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57 year old man has had for shoulder surgeries after a work related injury. He is
currently attending physical therapy. He is prescribed oxycodone/acetaminophen 5/3 to
5MG one every six hours as needed for pain. He reports using fewer pills than
prescribed, five or six pills per week his prescription monitoring reports showing regular
refills of prescription for 120 pills per month. Look two pills yesterday. A urine toxicology
screen is negative for THC cocaine amphetamines methadone and opiates. Which of
the following is true
a. Patient should be discharged, he is not taking the oxycodone and may be diverting or
stockpiling it.
b. Pill count should be performed at scheduled appointments and that random callbacks
between appointments.
c. His current prescription should be continued with the same dose and quantity of pills
dispensed per month.
d. The absence of positive indicates that no useful information can we g - CORRECT
ANSWER: Pill count should be performed at scheduled appointments and that random
callbacks between appointments.
A 20 year old patient reports a history of PTSD, ADHD, and depression. He is
prescribed hydrocodone/acetaminophen 10/3 to 5 MG, every four hours as needed for
chronic left foot pain after falling off a ladder at work one year ago and breaking several
metatarsals. The maximum dose is six tablets per day, 180 tablets are dispensed for a
month. He is also prescribed extended release dextroamphetamine/amphetamine
(adderall) 20 mg daily, fluoxatine (prozac) 20 mg dele. The prescription monitoring
program reports show that his last hydrocodone refill was two weeks ago. He was seen
in the emergency room two days ago over the weekend, requesting opioids for a
migraine headache. Urine toxicology in the ED was positive for ethyl glucuronide
cocaine and feta means and negative for opiates. Which is the next course of action
, a. Using a FRAMES brief intervention, refer the patient for a substance use disorder
evaluation
b. Incre - CORRECT ANSWER: Using a FRAMES brief intervention, refer the patient for
a substance use disorder evaluation
A 43-year-old patient in our outpatient clinic started opioids eight years ago. They are
currently taking 60 MME of opioid medication per day. After discussion of potential risks
and benefits, you and the patient collaboratively decide to gradually taper to a dose
below 50 MME per day. After the initial dose reduction, they are experiencing withdrawl
symptoms. All of the following are true in the situation EXCEPT:
a. The patient may resort to other methods of obtaining opioids to address withdrawl
symptoms
b. The patient may be at risk of experiencing pain exacerbation, psychological distress
and/or suicidal ideation
c. Adding a benzodiazepine to treat withdrawal symptoms is recommended
d. Slowing or pausing the taper may be beneficial to minimize the withdrawal symptoms
- CORRECT ANSWER: Adding a benzodiazepine to treat withdrawal symptoms is
recommended
A 72-year-old patient with metastatic lung cancer is currently receiving palliative care.
Immediate release opioids are used for breakthrough pain aew best dosed at
a. Every 8 hours avoiding adverse effects
b. Every 6 hours to prevent dependence
c. Every 3 hours to effectively treat pain
d. Every 1 hours to ensure accumulation - CORRECT ANSWER: Every 3 hours to
effectively treat pain
all of the following are legally required to be included ion a electronic prescription
EXCEPT: