CPMP Practice Test

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CPMP Practice Test (V1)

Dive into practice questions

Question 1

A patient stable on long-term oxycodone ER 40mg BID is being rotated to transdermal fentanyl due to dysphagia. Using a standard equianalgesic conversion table (where 30mg oral morphine = 20mg oral oxycodone), what is the most appropriate initial fentanyl patch strength to recommend?

  1. 12 mcg/hr
  2. 25 mcg/hr
  3. 50 mcg/hr
  4. 100 mcg/hr

Question 2

A 35-year-old male with chronic low back pain reports his current therapy of hydrocodone/acetaminophen 10/325mg every 6 hours is no longer effective. His PDMP report shows he consistently fills on time from a single prescriber and pharmacy. Which of the following is the best example of multimodal analgesia to recommend to his provider?

  1. Adding a long-acting opioid like morphine ER while keeping the hydrocodone for breakthrough pain.
  2. Switching the hydrocodone to a more potent opioid like hydromorphone.
  3. Continuing the hydrocodone and adding a topical analgesic (e.g., diclofenac gel) and a trial of duloxetine.
  4. Increasing the dose of the hydrocodone/acetaminophen to two tablets every 4 hours.

Question 3

A pharmacist receives a prescription for methadone 10mg TID for a patient with severe neuropathic pain. The patient's profile shows they are also taking citalopram 40mg daily. What is the most significant risk associated with this combination that requires prescriber consultation?

  1. Increased risk of constipation.
  2. Decreased efficacy of the citalopram.
  3. Increased risk of QT prolongation and Torsades de Pointes.
  4. Increased risk of hepatic injury.

Question 4

According to the Opioid Analgesic REMS, what is a dispenser's (pharmacist's) primary responsibility when dispensing an opioid?

  1. Provide a Medication Guide to every patient with every opioid fill and counsel on safe use.
  2. Enroll every patient receiving an opioid in a national patient registry.
  3. Perform a urine drug screen on any patient receiving more than 90 MME per day.
  4. Obtain a signed pain management agreement from the patient before dispensing.

Answer Key

  • Question 1: B. 25 mcg/hr (80mg oral oxycodone/day = 120mg oral morphine equivalents/day. A common conversion is that 2mg oral morphine is roughly equivalent to 1mcg/hr of fentanyl. 120 / 2 = 60 mcg/hr. A mandatory dose reduction of 25-50% for incomplete cross-tolerance is required. 50% of 60 is 30. 25mcg/hr is the closest and safest starting dose.)
  • Question 2: C. Continuing the hydrocodone and adding a topical analgesic (e.g., diclofenac gel) and a trial of duloxetine. (This is the best example of multimodal analgesia, as it uses agents with different mechanisms of action.)
  • Question 3: C. Increased risk of QT prolongation and Torsades de Pointes. (Both methadone and citalopram carry a risk of QT prolongation, and their combination is a significant concern.)
  • Question 4: A. Provide a Medication Guide to every patient with every opioid fill and counsel on safe use. (This is a core dispenser requirement under the REMS program.)