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McGraw-Hill Specialty Board Review Pain Medicine

Salahadin Abdi, Pradeep Chopra, Howard Smith

Chapter 12

Drug Abuse and Addiction - all with Video Answers

Educators

Chapter Questions

Problem 873

In performing urine drug testing (UDT), a physician must know all of the following, EXCEPT
(A) the characteristics of the testing procedures, since many drugs are not routinely detected by all UDTs
(B) that although no aberrant behavior is pathognomonic of abuse or addiction, such behavior should never be ignored
(C) reliance on aberrant behavior to trigger a UDT will miss more than $50 \%$ of those individuals using unprescribed or illicit drugs
(D) always prescribe "on-demand" for the patient until you are comfortable with the situation
(E) a history of drug abuse does not preclude treatment with a controlled substance, when indicated, but does require a treatment plan with firmly defined boundaries

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Problem 874

A 65-year-old man with cancer and multiple bony metastases complains of increasing requirement of intrathecal morphine. However, he also complains of increased nausea associated with the increased dose. All the workup with regards to carcinomatous spread failed to show any progression of the disease. Which of the following explanations is accurate?
(A) The catheter is no longer in the intrathecal space and he is not receiving appropriate dosages
(B) He is addicted to the drugs and requesting higher doses
(C) He is physically dependent on the drug and is nauseated because of withdrawal symptoms
(D) He has developed tolerance to the analgesics effects of intrathecal morphine
(E) There is significant progression of the disease, which was unidentified by the evaluation

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Problem 875

Which of the following is true regarding quality assurance?
(A) Quality assurance, quality improvement, and quality management are interchangeable words
(B) Quality assurance is internally driven, follows patient care, and has no endpoints
(C) Quality improvement is externally driven, focused on individuals, and works toward end points
(D) Total quality of management, quality management and improvement, and continuous quality improvement are synonymous with quality assurance
(E) A quality improvement program is different from quality assurance and focuses on patient care, process, and integrated analysis

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Problem 876

Which of the following is true with typical detection times for urine testing of common drugs of abuse?
(A) Methadone, 2 to 4 days
(B) Chronic use of marijuana, 1 to 3 days
(C) Morphine, 15 days
(D) Cocaine, 15 days
(E) Benzodiazepines, 15 days

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01:18

Problem 877

What is the mode of action for cocaine in the central nervous system?
(A) Increasing the reuptake of norepinephrine
(B) Blocking dopamine receptors
(C) Activating $\gamma$-aminobutyric acid (GABA) receptors
(D) Mediating its effect through dopamine cells in the ventral tegmentum
(E) Inhibiting acetylcholine esterase in the central nervous system

Melissa Geisel
Melissa Geisel
Numerade Educator

Problem 878

Which is the accurate statement on federal regulations?
(A) They are promulgated by the US Congress, CMS, and Office of Inspector General (OIG)
(B) They are promulgated by the Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and OIG
(C) Courts may not promulgate any regulations, as it is the duty of the US Congress and Administration
(D) They are enforced by the US Congress
(E) They are enforced by local Medicare carriers

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Problem 879

A 38-year-old white male with history of low back pain with radiation into the lower extremity with disc herniation demonstrated at L4-5 with nerve root compression, and electromyographic evidence of L5 radiculopathy was referred for consultation. You have examined the patient and decided to perform transforaminal epidural steroid injection at the L5 nerve root. This encounter is appropriately considered as follows:
(A) It is a consultation as the patient was referred by another physician for management
(B) It is a consultation as the patient was referred and your opinion was requested
(C) It is a new office visit since it is a known problem and the patient was referred to you for the treatment
(D) It is a consultation as you told the patient to return to the referring physician after completion of course of epidurals
(E) It is a consultation, as you do not plan on billing for another consultation within the next 3 years

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01:47

Problem 880

Which of the following is schedule I substance?
(A) Buprenorphine
(B) Hydromorphone
(C) Heroin
(D) Cocaine
(E) Morphine

Qudsiya Anis
Qudsiya Anis
Numerade Educator

Problem 881

All of the following are accurate statements with managing opioid-dependent pregnant patients experiencing withdrawal symptoms when the drug is discontinued, EXCEPT
(A) methadone frequently is used to treat acute withdrawal from opioids
(B) current federal regulations restrict the use of methadone for the treatment of opioid addiction to specially registered clinics
(C) methadone may be used by a physician in a private practice for temporary maintenance or detoxification when an addicted patient is admitted to the hospital for an illness other than opioid addiction
(D) methadone may never be used by a private practitioner in an outpatient setting when administered daily
(E) methadone may be used by a private practitioner in an outpatient setting when administered daily for a maximum of 3 days

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Problem 882

Your friend's daughter whom you have known for several years makes an appointment with you. During the visit, she tells you that she is a heroin addict and requests a prescription for hydrocodone. Your options in this situation are as follows:
(A) Immediately call her father and give hydrocodone
(B) Immediately tell father and give her methadone
(C) Start rapid detoxification in your office
(D) Provide her with a prescription for methadone maintenance
(E) Do not tell the father and do not give hydrocodone

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Problem 883

Which of the following is true regarding opioid-induced constipation?
(A) Treat constipation
(B) Obtain a surgical consult to rule out complication
(C) Evaluate for drug abuse
(D) Start on transdermal fentanyl
(E) Start on methadone-maintenance program

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Problem 884

What are the risks of malprescribing?
(1) Legal charges, probably jail time
(2) Conviction rate is currently almost $30 \%$
(3) Felony conviction will likely prevent or at least severely limit future practice
(4) Duped and dated are highly viable defenses

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01:26

Problem 885

Which of the following is (are) an accurate statement(s) with regards to function of Controlled Substances Act?
(1) It creates a closed system of distribution for those authorized to handle controlled substances
(2) The cornerstone of this system is the licensure of all those authorized by the State Medical Licensure Board to handle controlled substances
(3) Only the individuals and practices which dispense directly to the patients from their clinics are required to maintain a DEA license
(4) It requires maintaining complete inventory of controlled substances, only if the drugs are administered by physician, but not if dispensed to the patient

Asmita Mehta
Asmita Mehta
Numerade Educator
01:12

Problem 886

What are the pitfalls of opioid UDT?
(1) Tests for opiates are very responsive for morphine and codeine
(2) UDTs do not distinguish between morphine and codeine
(3) UDTs show a low sensitivity for semisynthetic/synthetic opioids such as oxycodone
(4) A negative response excludes oxycodone and methadone use

Lottie Adams
Lottie Adams
Numerade Educator

Problem 887

What are the pitfalls of prescription practices?
(1) The four $\mathrm{D}^{\prime} \mathrm{s}$ - deficient, duped, deliberate, dependent practitioner
(2) Never say "NO"—family, friends, patients
(3) Ignore complaints
(4) Focus on positive aspects of regulations and reimbursement

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01:29

Problem 888

What are the risks of malprescribing related to practice management?
(1) Loss of provider status
(2) Insurers frequently report to Boards
(3) Plans may remove providers for overprescribing
(4) Insurers are unable to report to any type of national databank for malprescribing

Sanchit Jain
Sanchit Jain
Numerade Educator
04:00

Problem 889

Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) (DSM-IV) definition of substance abuse includes at least one of the following in 12 months:
(1) Maladaptive pattern leading to distress or impairment
(2) Recurrent failure to fill role
(3) Recurrent physically hazardous behavior
(4) Recurrent legal problems

Alyssa Mae L.
Alyssa Mae L.
Numerade Educator
01:26

Problem 890

Which of the following is (are) correct statement(s) regarding amphetamines in UDT?
(1) Tests for amphetamine/methamphetamine are highly cross-reactive
(2) Very predictive for amphetamine/methamphetamine use
(3) UDT will detect other sympathomimetic amines such as ephedrine and pseudoephedrine
(4) Further testing is not required

Asmita Mehta
Asmita Mehta
Numerade Educator
01:26

Problem 891

Which of the following is (are) the correct statement(s) about UDT for cocaine?
(1) Tests for cocaine react principally with cocaine and its primary metabolite, benzoylecgonine
(2) Tests for cocaine are nonspecific in predicting cocaine use
(3) Tests for cocaine have low cross-reactivity with other substances
(4) Cold medicines may test false-positive for cocaine

Asmita Mehta
Asmita Mehta
Numerade Educator

Problem 892

What precautions must a physician take in interpretation of UDT?
(1) Consult with laboratory regarding any unexpected results
(2) Never use results to strengthen physician-patient relationship and support positive behavior change
(3) Schedule an appointment to discuss abnormal/unexpected results with the patient; discuss in a positive, supportive fashion to enhance readiness to change/motivational enhancement therapy (MET) opportunities
(4) It is not necessary to document results and interpretation

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Problem 893

Which of the following is (are) true about postoperative pain management in patients receiving methadone maintenance treatment?
(1) Continue maintenance treatment without interruption
(2) Immediately stop maintenance treatment
(3) Provide adequate individualized doses of opioid agonists, which must be titrated to the desired analgesic effect
(4) If opioids are administered in methadone maintenance patients, doses should be given less frequently and as needed

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Problem 894

A 38-year-old white male with chronic low back pain and history of alcoholism, on a total of $200 \mathrm{mg}$ of morphine per day, was admitted to the emergency room because he was acting agitated and confused. The emergency room physician notifies you of his admission. Which of the following identifies delirium tremens in differential diagnosis of this patient's condition?
(1) Clear sensorium
(2) Prominent tremor
(3) Auditory hallucination
(4) Dilated pupils with slow reaction to light

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02:01

Problem 895

Which of the following is (are) true regarding the five schedules of controlled substances, known as schedules I, II, III, IV, and V?
(1) Schedule I substances have high potential for abuse and the substance has no currently accepted medical use in treatment in the United States
(2) Schedule I substances may be changed to a lower schedule if the safety of the drug is demonstrated even though there is a high potential for abuse and there is no accepted medical use in treatment
(3) Schedule II drugs have high potential for abuse and may lead to severe psychologic or physical dependence
(4) Schedule V drugs or substances have a high potential for abuse and may lead to physical or psychologic dependence

Parvati Devi
Parvati Devi
Numerade Educator
00:32

Problem 896

What are the characteristics of a drug-dependent (addict) practitioner?
(1) Starts by taking controlled-drug samples
(2) Never asks staff to pick up medications in their names
(3) Calls in scripts in names of family members or fictitious patients and picks them up himself
(4) Never uses another doctor's DEA number

Sam Limsuwannarot
Sam Limsuwannarot
Numerade Educator
00:36

Problem 897

Which is (are) the true statement(s) about marijuana UDT?
(1) UDTs provide reasonable reliability
(2) Marinol tests positive
(3) Protonix may test false-positive
(4) Marijuana may be positive 2 years after use

Maxime Rossetti
Maxime Rossetti
Numerade Educator
01:26

Problem 898

Which of the following is (are) the correct statement(s) for UDT?
(1) Thin-layer chromatography (TLC) is a relatively old technique, testing the migration of a drug on a plate or film, which is compared to a known control
(2) Gas chromatography (GC) is most sensitive and specific test, most reliable, and labor intensive/costly
(3) Enzyme immunoassay is easy to perform/ highly sensitive, more sensitive than TLC, and less expensive than GC
(4) Rapid drug screens are not similar to other enzyme immunoassay tests and may be more expensive

Asmita Mehta
Asmita Mehta
Numerade Educator
00:24

Problem 899

Drug testing may be performed by any of the following:
(1) Hair samples
(2) Saliva testing
(3) Serum drug testing
(4) Urine drug screening

Sunshine Brosi
Sunshine Brosi
Numerade Educator

Problem 900

Which of the following is (are) accurate for addiction and dependence?
(1) Based on the Controlled Substances Act, the term "addict" means any individual who habitually uses any narcotic drug so as to endanger the public health and safety
(2) Based on DSM-IV definition, addiction means maladaptive pattern leading to distress or impairment
(3) DSM-IV definition of substance dependence includes tolerance, withdrawal, and continued use despite problems
(4) Federation of State Medical Board guidelines for the treatment of pain recommends use of controlled substances in patients with history of substance with no additional monitoring, referral, or documentation

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