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Primary Care 707 Module 5 Exam Questions with
Answers
1.Where do 50% of the medications from abuse come from?: Primary care providers 2.What happens when the historic response to a drug is no longer achieved at the same dosage level and increases are necessary?: Tolerance 3.What is a state where the body functions normally only with the drug and withdraw happens when the drug is removed?: Dependence 4.What is when you use something because it becomes associated with alleviating mental duress, such as anxiety, depression, or other associated conditions?: Psychological dependence 5.What results from a fear of being in pain so the person takes pain medication to prevent it from happening?: Pseudo-addiction 6.What is a primary product of a neurobiologic relapsing disease that is char- acterized by compulsive drug seeking or use despite harmful consequences to themselves or others?: addiction 7.What is the most widespread medical problem?: Pain 8.What type of pain is due to arthropathies, ischedmic disorders,
2 / myalgias, skin and mucosal ulcerations, superficial pain such as burns, and visceral pain such as appendicitis, pancreatitis, renal lithiasis?: Nociceptive pain 9.What type of pain is characterized by tissue damage, such as cut or surgical incision, and is the most common type of pain?: Nociceptive pain 10.What type of pain is due to neuropathies as in alcoholism and diabetes, cancer-related pain, regional pain syndromes, HIV, multiple sclerosis, phan- tom limb pain, post herpetic neuralgia, trigeminal neuralgia, and post-cva pain?: Neuropathic pain 11.What type of pain is caused by damage to the nerve system?: Neuropathic pain 12.What type of treatment does neuropathic pain need?: Multimodal therapies (antidepressants and meds that act on neurotransmitters) 13.What type of pain is due to chronic or recurrent headaches, vasculitis?: - Mixed or underdetermined etiology 14.What is the first step to prescribing opioids safely?: patient history 15.What histories are included on a patient who could potentially receive opi- oid treatment?: (1) social history (2) drug abuse history (3) depression screening
4 / 23.What can mild pain managed with?: Nonopiods 24.What is the first route of pain medication?: PO 25.Should you prescribe 2 long acting opioids together?: No 26.What are red flag behaviors?: (1) ask for dose adjustments (2) ongoing delays for planned surgery (3) providers who make risk assessment without physical assessment (4) history of requesting early refills (5) patient who risk nonopioid treat- ment plan (6) will not allow urine drug screen (7) when patients are not safeguarding medications (8) when patients have frequent after hour emergency room visits 27.If a patient has anxiety but also needs an opioid prescription for pain, what other drug would you want to make sure they are not taking?: Benzodiazepines 28.What would be a good thing for a provider to save for opioid prescribing?- : Copy of each written prescription
- What type of pain is sudden onset and of short duration and chronic lasting 3-6 months or longer?: Acute pain 30.What type of pain is physiological, sudden, generally well-defined, self- lim- iting with healing, varies with more overt signs, symptoms are
5 / correctable, anxiety and irritability, and complete relief in most cases?: Acute pain 31.What type of pan is pathological, gradual development, less easy to differ- entiate, lasts beyond 6 months, varies with fewer overt signs, symptoms are persistent, depression, insomnia, lethargy, and complete relief is generally not achieved?: Chronic pain 32.What type of scheduled drug has no accepted medical use and is used in research facilities only?: Schedule I 33.What are examples of schedule I drugs?: Heroin, LSD, mescaline, peyote, marijuana 34.What type of scheduled drug permits no refills, no telephone orders except with emergency and follow-up in 7 days, and electronic prescribing is available with specific software and secure identification process?: Schedule II 35.What are examples of schedule II drugs?: Morphine, codeine, meperidine, opium, hydromorphone, oxycodone, oxymorphone, methadone, fentanyl, cocaine, amphetamine, methylphenidate, pentobarbital, secobarbital 36.What scheduled drug requires that a prescription be written after 6
7 / and address (4) drug name (5) drug strength (6) dosage form (7) quantity prescribed (8) directions for use (9) number of refills (10) manual signature of provider: 45.What are 5 points of pain mgmt. from the original WHO pain ladder?: (1) give oral analgesics first (2) give analgesics at regular intervals and adjust the dosage until the patient is comfortable (3) prescribe analgesics according to pain intensity as evaluated by a scale of intensity pain (4) dosing of pain medication should be adapted to the individual - the correct dose is one that will allow adequate pain relief (5) provide a detailed written plan for the patient and family 46.What is the most common problem with cancer related pain?: Under- treat- ment 47.Why is pain management of special concern in the elderly?: Under treat- ment, experience more pain 48.Who is pain more common in?: Elderly 49.What are physiological factors to consider when prescribing to elderly patients?: (1) kidneys smaller with decreased blood flow and filtration (2) decrease in mass of blood flow (3) decreased saliva (4) changes in gastric secretions
8 / 50.What is the recommended starting dose for elderly patients using opi- oids?: Lowest dose (then titrate up) 51.What is recommended starting dose for nonopioid tolerant patients?: 1/3 to ½ the normal starting dose 52.What is important to consider with elderly before prescribing opioid treat- ment?: Bowel regimen 53.What is the first line treatment for pain during pregnancy?: Nonpharmaco- logical treatment 54.What nonopioid medication is considered safe during pregnancy?: Tylenol 55.What are the adverse effects of using opioids during pregnancy?: (1) miscarriage (2) fetal growth restriction (3) preeclampsia (4) premature rupture of membranes (5) preterm delivery (6) stillbirth 56.What type of opioid therapy should be avoided during pregnancy?: Chronic opioid therapy 57.Women who are using opioids in the peri-conceptual period have a 2.2- fold increase in fetal risk of what?: Neural tube defects 58.What would you also want a prescription for a patient who is at risk for opioid overdose?: Naloxone hydrochloride
10 / addiction?- : Buphrenorphine 67.What type of receptor is associated with the classic effects of opiates: analgesia, respiratory depression, euphoria?: Mu receptor 68.What type of receptor is associated with analgesia and sedation, such as nubain and stadol?: Kappa receptor 69.What type of receptors are associated with dysphoria and hallucinations?- : Delta & sigma receptor 70.Medications that stimulate the Mu receptor also stimulate what other receptor to some exent?: Kappa receptor 71.What is important patient education when prescribing opioids?: (1) illegal to share (2) don't drink alcohol (3) schedule and onset of action (4) sedation effects (especially wit work and driving) (5) child safety and storage 72.What are examples of non-opioid pain medications?: (1) nonsteroidal anti-inflammatory drugs (2) acetaminophen 73.Do opiate agonist or partial agonists have a greater risk of overdose?: Full agonist 74.What is the maximum dose of APAP in a 24 hr period?: 4,000 mg
11 / 75.Who is acetaminophen contraindicated with?: (1) alcoholics (2) liver damage (3) cirrhosis (4) hepatitis (5) dehydration (6) takes other liver toxic drugs 76.APAP creates NAPQI, which is broken down into a nontoxic substance by what?: Glutathione 77.What organ does APAP adversely affect?: Liver 78.What organ does NSAIDs adversely affect the most?: kidneys 79.If a patient has a history of MI or GI bleed, should they take NSAIDs?: No 80.What is the lowest risk NSAID?: Naproxen 81.What are example of COX-1 NSAIDs?: (1) ibuprofen (2) diclofenac (3) keopro- fen (4) indomethacin (5) meloxicam (6) ketorolac (toradol) 82.What are examples of COX-2 NSAIDs?: Celecoxib 83.Do COX-1 or COX-2 have higher cardiovascular risks and lower GI risks?- : COX- 2 84.What is the purpose of prostaglandins?: (1) protect gastric mucosa (2) pro- vide vascular homeostasis (3) platelet aggregation (4) kidney function 85.Is COX1 or COX2 present in inflammation?: COX
13 / 97.What type of headache is a combination of tension and migraine headache?: Cluster 98.What type of headache is due to overuse of medications to treat headache pain? The medications can cause the worsening of the pain.: Rebound 99.What is the treatement for rebound headaches?: Discontinue all pain med- ications
- Who are migraine headaches more common in?: Women
- What types of headaches require abortive therapy or preventative thera- py?: Migraine and cluster
- What types of medications are used to treat migraine headaches?: (1) ergots (2) selective serotonin agonists (3) caffeine (4) NSAIDs (5) anti-emetics (6) beta-blockers (7) TCAs (8) narcotics
- What has evidence shown for migraine prevention and botulinum A injec- tions?: Modest benefit
- What is normally first line treatment for migraines?: Lifestyle changes and non pharmaceutical methods
- What are nonpharmaceutical methods for migraines?: (1) stress
14 / reduction (2) regular sleeping (3) regular eating (4) reduction or cessation of alcohol (5) reduction or cessation of tyramine-containing foods
- What are abortive treatments for migraines?: (1) triptans (2) ergot alkaloids (3) analgesics (4) NSAIDS (5) antiemetics (6) combination products
- What are indications for prophylactic medications for migraines?: (1) greater than 2 months (2) attacks last greater than 24 hours (3) cause major disruption with ADLs (4) abortive therapy fails or is overused (5) symptomatic medications are contraindicated or ineffective (6) use of abortive meds 2 times a week (7) migraine variants produce profound neurological effects
- What are 3 drugs that are FDA approved for fibromyalgia treatment?: (1) milnacipran (2) duloxetine (3) pregabalin
- What drugs are not recommended for fibromyalgia?: (1) citalopram (2) toradol (3) opiates (4) benzodiazepines (5) NSAIDs (6) magnesium (7) guaifenesin (8) DHEA (9) melatonin (10) calcitonin
