Pre-Activity Test

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1. Among patients with chronic nonmalignant pain, approximately what percent report opioid-induced constipation (OIC)?

25%

40%

60%

80%

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2. Opioids exert their effect on the gastrointestinal tract through:

Gamma-opioid receptor

Mu-opioid receptor

Opioid-binding protein

Diminished dopamine production

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3. Which of the following is considered a surfactant laxative/stool softener?

Psyllium

Senna

Docusate

Magnesium sulfate

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4. Which of the following belongs to the class of peripherally-acting mu-opioid receptor antagonist?

Methylnaltrexone

Naloxegol

Lubiprostone

Both methylnaltrexone and naloxegol

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5. Signs of an insufficient response to laxative therapy for OIC include all of the following except:

Hard stools

Excessive straining

Having about 1 stool per day

Sense of incomplete evacuation

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6. A 52-year-old man with chronic pain due to osteoarthritis of the knees and hips has been prescribed methadone every 8 hours as well as oxycodone PRN. After 3 weeks, he complains of infrequent stools that are difficult to pass. He is prescribed senna along with a recommendation to increase his dietary fiber intake. After 2 weeks, he reports no improvement in bowel movements and complains that he spends an excessive amount of time on the toilet. He also states that sometimes he takes a dose of oxycodone to minimize abdominal pain caused by his constipation. An appropriate next step for this patient is:

Change methadone to fentanyl patch

Increase the dose of senna

Add a bulking agent (e.g., psyllium) to his regimen

Initiate treatment with PAMORA

Initiate treatment with lubiprostone