BCACP Pain Management and Opioid Stewardship

Question 1

A patient on morphine 30 mg oral every 4 hours (180 mg/day) requires conversion to oxycodone due to adverse effects.
Using standard equianalgesic conversion (oral morphine to oral oxycodone ratio of 1.5:1), what is the approximate total daily oxycodone dose?

Accepted Answer

120 mg/day

Answer

90 mg/day

Answer

180 mg/day

Answer

270 mg/day

Question 2

Which validated tool is MOST commonly used in ambulatory care to assess a patient's risk for opioid misuse or aberrant drug-related behaviors BEFORE initiating long-term opioid therapy?

Accepted Answer

ORT (Opioid Risk Tool)

Answer

PHQ-9 (Patient Health Questionnaire-9)

Answer

AUDIT-C (Alcohol Use Disorders Identification Test)

Answer

CAGE questionnaire

Question 3

A pharmacist is counseling a patient on naloxone use. The patient's caregiver asks when to administer naloxone. Which clinical sign is the MOST important indicator of opioid overdose requiring immediate naloxone administration?

Accepted Answer

Slow, shallow respirations (fewer than 12 breaths per minute) with unresponsiveness

Answer

Nausea and vomiting after taking opioids

Answer

Excessive sedation and miosis (pinpoint pupils)

Answer

Constipation and urinary retention

Question 4

According to the CDC Clinical Practice Guideline for Prescribing Opioids (2022), which of the following is the recommended approach for a patient with chronic non-cancer pain who is opioid-naive?

Accepted Answer

Start with non-opioid therapies; if opioids are used, begin with the lowest effective dose of immediate-release opioids

Answer

Begin with a long-acting opioid to provide consistent analgesia throughout the day

Answer

Prescribe the highest dose needed to achieve complete pain relief as the primary goal

Answer

Opioids are absolutely contraindicated in all chronic non-cancer pain and should never be initiated

Question 5

A patient with chronic low back pain and depression is seeking pharmacological treatment that may address both conditions. Which non-opioid analgesic class has dual evidence for both chronic musculoskeletal pain and depression?

Accepted Answer

SNRIs (e.g., duloxetine)

Answer

COX-2 inhibitors (e.g., celecoxib)

Answer

Gabapentin

Answer

Topical diclofenac

Question 6

A patient on long-term opioid therapy for chronic pain presents for a routine monitoring visit. Which of the following is a recommended component of ongoing monitoring according to opioid prescribing guidelines?

Accepted Answer

Urine drug screening and prescription drug monitoring program (PDMP) check

Answer

Monthly complete blood count to monitor for opioid-induced cytopenias

Answer

Weekly liver function tests due to opioid hepatotoxicity risk

Answer

Routine cardiac stress testing due to QTc prolongation from all opioids