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Pain Management & Opioid Stewardship Flashcards

7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Pain Management & Opioid Stewardship flashcards as text

  1. A patient on chronic opioid therapy presents with constipation that has not responded to standard laxatives. Which agent is specifically FDA-approved for opioid-induced constipation (OIC) in non-cancer patients?

    Answer: Methylnaltrexone (Relistor)

    Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist (PAMORA) FDA-approved for OIC that blocks GI opioid effects without reversing central analgesia.

  2. Which state-level monitoring program should a pharmacist consult before dispensing a Schedule II opioid to a new patient to identify potential 'doctor shopping'?

    Answer: Prescription Drug Monitoring Program (PDMP)

    PDMPs are state-run electronic databases that track controlled substance prescriptions, helping pharmacists identify patients obtaining opioids from multiple prescribers.

  3. An MTM pharmacist identifies a patient on chronic opioids who scores 15 on the COMM (Current Opioid Misuse Measure). What does a score ≥9 on this scale indicate?

    Answer: The patient is likely currently misusing opioids and warrants further evaluation

    A COMM score ≥9 suggests probable current opioid misuse and should prompt the clinician to reassess the treatment plan and consider addiction specialist referral.

  4. Naloxone dispensed for opioid overdose reversal primarily works by which mechanism?

    Answer: Competitive antagonism at mu-opioid receptors

    Naloxone competitively antagonizes mu-opioid receptors, rapidly reversing opioid-induced respiratory depression, sedation, and analgesia.

  5. A cancer patient requires around-the-clock opioid therapy with a short-acting agent for breakthrough pain. What is the standard recommendation for breakthrough dose as a percentage of the total daily opioid dose?

    Answer: 10–15% of the total daily dose every 4–6 hours as needed

    Breakthrough doses are typically 10–15% of the total daily opioid dose (equivalent to 1/6 of the 24-hour dose), given every 1–4 hours as needed.

  6. Which opioid rotation strategy is recommended to reduce incomplete cross-tolerance and prevent underdosing when switching between opioids?

    Answer: Reduce the calculated equianalgesic dose of the new opioid by 25–50%

    Due to incomplete cross-tolerance, the equianalgesic dose of the new opioid is typically reduced by 25–50% to avoid inadvertent overdose.

  7. What is the primary role of a Risk Evaluation and Mitigation Strategy (REMS) for extended-release/long-acting (ER/LA) opioids?

    Answer: To ensure prescribers, pharmacists, and patients understand serious risks and safe use

    The ER/LA Opioid Analgesics REMS requires prescriber education, patient counseling via Medication Guides, and emphasizes appropriate patient selection to mitigate risks of misuse, abuse, addiction, overdose, and death.