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Opioid Treatment Guidelines for Chronic Pain - Part 3

Appendix B: Urine Drug Testing

1. While a patient can decline to consent to a urine drug test, the healthcare provider cannot factor that declination into their thinking about whether it is safe to continue with OT for that patient.

A. True

B. False


2. Which type of urine drug testing can give a confirmation for a large number of medications, substances, and drugs at one time and may be helpful in many patients at initiation of OT, periodically during OT, and following cessation of OT if SUD is a possibility?

A. Immunoassay

B. Gas chromatography-mass spectrometry

C. Liquid chromatography-mass spectrometry

D. None of the above


3. Urine collected in the early morning is most concentrated and most reliable.

A. True

B. False


Appendix D: Drug Tables

4. When converting one opioid to another, the calculated dose of one opioid in morphine milligram equivalents can be used to determine the dose of another opioid in morphine milligram equivalents.

A. True

B. False


5. When converting opioids, the new opioid is typically dosed at _____% lower than the calculated MME dose to avoid accident overdose due to incomplete cross-tolerance and individual variability in opioid pharmacokinetics.

A. 10 - 20

B. 20 - 40

C. 33 - 50

D. 50 - 75


6. When converting _____, caution must be taken because it is dosed in mcg/hr instead of mg/d.

A. Fentanyl

B. Codeine

C. Hydrocodone

D. Oxycodone


7. With repeated dosing of methadone, duration of analgesia is:

A. 4 - 6 hours

B. 8 - 12 hours

C. 12 - 16 hours

D. 12 - 24 hours


8. Significant methadone toxicity can occur, particularly when:

A. Doses are increased too frequently

B. Conversion doses are too high

C. Dosing intervals are too close

D. Any of the above


9. Switching from methadone to another opioid is simply the reverse process, that is, the morphine to methadone conversion ratio is the same as the methadone to morphine ratio.

A. True

B. False


Appendix H: 2010 Recommendation Categorization Table

10. Intensity of pain should be measured using a numeric rating scale (0 - 10 scale) for which of the following?

A. Current pain

B. Least pain in last week

C. “Usual” or “average” pain in last week

D. All of the above


11. Opioid therapy trial can be initiated with caution in which of the following situations?

A. Unwillingness to adjust at-risk activities resulting in serious re-injury.

B. Acute psychiatric instability or uncontrolled suicide risk.

C. Prior adequate trials of specific opioids that were discontinued due to intolerance, serious adverse effects that cannot be treated, or lack of efficacy.

D. Opioid therapy trial can be initiated with caution in all of the above.


12. If a high dose of medication (greater than _____ mg/day morphine equivalent) provides no further improvement in function, consultation should be considered rather than further increasing the dose.

A. 100

B. 200

C. 350

D. 500


13. The patient should be required to provide an opioid log at each visit.

A. True

B. False


14. Opioid therapy should be tapered off and discontinued if:

A. The medication fails to show partial analgesia with incremental dose titration.

B. Trials with different agents provide inadequate analgesia.

C. The patient requests it.

D. Any of the above.


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