MTM Pain Management & Opioid Stewardship 5

Question 1

A pharmacist reviewing a patient's medication list notices fentanyl 50 mcg/hr patch, sertraline 100 mg daily, and tramadol 50 mg PRN. What serious drug interaction risk should be flagged?

Accepted Answer

Serotonin syndrome from serotonergic activity of tramadol combined with sertraline

Answer

Tramadol inhibits serotonin reuptake and, combined with sertraline (an SSRI), significantly increases the risk of serotonin syndrome, a potentially life-threatening condition.

Question 2

What is the correct initial naloxone dose and route for reversing suspected opioid overdose in a community setting using the nasal spray formulation?

Accepted Answer

4 mg intranasally into one nostril, repeated every 2–3 minutes if no response

Answer

Narcan nasal spray 4 mg (one spray into one nostril) is the FDA-approved community dose, with repeat administration every 2–3 minutes if the patient does not respond.

Question 3

An MTM pharmacist is completing a comprehensive medication review for a 72-year-old on oxycodone 10 mg q6h. Which Beers Criteria concern is most relevant?

Accepted Answer

Opioids increase risk of falls, fractures, delirium, and respiratory depression in older adults

Answer

The AGS Beers Criteria identifies opioids as potentially inappropriate in older adults due to increased risks of falls, fractures, confusion, delirium, and respiratory depression.

Question 4

Which schedule classification does the DEA assign to hydrocodone combination products (e.g., Vicodin) as of 2014?

Accepted Answer

Schedule II

Answer

In 2014, the DEA reclassified hydrocodone combination products from Schedule III to Schedule II due to high abuse potential, requiring a written prescription with no refills.

Question 5

A patient with renal impairment (CrCl 20 mL/min) requires opioid analgesic therapy. Which opioid is generally preferred due to the absence of clinically significant active metabolite accumulation?

Accepted Answer

Fentanyl

Answer

Fentanyl is primarily metabolized to inactive metabolites and is generally preferred in renal impairment, whereas morphine, codeine, and hydromorphone have active or toxic metabolites that accumulate with decreased renal function.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Pain Management & Opioid Stewardship 5