American Board of Internal Medicine (ABIM) Certification Practice Exam

What should all patients on scheduled opioid therapy be prescribed?

1. A muscle relaxant

2. A stimulant laxative

3. An anti-nausea medication

4. Regular blood tests

The correct answer is: A stimulant laxative

Patients on scheduled opioid therapy should be prescribed a stimulant laxative primarily due to the well-established side effect of constipation associated with opioid use. Opioids bind to receptors in the gastrointestinal tract, leading to decreased peristalsis and impaired bowel function. This results in constipation for many patients, which can significantly impact their quality of life. Prophylactic treatment with a stimulant laxative can help mitigate this common side effect, ensuring that patients remain more comfortable and compliant with their pain management regimen. Stimulant laxatives work by promoting bowel movements and preventing the constipation that often occurs with opioid medications. The importance of this intervention is emphasized in clinical guidelines, which suggest that all patients receiving chronic opioid therapy should be preemptively managed for constipation. While other options might be relevant in specific circumstances, they do not address the universal issue of opioid-induced constipation as effectively. Muscle relaxants and anti-nausea medications might be appropriate for certain patients in specific situations but are not necessary for all individuals on opioids. Regular blood tests are not typically required for monitoring the side effects of opioid therapy in a broad patient population. Thus, the recommendation to prescribe a stimulant laxative is aligned with best practices for managing the common and predictable complication of constipation in patients on