___________________ Opioid Stewardship in Multimorbidity: Balancing Pain, Function, and Polypharmacy
F inal E xam
OPIOID STEWARDSHIP IN MULTIMORBIDITY: BALANCING PAIN, FUNCTION, AND POLYPHARMACY
Select the best answer for each question and mark your answers on page 61. For faster service, complete your test online at BOOK.CME.EDU.
11. An older patient with diabetes and stage 3 chronic kidney disease is taking oxycodone and newly started on pregabalin for neuropathic pain. To minimize additive CNS and respiratory depression risk, what action is recommended now? A) Add a benzodiazepine at bedtime to reduce opioid requirements. B) Adjust pregabalin dosing to the patient’s creatinine clearance. C) Make no changes unless confusion, dizziness, or dyspnea develop. D) Maintain standard pregabalin dosing because it is primarily hepatically cleared.
15. A 78-year-old with heart failure and stage 3 CKD has focal knee osteoarthritis pain and extensive polypharmacy. Which pain strategy best minimizes systemic risks and drug interactions while providing comparable efficacy for focal joint pain? A) Immediate-release oxycodone B) Oral NSAIDs such as naproxen C) Scheduled systemic corticosteroids D) Topical agents (e.g., diclofenac gel or lidocaine patches) 16. When functional restoration is prioritized over complete pain elimination in multimorbid patients, which nonpharmacologic approach both improves pain and function without adding to polypharmacy? A) Opioid dose escalation to target zero pain B) Adding gabapentinoids to existing opioid therapy C) Initiating long-term benzodiazepines for insomnia D) Physical therapy focused on strengthening and gait 17. What limitation of the Opioid Risk Tool (ORT) and SOAPP-R is highlighted for multimorbid patients? A) They are prohibited by the CDC guideline. B) They replace the need to check PDMPs during therapy. C) They reliably overestimate risk in older adults with polypharmacy. D) They may underestimate risk in patients with cognitive impairment, polypharmacy, or multiple prescribers. 18. A multimorbid patient on 45 MME/day of oxycodone and gabapentin is maintained on chronic opioid therapy. What steps should be taken regarding naloxone? A) Reserve naloxone solely for patients who are also prescribed benzodiazepines. B) Wait to prescribe naloxone until the daily opioid dose reaches at least 90 MME/day. C) Provide naloxone only with a documented prior overdose; otherwise defer at this dose.
12. Concurrent opioid–benzodiazepine use increases overdose risk by approximately
A) 10-fold. B) 1.5-fold. C) 3- to 5-fold. D) No significant increase
13. A patient on sertraline needs an opioid for chronic pain. To avoid serotonergic interactions, which opioid is preferred?
A) Tramadol B) Morphine C) Meperidine D) Tapentadol
14. For older adults or those with hepatic impairment or chronic alcohol use, what maximum daily dose of acetaminophen is recommended?
A) 1 gram/day B) 2 grams/day C) 3 grams/day D) 4 grams/day
D) Offer naloxone now; multimorbidity and gabapentinoid co-use warrant a lower threshold to reduce overdose risk.
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