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1. All of the following are associated with postherpetic neuralgia (PHN), EXCEPT:

A. Depression B. Anorexia C. Angina D. Insomnia

2. Older adult patients may not communicate their pain because of which of the following factors:

A. Older adult patients feel less pain B. They are unwilling to report their pain C. They feel that they shouldn't have pain D. They are afraid to see a doctor

3. Which of the following is TRUE about pain assessment for those with PHN:

A. The Numeric Pain Rating Scale is the best tool for chronic pain B. The Zoster Impact Questionnaire (ZIQ) is the only tool validated for the assessment of PHN C. Functional pain scales assess how much weight a patient can lift D. Activities of daily living questions use the degree of interference with daily activities

4. Which of the following is most appropriate for assessing pain in patients with cognitive impairment:

A. Input only from the patient B. Interpersonal interactions of the patient C. Mini-Mental State Examination D. Input only from family members

5. Which of the following is TRUE about the herpes zoster vaccine:

A. Currently Medicare Part D plans do not cover it B. The effectiveness decreases with time C. It is less potent than the varicella vaccine D. It is safe to give to pregnant women

6. Which of the following has been shown to reduce the development of PHN:

A. Prednisone B. Amitriptyline C. Gabapentin D. Valacyclovir

7. Which of the following is TRUE regarding the pain pathways:

A. The HZ infection causes inflammation of the peripheral nociceptors B. Stimulation of the sympathetic nervous system causes vasoconstriction C. The burning type of pain with PHN is associated with myelinated C-fibers D. An excess of norepinephrine increases pain as part of modulation

8. The American Academy of Neurology (AAN) recommends which of the following as first-line therapy for PHN:

A. Pregabalin B. Duloxetine C. Lidocaine cream D. Capsaicin

9. When evaluating pharmacotherapeutic pain studies, which of the following is considered TRUE:

A. A clinically meaningful reduction in pain is at least 50% B. A reduction from 7 to 6 on the Numeric Pain Rating Scale may be statistically significant C. A reduction from 7 to 6 on the Numeric Pain Rating Scale is clinically significant D. Placebo analgesic treatment arms typically reduce pain by less than 10%

10. Which of the following is TRUE about interventional therapies:

A. Interventional therapies are not effective for treating or preventing PHN B. Intrathecal corticosteroids are effective, but may not be safe for treating PHN C. Sympathetic nerve blocks are effective for treating, but not preventing, PHN D. Intrathecal morphine is safe and effective for treating PHN

11. Which of the following is TRUE about lidocaine:

A. Lidocaine blocks sodium channels, lowering the firing threshold of pain fibers B. Lidocaine patches reduce allodynia caused by central sensitization C. Lidocaine cream may be applied up to 12 hours each day D. Lidocaine patches are the most effective analgesic for PHN

12. Which of the following is TRUE about gabapentinoids:

A. Gabapentin GR formulation is more effective than standard gabapentin B. Pregabalin has better bioavailability because it does not use L-amino acid transporter (LAT) C. They prevent release of excitatory neurotransmitters like glutamate D. They should all be taken with a high-fat meal

13. A patient calls with complaints of feet swelling and problems with short-term memory. Which of the following is MOST likely to be the cause of her complaints:

A. Amitriptyline B. Morphine C. Capsaicin D. Pregabalin

14. Blood pressure should be monitored with which of the following:

A. Capsaicin 8% patch B. Pregabalin C. Lidocaine patch D. Tramadol

15. A patient with benign prostatic hypertrophy has developed PHN. Which of the following should not be used first:

A. Gabapentin B. Pregabalin C. Amitriptyline D. Lidocaine patch

16. Which of the following is TRUE about the use of opioids for PHN:

A. Gabapentinoids may reduce the amount of opioid needed B. They are not recommended by AAN as first-line agents for PHN C. There are robust data supporting the use of tramadol for PHN D. Tramadol is an opioid agonist as well as a sodium channel blocker

17. A patient calls to report that he cannot stand the burning with capsaicin cream after 3 days and it is not helping his pain. Which of the following would you tell him:

A. He should apply it only twice daily instead of 4 times daily to reduce the burning B. He should continue to use it as much as possible to sensitize the TRPV1 receptor C. He will need to use this for at least 2 weeks to really see the benefit D. He should ask his doctor about trying the 8% patch because this would cause less burning

18. Which of the following is a benefit of the new gabapentin GR formulation:

A. It is less expensive than standard gabapentin B. It is a good choice for a patient with metabolic syndrome C. It does not require dose reduction for renal impairment D. It may cause less sedation than IR gabapentin

19. Pharmacist interventions have shown which of the following benefits:

A. A reduction in the number of drugs that meet the Beers criteria per patient B. Improved pain scores for those with PHN C. Improved vaccination rates with the varicella zoster vaccine D. Better patient understanding of herpes zoster (HZ) and PHN

20. Which of the following is TRUE with regard to health literacy:

A. Older adults have one of the highest health literacy rates B. Patients with low health literacy do not tend to ask questions C. Written information is the most important information to give D. Pharmacists mostly provide oral instructions for patients