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Clinical Drug Testing in Primary Care

Introduction

1. Drug tests target specific drugs or drug classes and can detect substances only when they are present above predetermined thresholds.

A. True

B. False


2. Situations in which clinical drug testing can be used include:

A. Pain management with opioid medications

B. Monitoring patients’ prescribed medications with addictive potential

C. Primary care, psychiatry, and other situations when healthcare providers need to determine alcohol or other substance use in patients

D. A and C above.

E. A, B and C above.


3. Practitioners can also use drug testing to help identify patients who may need an intervention for substance use disorders (SUDs).

A. True

B. False


4. Treatment of other medical disorders such as HIV/AIDs or diabetes may be complicated by the presence of a substance use disorder (SUD) which drug testing can help identify.

A. True

B. False


5. Which of the following statements about the relationship between clinical and workplace drug testing is not true?

A. Drug testing used for clinical reasons is identical to workplace drug testing programs.

B. Clinical drug testing draws on the experience of Federal Mandatory Workplace Drug Testing.

C. An important reason for clinical practitioners to become familiar with Federal Mandatory Workplace Drug Testing is that the majority of drug testing is done for workplace purposes.


Chapter 2 - Terminology and Essential Concepts in Drug Testing

6. Drug testing usually involves a two-step process. The first step is a screening test that:

A. Tests for the presence or absence of a substance or its metabolite

B. Tests for fluorescent markers left by certain drugs

C. Tests for the amount of a specific drug in the patient's system


7. Some laboratories bypass screening tests and submit all specimens for confirmatory drug tests due to recent improvements in confirmatory testing technology.

A. True

B. False


8. Point of care testing (POCT) is always a confirmatory drug test.

A. True

B. False


9. Which of the following statements is not true of confirmatory drug tests, according to this paper?

A. They provide quantitative concentrations of specific substances or their metabolites in the specimen.

B. They have high specificity and sensitivity.

C. They test for a broad range of substances or their metabolites.

D. They require a trained technician to perform the test and interpret the results.

E. They can identify specific drugs within drug classes.


10. One measure of a drug test's reliability is sensitivity, which is the test’s ability to reliably detect the presence of a drug or metabolite at or above the designated cutoff concentration.

A. True

B. False


11. Confirmatory tests do not require high specificity.

A. True

B. False


12. Screening tests are manufactured to be as sensitive as possible, while minimizing the possibility of a false positive result. In other words, these tests are primarily designed to:

A. Indicate if a drug is present in the specimen

B. Avoid all possibility of a false positive

C. Look for cannabinoids and cocaine metabolite


13. The window of detection, also called the detection time, depends on several factors. Which of the following is not one of them?

A. Chemical properties of the substances the test is being performed for

B. The insensitivity of the test

C. Individual metabolism rates and excretion routes

D. How the substance is administered, how often it's used, and amount of the substance ingested


14. Which of the following statements is not true?

A. All biological matrices may show the presence of both parent drugs and their metabolites.

B. Drug metabolites last a much shorter time in the body longer than do the parent drugs.

C. Blood and oral fluid are better suited for detecting a parent drug.

D. Urine is most likely to contain a drug’s metabolites.


15. Federal cutoff concentrations are not appropriate for clinical use.

A. True

B. False


16. Some over-the-counter decongestants, such as pseudoephedrine, register a positive drug test result for amphetamine. This is an example of:

A. An inaccurate window of detection.

B. Testing after the window of detection has closed.

C. Cross reactivity


17. A drug test panel is:

A. A panel of clinicians that determines Federal Mandatory Workplace Drug Testing levels.

B. A list (or menu) of drugs or drug classes that can be tested for in a specimen

C. A blood panel used for testing for the presence of specific drugs


18. Point of Care Tests (POCTs):

A. Are administered in the practitioner's office

B. Reveal results quickly

C. Are relatively simple to perform

D. Are usually limited to indicating only positive or negative results

E. All of the above


Chapter 3—Preparing for Drug Testing

19. When deciding which drugs to screen and test for, which of the following are useful criteria?

A. Patient history, physical examination, and laboratory findings

B. The substances commonly abused in the practitioners’ patient population

C. Substances that may present high risk for additive or synergistic interactions with prescribed medication.

D. A and C above.

E. A, B and C above.


20. There are several matrices for drug and alcohol testing for adults that practitioners can choose. Which of the following can only be used to test for alcohol? 

A. Urine

B. Oral fluid

C. Sweat

D. Blood

E. Breath


21. According to the table of advantages and disadvantages, which of the following is not a disadvantage of urine as a matrix for drug testing?

A. Urine has a short to intermediate window of detection

B. Urine is easy to adulterate or substitute

C. It may require observed collection

D. Some individuals experience “shy bladder” syndrome and cannot produce a specimen

E. The highly acidic nature of urine limits its usefulness


22. Which of the following statements is true?

A. Because many drugs are cleared from the blood rapidly, testing of blood or its components has short periods of detection.

B. Urine detection times vary from less than 1 day after ingestion to several weeks.

C. Hair has a longer window of detection, but is best suited for detection of heavy drug use.

D. All of the above.


23. Hair is not suited for detection of very recent use, or occasional drug use.

A. True

B. False


24. There is very little that needs to be considered in deciding whether to test onsite with a POCT for the initial drug screening or use a laboratory.

A. True

B. False


25. Collection of most specimen matrices (different from actual testing) does not require special arrangements.

A. True

B. False


26. Using a laboratory for drug screening has several advantages and one main disadvantage. According to this paper the disadvantage is:

A. High cost

B. Lack of control

C. Long turnaround time

D. The possibility of contamination en route


27. If you are planning to use a laboratory rather than POCT for drug testing, things you should consider include:

A. The lab's analytic capabilities

B. Panels that test for other drugs and drug classes beyond the Federal Five

C. If the laboratory follows established Federal and State regulations

D. A and C above

E. A, B and C above


28. Which of the following statements is not true of POCTs?

A. They use well-established immunoassay technologies for drug detection

B. They determine the presence of parent drugs or their metabolites

C. They usually require a large quantity of a specimen

D. They identify drug classes, single drugs, or metabolites


29. Positive POCT results should usually be followed by a laboratory confirmatory test if the patient denies drug use when confronted with the positive results.

A. True

B. False


Chapter 4—Drug Testing in Primary Care

30. According to this paper there are many reasons a practitioner may want to use drug testing in the primary care setting, including:

A. Evaluating patients in psychiatric care for substance abuse issues, or before prescribing psychoactive medications.

B. Identifying potential substance use problems in women who are pregnant.

C. Avoiding malpractice lawsuits.

D. Ensuring patient safety prior to surgery or other invasive procedures to prevent medication interactions

E. A, B and D above.


31. Clinical drug testing should have established collection procedures for that facility or office that follow:

A. Standards of the College of American Pathologists

B. Clinical Laboratory Improvement Amendments

C. Local and State regulations

D. All of the above


32. Some things patients may not disclose to their practitioner that drug testing can identify include:

A. Medications prescribed by other providers or over-the-counter (OTC) medications and herbal products

B. That they take medications prescribed for other people

C. Use of illicit drugs or how much alcohol they consume

D. If they have stopped taking their medications

E. All of the above


33. A positive test result for illicit drugs or non-prescribed licit medications means:

A. A substance use disorder (SUD) may exist.

B. It is highly likelyan SUD exists

C. The patient needs further screening to rule out an SUD or determine whether an SUD assessment is needed

D. A and C above.


34. When interpreting drug test results, the practitioner should know exactly what a test is—and is not—measuring.

A. True

B. False


35. Once a practitioner has made a diagnosis of SUD the practitioner has an opportunity to recommend appropriate treatment.

A. True

B. False


36. Prior to testing, the practitioner needs to do three important things, according to this paper. Which of the following is not one of these? 

A. Explain to the patient the reasons for performing drug testing,

B. Explain how the test results will be used.

C. Discuss with the patient the practitioner’s duty to maintain confidentiality.

D. Explain the drug testing technology that will be used.


37. Key things a practitioner can do that will help build a relationship of trust and openness include:

A. Communicating openly

B. Listening actively

C. Treating the patient with dignity and respect

D. Reassuring the patient that medical records are confidential

E. All of the above


38. Cultural differences between practitioner and patient can make it difficult to build and maintain a productive therapeutic relationship.

A. True

B. False


39. Federal law and regulations regarding confidentiality of alcohol and drug abuse patient records generally requires written permission from the patient to disclose any information.

A. True

B. False


40. The results of drug tests are a certain indicator of an SUD.

A. True

B. False


41. If a positive result for a drug test is surprising and the patient vehemently denies recent or current use, the practitioner should:

A. Assume the patient is telling the truth

B. Assume the patient is lying

C. Order a laboratory confirmatory test


42. A negative drug test does not necessarily mean the patient has not used a particular substance or taken the prescribed medication.

A. True

B. False


43. How often a practitioner should conduct drug testing depends on:

A. The practitioner

B. The patient

C. The diagnosis

D. The reason for testing

E. All of the above


44. Which of the following items of information does not need to be included in a patient's medical record?

A. The medical necessity for drug testing.

B. Tests performed and test results

C. Changes made to the treatment plan based on test results

D. Referrals made

E. Written procedures for performing POCTs


Chapter 5—Urine Drug Testing for Specific

45. Urine is the most rigorously evaluated and most commonly used matrix for drug testing

A. True

B. False


46. When testing for cocaine using urine, the target compound is usually

A. The metabolite, benzoylecgonine

B. The parent cocaine molecule

C. A combination of both metabolite and parent molecule


47. Using urine as a matrix is vulnerable to different forms of patient tampering:

A. Adulteration

B. Substitution

C. Dilution

D. A, B and C

E. A and C


48. This paper discusses several measures to prevent tampering with a urine sample. Which of the following is not one of these measures?

A. Directly observing the patient provide the sample

B. Video taping sample provision

C. Turning off water to the taps and adding bluing agent to the toilet water

D. Not providing soap in the restroom where sample provision is being done

E. Not allowing the patient to take coats, purses or handbags or other possessions into the restroom before or during sample provision


49. Many substances used to adulterate a urine sample can be purchased over the Internet, such as "Clean-X", "Klear", "Whizzies", and "Urine Luck".

A. True

B. False


50. This paper discusses urine testing issues for eleven specific drugs or classes of drugs. Issues covered in the paper include:

A. Cut-off concentration

B. Window of detection

C. Types of tests commonly used for each drug

D. What is usually tested for (parent drug or metabolite)

E. All of the above


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