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Adverse Drug Event Prevention: Diabetes and Opioids

Introduction

1. The term "adverse drug event" includes which of the following?

A. Medication errors B. Allergic reactions C. Overdoses D. All of the above

2. The likelihood of ADEs occurring may increase during transitions of care.

A. True B. False

3. Analysis of 2011 data indicate that _____ are at the highest risk of acquiring an ADE during a hospital stay.

A. Medicaid beneficiaries B. Medicare beneficiares C. Those with English as their second language D. Those with disabilities

4. All of the following are the most commonly implicated drug classes in ADEs, except for:

A. Sedatives B. Anticoagulants C. Opioids D. Insulin

5. To date, data commonly implicate age as a principle underlying risk factor for ADEs.

A. True B. False

6. Implementing ADE prevention efforts requires:

A. Extensive staff training B. Investment of financial resources C. Coordination of providers D. All of the above

Diabetes Agents

7. All of the following are "diabetes agents associated with serious hypoglycemia," except for:

A. Insulin B. Sulfonylureas C. Metformin monotherapy D. All of the above are associated with serious hypoglycemia

8. The Institute for Safe Medication Practice has identified insulin as an inpatient high-alert medication.

A. True B. False

9. Insulin may be implicated in _____% of medication error-related deaths.

A. 10 B. 25 C. 33 D. 50

10. Studies have shown that higher frequency of severe / serious hypoglycemic events are associated with all of the following, except for:

A. Lower socioeconomic status B. Advanced age C. Depression D. Duration of the disease

11. The American Geriatric Society has indicated that the use of medications other than insulin to lower HbA1c to less than 7.5 percent in most persons with type 2 diabetes aged 65 or older is not warranted.

A. True B. False

12. Which of the following is an iatrogenic factor that may increase an individual's likelihood of experiencing a hypoglycemic event?

A. Using insulin and/or oral hypoglycemic agents too aggressively, inappropriately, or without sufficient followup in the hospital setting. B. A patient having a low body mass index, cachexia, increased age, and/or congestive heart failure. C. Changes to a patient's drug regimen that alter insulin resistance and/or the metabolism of hypoglycemic agents. D. All of the above.

13. It is critical that clinical judgment, not metrics, guide medication administration and glycemic targets for individual patients.

A. True B. False

14. Health care provider education should emphasize:

A. Cultural competency B. Shared decision-making practices C. Motivational interviewing D. All of the above

15. A key element of any strategy to reduce the risk of hypoglycemic events is recognizing the importance of existing co-morbid conditions that may affect adherence and risk of medication side effects, as well as physical function and quality of life.

A. True B. False

16. Impaired liver function can prolong the half-life of insulin and alter sulfonylurea degradation, resulting in increased incidence of hypoglycemia events.

A. True B. False

17. Federal and private sector professional guidelines recommend educating patients, families, and caregivers regarding the parameters for diabetes medications, including:

A. Timing with meals and activities. B. Identifying blood glucose levels that require immediate provider notification. C. Identifying blood glucose level patterns that require notification on a more routine basis. D. All of the above.

18. In clinical settings in which there is no single or ideal diagnostic treatment regimen, shared decision making is an important tool in guiding prescribing decisions.

A. True B. False

19. Medication errors and ADEs have been linked to poor communication of instructions to the patient at the time of discharge.

A. True B. False

Opioids

20. All of the following are opioid ADEs, except for:

A. Respiratory depression B. Immunological and hormonal dysfunction C. Internal hemorrhaging D. Pruritus

21. In pain care, treatment decisions require that the potential benefits of opioid analgesia be weighed against the potential safety risks of opioid treatment.

A. True B. False

22. Which of the following is likely to play a far larger role in causing opioid ADEs in outpatient settings compared to inpatient settings?

A. Safer prescribing and monitoring by providers and patient-centered interventions. B. System-wide changes. C. Both (A) and (B) are equally likely to play a role in causing opioid ADEs. D. None of the above.

23. The Joint Commission has identified opioids as an important cause of inpatient ADEs, with the most dangerous ADE being:

A. Respiratory depression B. Immunological and hormonal dysfunction C. Internal hemorrhaging D. Pruritus

24. Federal Agencies have identified which of the following as a potential target for reducing opioid ADEs?

A. Initiating patients on a high dose of opioids. B. Converting between opioid formulations. C. Opioid dose titration. D. All of the above.

25. All of the following factors have been associated with increased risk for opioid overdose in the outpatient setting, except for:

A. Concomitant use of central nervous system depressants. B. Insufficient dose titrations. C. Active or history of substance abuse. D. Aberrant medication-related behaviors.

26. Opioid prescribing guidelines for the treatment of chronic pain promote assessment of patient risk factors prior to initiating opioid therapy and recommend continued assessment of patient therapy goals and outcomes to determine the effectiveness and appropriateness of therapy.

A. True B. False

27. To promote safe opioid use at home, patients should be educated about:

A. The safe and proper use of opioids for pain management. B. Not sharing opioids. C. Secure storage of opioids. D. All of the above.

28. In order to minimize ADEs, the State Medicaid agency's electronic monitoring system screens prescription drug claims to do all of the following, except for:

A. Identify therapeutic duplication. B. Collect data of the potential risk factors associated with opioid ADEs. C. Recognize incorrect dosage or duration of treatment. D. Determine drug-disease contraindications.

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