Pain Management & Opioid Stewardship Flashcards

A patient with moderate hepatic impairment requires opioid therapy. Which opioid should be used with the MOST caution due to active metabolite accumulation?

Answer: Morphine

Morphine's active metabolite morphine-6-glucuronide (M6G) accumulates with hepatic or renal impairment and can cause prolonged sedation and respiratory depression.

Buprenorphine/naloxone (Suboxone) is used in medication-assisted treatment (MAT) for opioid use disorder. Why is naloxone included in this formulation?

Answer: To prevent parenteral misuse by precipitating withdrawal if injected

Naloxone has very low sublingual bioavailability but is rapidly absorbed if injected, precipitating immediate opioid withdrawal and deterring parenteral abuse.

During an MTM session, a patient on long-term opioids reports new-onset fatigue, low libido, and depression. Which opioid-related endocrine effect should the pharmacist suspect?

Answer: Opioid-induced androgen deficiency (OPIAD)

Chronic opioid use suppresses the hypothalamic-pituitary-gonadal axis, causing opioid-induced androgen deficiency (OPIAD), which presents with fatigue, low libido, depression, and sexual dysfunction.

Opioid-induced hyperalgesia (OIH) differs from opioid tolerance in which key way?

Answer: OIH results in increased pain sensitivity despite adequate dosing, while tolerance is reduced efficacy requiring higher doses

OIH is a paradoxical increased pain sensitivity caused by opioids themselves, whereas tolerance is diminished analgesic effect; OIH may improve with opioid dose reduction or rotation.

A pharmacist is counseling on safe storage and disposal of unused opioids. Which method is FDA-recommended as the preferred disposal route when a drug take-back location is unavailable?

Answer: Mixing with coffee grounds in a sealed bag and discarding in household trash

The FDA recommends mixing unused opioids with an undesirable substance like coffee grounds or dirt in a sealed container and disposing in household trash when take-back programs are unavailable.

According to the 2022 CDC Clinical Practice Guideline, what is recommended regarding the duration of opioid therapy for acute non-surgical pain?

Answer: The lowest effective dose for the shortest duration is preferred, typically no more than a few days

The 2022 CDC guideline recommends prescribing the lowest effective opioid dose for the shortest duration needed, often just a few days, for acute non-surgical pain.

Which adjuvant analgesic is considered first-line for neuropathic pain conditions such as diabetic peripheral neuropathy, prior to initiating opioid therapy?

Answer: Gabapentin or pregabalin

Gabapentinoids (gabapentin, pregabalin) are first-line agents for neuropathic pain per multiple guidelines, acting on alpha-2-delta calcium channel subunits to reduce aberrant neuronal firing.