Pharm Module 5

1. Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?
1. High-dose colchicine
2. Low-dose colchicine
3. High-dose aspirin
4. Acetaminophen with codeine
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6. Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
1. Metformin, a biguanide to prevent diabetes
2. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease
3. Naproxen, an NSAID to treat joint pain
4. Furosemide, a diuretic to treat fluid retention
7. Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued?
1. Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids.
2. Prednisone can be abruptly discontinued with no adverse effects.
3. Develop a tapering schedule to slowly wean Daniel off the prednisone.
4. Substitute the prednisone with another anti-inflammatory such as ibuprofen.
10. Patients who are on chronic long-term corticosteroid therapy need education regarding:
1. Receiving all vaccinations, especially the live flu vaccine
2. Reporting black tarry stools or abdominal pain
3. Eating a high carbohydrate diet with plenty of fluids
4. Small amounts of alcohol are generally tolerated.
11. All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding: 1. Potential for causing life-threatening GI bleeds 2. Increased risk of developing systemic arthritis with prolonged use 3. Risk of life-threatening rashes, including Stevens-Johnson 4. Potential for transient changes in serum glucose112. Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes: 1. It is okay to double the dose of Vicodin if the pain is severe. 2. Vicodin is not habit-forming. 3. He should not take any other acetaminophen-containing medications. 4. Vicodin may cause diarrhea; increase his fluid intake.313. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs: 1. Omeprazole, a proton pump inhibitor 2. Combined oral contraceptives 3. Diphenhydramine, an antihistamine 4. Warfarin, an anticoagulant414. Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen? 1. They can cut an adult ibuprofen tablet in half to give Josefina. 2. The ibuprofen dose can be doubled for severe pain. 3. Josefina needs to be well-hydrated while taking ibuprofen. 4. Ibuprofen is completely safe in children with no known adverse effects.315. Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to "get going" each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? 1. Add an H2 blocker such as ranitidine to his therapy. 2. Discontinue the aspirin and switch him to Vicodin for the pain. 3. Decrease the aspirin dose to one tablet daily. 4. Have Henry take an antacid 15 minutes before taking the aspirin each day.116. The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is: 1. 48 hours 2. 4 to 6 days 3. 4 weeks 4. 2 months217. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is: 1. Black tarry stools 2. Vomiting 3. Tremors 4. Tinnitus418. Monitoring a patient on a high-dose aspirin level includes: 1. Salicylate level 2. Complete blood count 3. Urine pH 4. All of the above419. Patients who are on long-term aspirin therapy should have annually. 1. Complete blood count 2. Salicylate level 3. Amylase 4. Urine analysis1_____1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2 1. converts arachidonic acid into a chemical mediator for inflammation. 2. directly causes vasodilation and increased capillary permeability. 3. irritates the gastric mucosa to cause gastrointestinal upset. 4. releases prostaglandins, which cause inflammation and pain in tissues.ANS: 1 COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins._____2. A nursing student asks how nonsteroidal anti-inflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs 1. exert direct actions to cause relaxation of smooth muscle. 2. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. 3. interfere with neuronal pathways associated with prostaglandin action. 4. suppress prostaglandin activity by blocking tissue receptor sites.ANS: 2 NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways._____3. A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take? 1. Counsel the patient to discuss a prescription NSAID with the provider. 2. Recommend adding aspirin to increase the anti-inflammatory effect. 3. Suggest asking the provider about a short course of corticosteroids. 4. Tell the patient to increase the dose to 800 mg every 4 hours.ANS: 1 The patient should discuss another NSAID with the provider if tolerance has developed to the over-thecounter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours._____4. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin 1. increases gastrointestinal secretions. 2. increases hypersensitivity reactions. 3. inhibits both COX-1 and COX-2. 4. is an acidic compound.ANS: 3 Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid.______5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient's provider to discuss changing from aspirin to which drug? 1. A COX-2 inhibitor 2. Celecoxib (Celebrex) 3. Enteric-coated aspirin 4. Nabumetone (Relafen)ANS: 3 Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors._____6. A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason? 1. It can result in adverse effects on her fetus. 2. It causes an increased risk of Reyes syndrome. 3. It increases hemorrhage risk. 4. It will cause increased gastrointestinal distress.ANS: 1 Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution._____7. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? 1. Aspirin (Bayer) 2. Acetaminophen (Tylenol) 3. Anakinra (Kineret) 4. Prednisone (Deltasone)ANS: 1 Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect._____8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? 1. A normal serum aspirin level is between 30 and 40 mg/dL. 2. You may need to stop taking this drug a week prior to surgery. 3. You will need to monitor aspirin levels if you are also taking warfarin. 4. Your stools may become dark, but this is a harmless side effect.ANS: 2 Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported._____9. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? 1. Assess the patient for tinnitus. 2. Monitor the patient for signs of Reyes syndrome. 3. Notify the provider of severe aspirin toxicity. 4. Request an order for an increased aspirin dose.ANS: 1 Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased._____10. The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching? 1. I should limit sodium intake while taking this drug. 2. I should take indomethacin on an empty stomach. 3. I will need to check my blood pressure frequently. 4. I will take the medication twice daily.ANS: 2 Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily._____11. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication? 1. Diclofenac sodium (Voltaren) 2. Ketoprofen (Orudis) 3. Ketorolac (Toradol) 4. Naproxyn (Naprosyn)ANS: 3 Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain._____12. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient? 1. It may take several weeks to achieve therapeutic effects. 2. Unlike aspirin, there is no increased risk of bleeding with ibuprofen. 3. Take ibuprofen twice daily for maximum analgesic benefit. 4. Combine ibuprofen with acetaminophen for best effect.ANS: 1 OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen._____13. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? 1. Assess the patient for drug-seeking behaviors. 2. Notify the provider that the drug is not effective. 3. Reassure the patient that swelling will decrease eventually. 4. Remind the patient that this drug is given for pain only.ANS: 2 This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling._____14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching? 1. Do not take the medication during the first 2 days of your period. 2. The initial dose will be twice the amount of subsequent doses. 3. Take this medication with food to minimize gastrointestinal upset. 4. Take the drug on a regular basis to prevent dysmenorrhea.ANS: 2 The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed._____15. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? 1. Calcium level 2. Complete blood count 3. Electrolytes 4. PotassiumANS: 2 Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation._____16. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug? 1. Avoid all alcohol except beer. 2. Include salmon in the diet. 3. Increase fluid intake. 4. Take on an empty stomach.ANS: 3 The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food._____17. Which antigout medication is used to treat chronic tophaceous gout? 1. Allopurinol (Zyloprim) 2. Colchicine 3. Probenecid (Benemid) 4. Sulfinpyrazone (Anturane)ANS: 1 Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects._____18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient's medical record and will be concerned about which laboratory result? 1. Elevated BUN and creatinine 2. Increased serum uric acid 3. Slight increase in the white blood count 4. Increased serum glucoseANS: 1 Antigout drugs are excreted via the kidneys, so patients should have adequate renal function._____19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching? 1. I should increase my vitamin C intake. 2. I will get yearly eye exams. 3. I will increase my protein intake. 4. I will limit fluids to prevent edema.ANS: 2 Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids._____ 20. Which are characteristic signs of inflammation? (Select all that apply.) 1. Edema 2. Erythema 3. Heat 4. Numbness 5. Pallor 6. ParesthesiaANS: 1, 2, 3 Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise.1. The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: 1. Cardiovascular risk 2. Risk of stroke or other thromboembolic event 3. Breast cancer 4. Vasomotor symptoms42. The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: 1. 2 years 2. 5 years 3. 10 years 4. 15 years23. Dosage changes of conjugated equine estrogen (Premarin) are made at intervals. 1. 1 to 2 weeks 2. 2 to 4 weeks 3. 6 to 8 weeks 4. 12 weeks34. The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is: 1. Ability to deliver higher doses of estrogen in a non-oral form 2. The vaginal cream formula provides moisture to the vaginal area 3. Relief of symptoms without increasing cardiovascular risk 4. All of the above35. Women with an intact uterus should be treated with both estrogen and progestin due to: 1. Increased risk for endometrial cancer if estrogen alone is used 2. Combination therapy provides the best relief of menopausal vasomotor symptoms 3. Reduced risk for colon cancer with combined therapy 4. Lower risk of developing blood clots with combined therapy16. Ongoing monitoring for women on ERT includes: 1. Lipid levels, repeated annually if abnormal 2. Annual health history and review of risk profile 3. Annual mammogram 4. All of the above47. Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include: 1. Explaining that HRT is totally safe if used short term 2. Telling her to ignore media hype regarding HRT 3. Discussing the advantages and risks of HRT 4. Encouraging the patient to use phytoestrogens with the HRT38. Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk? 1. She is correct, black women do not have much risk of developing osteoporosis due to their dark skin. 2. Black women are at risk of developing osteoporosis due to their lower calcium intake as a group. 3. If she doesn't drink alcohol, her risk of developing osteoporosis is low. 4. If she has not lost more than 10% of her weight lately, her risk is low.29. Drugs that increase the risk of osteoporosis developing include: 1. Oral combined contraceptives 2. Carbamazepine 3. Calcium channel blockers 4. High doses of vitamin D210. Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively: 1. Inhibiting magnesium resorption in the kidneys 2. Increasing calcium absorption from the GI tract 3. Acting on the bone to inhibit osteoblast activity 4. Selectively acting on the estrogen receptors in the bone411. Sallie has been diagnosed with osteoporosis and is asking about the "once a month" pill to treat her condition. How do bisphosphonates treat osteoporosis? 1. By selectively activating estrogen pathways in the bone 2. By reducing bone resorption by inhibiting parathyroid hormone (PTH) 3. By reducing bone resorption and inhibiting osteoclastic activity 4. By increasing PTH production312. Inadequate vitamin D intake can contribute to the development of osteoporosis by: 1. Increasing calcitonin production 2. Increasing calcium absorption from the intestine 3. Altering calcium metabolism 4. Stimulating bone formation213. The drug recommended as primary prevention of osteoporosis in women over age 70 years is: 1. Alendronate (Fosamax) 2. Ibandronate (Boniva) 3. Calcium carbonate 4. Raloxifene (Evista)114. The drug recommended as primary prevention of osteoporosis in men over age 70 years is: 1. Alendronate (Fosamax) 2. Ibandronate (Boniva) 3. Calcium carbonate 4. Raloxifene (Evista)115. The ongoing monitoring for patients over age 65 years taking alendronate (Fosamax) or any other bisphosphonate is: 1. Annual dual-energy x-ray absorptiometry (DEXA) scans 2. Annual vitamin D level 3. Annual renal function evaluation 4. Electrolytes every 3 months316. Bisphosphonate administration education includes: 1. Taking it on a full stomach 2. Requiring sitting erect for at least 30 minutes afterward 3. Drinking it with orange juice 4. Taking it with H2 blockers or proton pump inhibitors (PPI) to protect the stomach217. IV forms of bisphosphonates are used for all the following except: 1. Severe gastric irritation with oral forms 2. Known cancer mets into the bone 3. Persons with advancing renal dysfunction 4. Progression of bone loss on oral formulations318. What is the established frequency of repeating DEXA imaging after stating bisphosphonates? 1. Every 2 years 2. Every 5 years 3. There is no evidence-based time line for monitoring after the first 2 years 4. There need to be annual exams319. What is the duration of SERM use for menopausal issues? 1. It matches the 5 years for estrogen products 2. The bone health impact allows long-term use 3. The increased risk of breast cancer encourages tapering as soon as possible 4. The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur220. Why are SERMS generally not ordered for women early into menopause? 1. The rapid onset of severe hot flashes can be unbearable. 2. The bone remodeling effect results in osteoporosis. 3. They tend to induce intermittent spotting. 4. They create more risk with breast cancer than they are worth.11. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the: 1. Sensory aspects of pain 2. Discriminative aspects of pain 3. Motivational aspects of pain 4. Cognitive aspects of pain32. Patients need to be questioned about all pain sites because: 1. Patients tend to report the most severe or important in their perception. 2. Pain tolerance generally decreases with repeated exposure. 3. The reported pain site is usually the most important to treat. 4. Pain may be referred from a different site to the one reported.13. The chemicals that promote the spread of pain locally include: 1. Serotonin 2. Norepinephrine 3. Enkephalin 4. Neurokinin A44. Narcotics are exogenous opiates. They act by: 1. Inhibiting pain transmission in the spinal cord 2. Attaching to receptors in the afferent neuron to inhibit the release of substance P 3. Blocking neurotransmitters in the midbrain 4. Increasing beta-lipoprotein excretion from the pituitary gland25. Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true? 1. Preterm and newborn infants do not yet have functional pain pathways. 2. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. 3. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness. 4. Decreases in pain tolerance are evident in older adults.16. Which of the following statements is true about acute pain? 1. Somatic pain comes from body surfaces and is only sharp and well-localized. 2. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. 3. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site. 4. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.37. One of the main drug classes used to treat acute pain is NSAIDs. They are used because: 1. They have less risk for liver damage than acetaminophen. 2. Inflammation is a common cause of acute pain. 3. They have minimal GI irritation. 4. Regulation of blood flow to the kidney is not affected by these drugs.28. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? 1. All opiates are scheduled drugs which require a DEA license to prescribe. 2. Opiates stimulate only mu receptors for the control of pain. 3. Most of the adverse effects of opiates are related to mu receptor stimulation. 4. Naloxone is an antagonist to opiates.29. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? 1. NSAIDs, opiates, corticosteroids 2. Low-dose opiates, salicylates, increased dose of opiates 3. Opiates, non-opiates, increased dose of non-opiate 4. Non-opiate, increased dose of non-opiate, opiate410. The goal of treatment of acute pain is: 1. Pain at a tolerable level where the patient may return to activities of daily living 2. Reduction of pain with a minimum of drug adverse effects 3. Reduction or elimination of pain with minimum adverse reactions 4. Adequate pain relief without constipation or nausea from the drugs311. Which of the following statements is true about age and pain? 1. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children. 2. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs. 3. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain. 4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.412. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to: 1. Determine if the diagnosis of source of pain is correct 2. Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required 3. Determine if the patient is willing and able to be an active participant in his or her pain management 4. All of the above413. Pathological similarities and differences between acute pain and chronic pain include: 1. Both have decreased levels of endorphins. 2. Chronic pain has a predominance of C-neuron stimulation. 3. Acute pain is most commonly associated with irritation of peripheral nerves. 4. Acute pain is diffuse and hard to localize.214. A treatment plan for management of chronic pain should include: 1. Negotiation with the patient to set personal goals for pain management 2. Discussion of ways to improve sleep and stress 3. An exercise program to improve function and fitness 4. All of the above415. Chronic pain is a complex problem. Some specific strategies to deal with it include: 1. Telling the patient to "let pain be your guide" to using treatment therapies 2. Prescribing pain medication on a "PRN" basis to keep down the amount used 3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment 4. All of the above316. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a "red flag" about potential chemical dependency? 1. Use of more than one drug to treat the pain 2. Multiple times when prescriptions are lost with requests to refill 3. Preferences for treatments that include alternative medicines 4. Presence of a family member who has abused drugs217. The Pain Management Contract is appropriate for: 1. Patients with cancer who are taking morphine 2. Patients with chronic pain who will require long-term use of opiates 3. Patients who have a complex drug regimen 4. Patients who see multiple providers for pain control2