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Clinical Drug Testing in Primary Care - Part 1

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


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