control
E. Unsure
11. Which of the following situations is most likely to result in unsuccessful opioid taper based on the current TDD?
A. Dose reduction of 15% every 1 week in a patient with long-term chronic pain
B. Dose reduction of 10% every 1 week in a patient with depression
C. Dose reduction of 10% every 2 weeks in a patient with renal dysfunction
D. Dose reduction of 5% every 2 weeks in a patient with acute pain
E. Unsure
12. Which patient filling an opioid prescription presents the greatest number of red flags for addiction, abuse, or overdose?
A. A generally healthy 39-year-old male who consumes alcohol socially
B. An alcoholic 54-year-old female with renal dysfunction
C. A healthy 34-year-old male using medical cannabis for neuropathic pain
D. A 64-year-old frail woman filling prescriptions at another pharmacy
E. Unsure
13. A patient with chronic pain has been treated successfully with morphine (TDD of 150 MME), and will be transitioned to methadone. Which dosage is most appropriate to initiate methadone?
A. 12.5 mg
B. 15 mg
C. 35 mg
D. 45 mg
E. Unsure
14. Which patient is most appropriate for coprescription of naloxone for emergency use?
A. A patient restarting chronic opioid therapy (TDD of 30 MME) and celecoxib after short-term incarceration
B. A patient with atrial fibrillation treated with amiodarone who is transitioning to methadone (TDD of 120 MME)
C. A patient transitioning morphine 20 mg TDD from multiple daily IR doses to daily ER doses
D. A patient tapering oxycodone (TDD of 80 MME) by 7.5% every 2 weeks
E. Unsure
15. For a patient who is planning to start an opioid taper, what initial symptoms reflective of withdrawal should the patient be counseled to report?
A. Spasms
B. Insomnia
C. Piloerection
D. Bradycardia
E. Unsure
