MCQ Quiz-Pain Management

MCQ Quiz: Pain Management

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Pain management is one of the most common and complex challenges in pharmacy practice, requiring a deep understanding of pathophysiology, pharmacology, and patient-centered care. From selecting appropriate OTC analgesics to managing complex chronic opioid therapy and utilizing adjuvant medications, the pharmacist’s role is critical. This quiz, designed for PharmD students, tests your knowledge of the principles and practices essential for providing safe and effective pain relief.

1. A patient describes their pain as “burning” and “tingling” in their feet. This is most characteristic of which type of pain?

  • Nociceptive pain
  • Somatic pain
  • Visceral pain
  • Neuropathic pain

Answer: Neuropathic pain

2. The mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs) primarily involves the inhibition of which enzyme(s)?

  • Lipoxygenase
  • Cyclooxygenase (COX)
  • Angiotensin-converting enzyme
  • HMG-CoA reductase

Answer: Cyclooxygenase (COX)

3. What is the maximum recommended daily dose of acetaminophen for an adult patient without liver disease, according to most guidelines?

  • 1000 mg
  • 2000 mg
  • 4000 mg
  • 6000 mg

Answer: 4000 mg

4. Opioid analgesics, such as morphine, primarily exert their effect by acting as agonists at which receptor?

  • NMDA receptor
  • GABA receptor
  • Mu (µ) opioid receptor
  • Delta (δ) opioid receptor

Answer: Mu (µ) opioid receptor

5. Which of the following is the most common and persistent side effect of chronic opioid therapy that patients typically do not develop tolerance to?

  • Sedation
  • Nausea
  • Respiratory depression
  • Constipation

Answer: Constipation

6. A patient who is a CYP2D6 poor metabolizer is prescribed codeine. What is the most likely outcome?

  • An exaggerated analgesic effect and risk of toxicity.
  • An increased risk of constipation.
  • A poor analgesic effect due to reduced conversion to morphine.
  • A rapid development of physical dependence.

Answer: A poor analgesic effect due to reduced conversion to morphine.

7. Which medication is an appropriate first-line adjuvant agent for treating neuropathic pain?

  • Hydrochlorothiazide
  • Lorazepam
  • Gabapentin
  • Metoprolol

Answer: Gabapentin

8. Naloxone is a medication used to:

  • Prevent opioid-induced constipation.
  • Treat severe neuropathic pain.
  • Rapidly reverse the effects of an opioid overdose.
  • Potentiate the analgesic effects of morphine.

Answer: Rapidly reverse the effects of an opioid overdose.

9. The World Health Organization (WHO) analgesic ladder recommends starting with which type of medication for mild pain?

  • A strong opioid.
  • An adjuvant analgesic only.
  • A non-opioid analgesic, such as acetaminophen or an NSAID.
  • A weak opioid.

Answer: A non-opioid analgesic, such as acetaminophen or an NSAID.

10. A key counseling point for a patient using a fentanyl patch for chronic pain is to:

  • Cut the patch in half to receive a lower dose.
  • Apply a heating pad over the patch to increase absorption.
  • Avoid exposure to heat, as it can cause a rapid, potentially fatal increase in drug absorption.
  • Change the patch every 24 hours.

Answer: Avoid exposure to heat, as it can cause a rapid, potentially fatal increase in drug absorption.

11. Which of the following best describes nociceptive pain?

  • Pain caused by damage to the nerves.
  • Pain that arises from a non-physical source.
  • Pain caused by stimulation of pain receptors from tissue injury, which can be somatic or visceral.
  • Pain that does not respond to any analgesics.

Answer: Pain caused by stimulation of pain receptors from tissue injury, which can be somatic or visceral.

12. The PQRST method is a tool used for:

  • Assessing the characteristics of a patient’s pain.
  • Calculating an equianalgesic opioid dose.
  • Screening for opioid use disorder.
  • Dosing naloxone during an overdose.

Answer: Assessing the characteristics of a patient’s pain.

13. A major concern with chronic use of NSAIDs, especially in elderly patients or those with certain comorbidities, is the risk of:

  • Hepatotoxicity.
  • GI bleeding and renal dysfunction.
  • Serotonin syndrome.
  • Respiratory depression.

Answer: GI bleeding and renal dysfunction.

14. When converting a patient from one opioid to another, it is a common practice to reduce the calculated equianalgesic dose by 25-50%. This is done to account for:

  • Incomplete cross-tolerance between opioids.
  • The high cost of the new opioid.
  • The patient’s preference for a lower dose.
  • A likely drug-drug interaction.

Answer: Incomplete cross-tolerance between opioids.

15. Amitriptyline, a tricyclic antidepressant (TCA), is often used as an adjuvant analgesic for:

  • Acute somatic pain.
  • Chronic neuropathic pain.
  • Inflammatory pain.
  • Post-operative pain.

Answer: Chronic neuropathic pain.

16. What is the primary mechanism of action of topical capsaicin cream for pain?

  • It numbs the area by blocking sodium channels.
  • It acts as a counter-irritant and depletes substance P from nerve endings.
  • It reduces inflammation by inhibiting COX-2.
  • It activates opioid receptors in the skin.

Answer: It acts as a counter-irritant and depletes substance P from nerve endings.

17. Physical dependence on an opioid is characterized by:

  • A psychological craving for the drug for its euphoric effects.
  • The occurrence of withdrawal symptoms upon abrupt discontinuation of the drug.
  • The need to increase the dose to achieve the same level of pain relief.
  • An improvement in the patient’s functional status.

Answer: The occurrence of withdrawal symptoms upon abrupt discontinuation of the drug.

18. A patient with a true allergy to codeine should be cautious with which of the following opioids due to potential cross-reactivity?

  • Fentanyl
  • Methadone
  • Hydrocodone
  • Meperidine

Answer: Hydrocodone

19. In managing cancer-related pain, the primary goal is often:

  • To use the lowest possible dose of opioids.
  • To avoid all adjuvant analgesics.
  • To provide adequate pain relief to improve the patient’s quality of life, often with around-the-clock dosing.
  • To limit analgesic use to a non-opioid only.

Answer: To provide adequate pain relief to improve the patient’s quality of life, often with around-the-clock dosing.

20. Which of the following is an example of a non-pharmacologic, mind-body approach to pain management?

  • Taking a dose of ibuprofen.
  • Applying a lidocaine patch.
  • Using guided imagery or meditation.
  • Receiving an epidural steroid injection.

Answer: Using guided imagery or meditation.

21. A patient with a history of GI ulcers needs an NSAID for inflammatory pain. Which of the following would be considered a safer option for the GI tract?

  • Naproxen
  • Ketorolac
  • Ibuprofen
  • Celecoxib

Answer: Celecoxib

22. A key component of a prescription drug monitoring program (PDMP) is to:

  • Allow pharmacists to see a patient’s history of controlled substance prescriptions to prevent diversion and duplication of therapy.
  • Track the sales of over-the-counter medications.
  • Provide patients with discounts on their prescriptions.
  • Help pharmacists compound pain medications.

Answer: Allow pharmacists to see a patient’s history of controlled substance prescriptions to prevent diversion and duplication of therapy.

23. Tolerance to which side effect of opioids develops most rapidly?

  • Constipation
  • Miosis (pupil constriction)
  • Sedation and nausea
  • Analgesia

Answer: Sedation and nausea

24. What is the primary active ingredient in many OTC topical analgesics like BenGay and Icy Hot?

  • Lidocaine
  • Capsaicin
  • Methyl salicylate (a counter-irritant).
  • Hydrocortisone

Answer: Methyl salicylate (a counter-irritant).

25. A pharmacist receives a prescription for oxycodone for a patient they know is also receiving methadone from a substance use disorder clinic. The pharmacist’s primary concern is:

  • The additive risk of severe respiratory depression.
  • A potential drug-food interaction.
  • The high cost of the medications.
  • The patient’s insurance coverage.

Answer: The additive risk of severe respiratory depression.

26. Pain management in the elderly is complicated by:

  • An increased risk of side effects and drug interactions due to age-related physiological changes.
  • The fact that elderly patients do not feel pain.
  • The lack of effective analgesics for this population.
  • The low prevalence of chronic pain in the elderly.

Answer: An increased risk of side effects and drug interactions due to age-related physiological changes.

27. What is the primary risk associated with acetaminophen overdose?

  • Severe nephrotoxicity
  • Severe cardiotoxicity
  • Severe hepatotoxicity
  • Severe respiratory depression

Answer: Severe hepatotoxicity

28. Why might a compounded topical gel containing ketoprofen, gabapentin, and lidocaine be prescribed?

  • To provide a systemic effect for severe pain.
  • To target localized pain while potentially minimizing systemic side effects.
  • Because a commercial product with this combination is widely available.
  • It is the least expensive option for pain management.

Answer: To target localized pain while potentially minimizing systemic side effects.

29. The term “breakthrough pain” in a patient on chronic opioid therapy refers to:

  • Pain that occurs when the patient stops taking their opioid.
  • A severe flare-up of pain that occurs despite the use of a long-acting, around-the-clock opioid.
  • The development of opioid-induced hyperalgesia.
  • Pain that is psychological in nature.

Answer: A severe flare-up of pain that occurs despite the use of a long-acting, around-the-clock opioid.

30. Which medication is a partial mu-opioid agonist and is often used for both pain and opioid use disorder?

  • Fentanyl
  • Morphine
  • Buprenorphine
  • Naloxone

Answer: Buprenorphine

31. The “ceiling effect” for analgesia is a characteristic of which type of medication?

  • Full opioid agonists like morphine.
  • Non-opioids like NSAIDs.
  • Partial agonists like buprenorphine.
  • Both B and C.

Answer: Both B and C.

32. When counseling a patient on self-care for acute musculoskeletal pain, what does the RICE acronym stand for?

  • Relief, Ibuprofen, Compression, Exercise
  • Rest, Ice, Compression, Elevation
  • Reassurance, Imaging, Consultation, Evaluation
  • Re-dose, Ingest, Continue, Endure

Answer: Rest, Ice, Compression, Elevation

33. Duloxetine is an SNRI that can be used as an adjuvant analgesic, particularly for:

  • Acute inflammatory pain.
  • Post-operative pain.
  • Neuropathic pain and fibromyalgia.
  • Headache pain.

Answer: Neuropathic pain and fibromyalgia.

34. A patient states they are “allergic” to codeine because it made them very nauseous. This is most likely a(n):

  • True IgE-mediated allergy.
  • Common, predictable side effect (adverse drug reaction).
  • Sign of an overdose.
  • Anaphylactic reaction.

Answer: Common, predictable side effect (adverse drug reaction).

35. Tramadol’s mechanism of action involves:

  • Weak mu-opioid agonism and inhibition of serotonin and norepinephrine reuptake.
  • Strong mu-opioid agonism only.
  • Inhibition of COX-1 and COX-2 enzymes.
  • Blockade of NMDA receptors.

Answer: Weak mu-opioid agonism and inhibition of serotonin and norepinephrine reuptake.

36. A multimodal approach to pain management involves:

  • Using only one medication at the highest possible dose.
  • Using multiple agents with different mechanisms of action, often including non-pharmacologic therapies.
  • Using only non-pharmacologic therapies.
  • Prescribing medications from only one drug class.

Answer: Using multiple agents with different mechanisms of action, often including non-pharmacologic therapies.

37. Which of the following is a key reason for the opioid crisis in the United States?

  • The under-prescribing of opioids for legitimate pain.
  • The lack of any effective non-opioid analgesics.
  • Over-prescribing of opioids and the rise of illicitly manufactured fentanyl.
  • The high price of naloxone.

Answer: Over-prescribing of opioids and the rise of illicitly manufactured fentanyl.

38. When assessing pain in a non-verbal patient, a pharmacist or clinician must rely on:

  • The patient’s own report of their pain score.
  • Behavioral signs such as facial grimacing, restlessness, or changes in vital signs.
  • The family’s opinion of what the pain level should be.
  • Laboratory test results.

Answer: Behavioral signs such as facial grimacing, restlessness, or changes in vital signs.

39. A patient-controlled analgesia (PCA) pump is a device that allows:

  • The nurse to administer bolus doses of opioids whenever they see fit.
  • A continuous infusion of an opioid without any patient input.
  • The patient to self-administer small, pre-set doses of an opioid for pain relief.
  • Family members to administer opioid doses to the patient.

Answer: The patient to self-administer small, pre-set doses of an opioid for pain relief.

40. A major counseling point for a patient starting a new prescription for an NSAID is to:

  • Take it on an empty stomach to increase absorption.
  • Take it with food or milk to reduce the risk of GI upset.
  • Combine it with aspirin for a better effect.
  • Expect it to cause significant drowsiness.

Answer: Take it with food or milk to reduce the risk of GI upset.

41. The primary difference between acute pain and chronic pain is:

  • The intensity of the pain.
  • The location of the pain.
  • The duration of the pain and its associated psychological impact.
  • The type of medication used to treat it.

Answer: The duration of the pain and its associated psychological impact.

42. For patients on chronic opioid therapy, a written “pain contract” or “treatment agreement” is used to:

  • Guarantee that the patient will be cured of their pain.
  • Establish clear expectations and responsibilities for both the patient and the prescriber to promote safety.
  • Prevent the patient from ever stopping the opioid.
  • Ensure the pharmacy will always have the medication in stock.

Answer: Establish clear expectations and responsibilities for both the patient and the prescriber to promote safety.

43. Which of the following is NOT a typical symptom of opioid withdrawal?

  • Diarrhea and abdominal cramping
  • Yawning and sweating
  • Pupil constriction (miosis)
  • Anxiety and restlessness

Answer: Pupil constriction (miosis)

44. The term “equianalgesic” refers to:

  • The doses of two different analgesics that provide approximately the same degree of pain relief.
  • The number of side effects caused by a medication.
  • The cost of two different medications.
  • The route of administration of a medication.

Answer: The doses of two different analgesics that provide approximately the same degree of pain relief.

45. Which of the following represents a significant drug interaction that increases the risk of respiratory depression?

  • Opioids and statins
  • Opioids and benzodiazepines
  • NSAIDs and beta-blockers
  • Acetaminophen and calcium channel blockers

Answer: Opioids and benzodiazepines

46. The pathophysiology of pain involves the process of transduction, which is:

  • The transmission of the pain signal up the spinal cord.
  • The conversion of a noxious stimulus into an electrical signal by a nociceptor.
  • The brain’s interpretation of the pain signal.
  • The descending modulation of the pain signal.

Answer: The conversion of a noxious stimulus into an electrical signal by a nociceptor.

47. Methadone is a unique opioid primarily because:

  • It has a very short half-life.
  • It has a very long and variable half-life and also blocks NMDA receptors.
  • It has no side effects.
  • It is not a controlled substance.

Answer: It has a very long and variable half-life and also blocks NMDA receptors.

48. Why is it important to ask a patient about their pain goals?

  • To set realistic expectations and create a patient-centered treatment plan.
  • To determine if they are eligible for a clinical trial.
  • To document their answer in the chart.
  • It is not important to ask about pain goals.

Answer: To set realistic expectations and create a patient-centered treatment plan.

49. Opioid-induced hyperalgesia is a phenomenon where:

  • A patient becomes more sensitive to pain as a result of opioid exposure.
  • A patient no longer responds to the analgesic effects of an opioid.
  • A patient develops an allergic reaction to an opioid.
  • A patient experiences euphoria from an opioid.

Answer: A patient becomes more sensitive to pain as a result of opioid exposure.

50. The ultimate goal of effective pain management is to:

  • Completely eliminate all sensation of pain, which is often not possible.
  • Improve the patient’s functional ability and quality of life.
  • Ensure the patient is on the highest possible dose of an opioid.
  • Use as many medications as possible.

Answer: Improve the patient’s functional ability and quality of life.

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