MTM Pain Management & Opioid Stewardship 4

Question 1

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

Accepted Answer

Morphine

Answer

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

Question 2

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

Accepted Answer

To prevent parenteral misuse by precipitating withdrawal if injected

Answer

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

Question 3

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?

Accepted Answer

Opioid-induced androgen deficiency (OPIAD)

Answer

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.

Question 4

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

Accepted Answer

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

Answer

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.

Question 5

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?

Accepted Answer

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

Answer

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.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Pain Management & Opioid Stewardship 4