Deck 12: Naturally Occurring and Synthetic Opiates and Their Antagonists

Question 1

Newborns of narcotic dependent women

A)tend to have lower birth weights and are more excitable and irritable than normal babies
B)show the same physical abnormalities as the fetal alcohol syndrome
C)generally don't show any abnormal problems at birth
D)none of the above

Answer 1

A

Question 2

Briefly describe the system the British presently use in dealing with heroin addiction.

Answer 2

Since the early 1900s, the British have viewed addiction as a medical problem.Thus, they have allowed physicians to prescribe heroin, while criminal penalties are applied for the illicit sale of opiates.They presently allow only specially licensed physicians to prescribe heroin (or cocaine) for the addict, but they tend to emphasize the use of oral methadone.Although most of these physicians are affiliated with special Drug Dependence Units, any physician can apply for a license.

Question 3

What are three pharmacological characteristics that distinguish morphine from cocaine?

Answer 3

Morphine: reduces wakefulness and alertness; is an agonist at enkephalin receptors; can induce very uncomfortable withdrawal following chronic use; induces effects blocked by opiate antagonists; has potent analgesic properties; induces respiratory depression; induces constipation; constricts pupils.Cocaine: enhances wakefulness and alertness; blocks dopamine reuptake; induces no severe withdrawal following chronic use; effects not blocked by opiate antagonists; has little or no analgesic qualities-although it can act as a local anesthetic; induces no respiratory depression or constipation; dilates pupils.

Question 4

With chronic exposure, which of these opioids will result in tolerance to many of its effects?

A)heroin
B)methadone
C)enkephalins
D)all of these

Question 5

What are three pharmacological characteristics of buprenorphine (Suboxone, Subutex) or LAAM (Orlamm) that would make them potentially useful in the treatment of heroin addiction?

Question 6

The euphorigenic properties of opiates like morphine are believed to be due to their activity at which type of receptor?

A)mu
B)kappa
C)sigma
D)5-HT

Question 7

Which of these is the most potent and short-acting narcotic?

A)morphine
B)heroin
C)fentanyl
D)methadone

Question 8

Which of the following is not a common effect of opiates?

A)pupillary dilation
B)constipation
C)decreased sex drive
D)decreased rate of respiration

Question 9

Heroin differs from morphine primarily with respect to its

A)neuropharmacological effects
B)relative ability to cross the blood brain barrier
C)degree of analgesia when taken orally
D)molecular structure

Question 10

Which of the following opioid peptides has properties of synthetic opiates?

A)enkephalins
B)endorphins
C)dynorphins
D)all of these

Question 11

Compare and contrast the relative efficacy of methadone (Dolophine) and naltrexone (ReVia) in the treatment of heroin addiction.

Question 12

The use of heroin under sterile conditions has been associated with lesions and/or cell death in the

A)kidney
B)liver
C)brain
D)none of these

Question 13

The abstinence syndrome associated with withdrawal from chronic heroin use is generally ________________________ with methadone withdrawal.

A)less severe than
B)more intense than
C)longer lasting than
D)the same intensity and duration as

Question 14

Methadone is

A)more potent than heroin or morphine
B)less potent than heroin or morphine
C)neither a nor b because methadone is a narcotic antagonist
D)either a or b could be true depending upon the route of administration and what the drugs are taken for

Question 15

Which of the following would narcotic addicts being treated for their addiction most likely to continue taking on a maintenance basis?

A)naloxone
B)naltrexone
C)methadone
D)clonidine

Question 16

The abstinence syndrome associated with opiate withdrawal

A)is similar to the symptoms of a severe flu
B)is often life-threatening
C)can be terminated with alcohol intake
D)can be terminated with a narcotic antagonist

Question 17

A primary advantage to the use of methadone over most other narcotics like morphine and heroin

A)is its ability to be reliably absorbed when taken orally
B)is its relatively long duration of action
C)is its more gradual and stable effects
D)all of the above

Question 18

What are three features of narcotics that distinguish them pharmacologically from other drugs with sedative-hypnotic properties, such as barbiturates and benzodiazepines?

Question 19

What factors account for the majority of deaths associated with heroin use?
e.g., alcohol, cocaine, can also cause death.Sometimes, adulterants mixed with heroin are implicated in heroin deaths.
e.g., poor nutrition, sharing of needles, drug deals that turn violent.As a result AIDS and other infectious agents are most common causes of death.Also, interactions between heroin and other drugs,

Question 20

Both methadone (Dolophine) and naltrexone (ReVia), drugs with very difference pharmacological properties, have been used in the treatment of heroin addiction.What is/are the rationales for the use of methadone and naltrexone in this problem?

Question 21

Chronic exposure to endorphins may result in

A)tolerance to many of their effects
B)physical dependence
C)opiate receptor desensitization
D)all of these

Question 22

Most of the deaths attributed to narcotic use are the result of

A)complications arising from the addicts' life-style
B)inadvertent use of large doses of opiates
C)pneumonia
D)sudden loss of opiate tolerance

Question 23

The receptors upon which opiates act

A)vary in terms of their types and distribution throughout the CNS
B)are found only in the midbrain and medulla
C)are different from those receptors which are acted on by endogenous opioid peptides
D)are also those for which cocaine is an agonist

Question 24

Which of these drugs would successfully reverse the effects of narcotics in an acute overdose?

A)methadone
B)clonidine
C)naloxone
D)LAAM (Orlamm)

Question 25

Which of the following are narcotic antagonists?

A)naloxone and naltrexone
B)methadone and LAAM
C)clonidine and buprenorphine
D)all of these

Question 26

Ultrarapid opioid detoxification utilizes a procedure that involves administering to an opiate dependent person

A)frequent, high doses of methadone
B)narcotic antagonists while he/she is anesthesized or heavily sedated for 24 - 48 hours
C)morphine and naltrexone together for several hours
D)endogenous antiopioid peptides for 24 to 48 hours

Question 27

The narcotic antagonists naloxone and naltrexone

A)will block virtually all the effects of narcotics like morphine and heroin
B)will induce an opiate-like abstinence syndrome if taken chronically
C)will decrease the craving for narcotics in people who have been dependent on narcotics
D)all of the above

Question 28

A key property of opioid drugs which underlies their addiction liability is their ability to indirectly activate _________________________ neurons projecting to the nucleus accumbens.

A)cholinergic
B)serotonergic
C)noradrenergic
D)dopaminergic

Question 29

Which of the following is NOT a feature of the way heroin addiction is dealt with in the United Kingdom?

A)heroin addiction is viewed more as a medical problem than a criminal activity
B)any physician in the United Kingdom can prescribe heroin to heroin addicts
C)most heroin addicts seeking prescriptions for heroin are treated in special Drug Dependence Units
D)methadone is promoted as the most appropriate maintenance drug for addicts

Question 30

In the treatment of heroin addiction, the narcotic agonist LAAM (Orlamm) and the mixed agonist-antagonist buprenorphine (Suboxone, Subutex) have advantages over methadone in terms of

A)suppressing the addicts' use of heroin
B)effectiveness in withdrawal detoxification
C)blocking the effects of heroin
D)their considerably longer durations of action

Question 31

The Harrison Act of 1914 made it illegal in the U.S.to

A)prescribe heroin for any purpose
B)sell narcotics except by a prescription obtained from a physician
C)import narcotics from other countries
D)prescribe narcotics to opiate dependent persons

Question 32

Opioid antagonists have been found to be useful in

A)preventing relapse in recovering opiate addicts
B)blocking acute opiate overdoses
C)the treatment of Alzheimer's disease symptoms
D)only a and b

Question 33

Naltrexone (ReVia) is not likely going to be a very common treatment for heroin addiction because

A)it does not block the effects of opiates like heroin and morphine very well
B)it produces a fairly strong degree of physical dependence of its own
C)it does not reduce the psychological craving for opiates in the addict
D)all of the above

Question 34

Buprenorphine (Suboxone, Subutex)

A)is a long-acting narcotic with mixed agonist-antagonist properties
B)is a fast-acting, opiate-like designer drug
C)induces a short lived, but highly intense abstinence syndrome after chronic exposure
D)is a pure opiate antagonist

Question 35

If patients with chronic pain and without a history of psychological disturbances or substance abuse are allowed to self-administer narcotics to control their pain, the majority of them

A)develop a strong addiction to narcotics
B)self-administer much larger doses than they would if the narcotics were administered to them by physicians at fixed intervals
C)develop a rapid and marked tolerance to the effects of narcotics
D)none of the above

Question 36

Opiates have the greatest clinical efficacy in reducing ________________________.

A)sharp, fast onset pain induced by a noxious stimulus
B)dull, aching pain that persists after a noxious stimulus has been applied
C)both sharp, fast onset and dull, aching pain to a comparable degree
D)non-emotional pain

Question 37

Why is clonidine believed to be useful in the treatment of opiate withdrawal?

A)it reduces the hyperactivity in the locus ceruleus that accompanies opiate withdrawal
B)it blocks opiate craving
C)it acts at mu opiate receptors
D)it acts on delta opiate receptors

Question 38

Which of the following is NOT a common effect of opiate administration?

A)analgesia
B)constipation
C)enhanced sex drive
D)respiratory depression

Question 39

Which of the following narcotics has the longest duration of effect?

A)heroin
B)morphine
C)methadone
D)buprenorphine (Suboxone, Subutex)

Question 40

Which of the following has NOT been associated with the legal restrictions resulting from the Harrison Narcotic Act of 1914?

A)increased use of intravenous narcotic use
B)decreased narcotic related crime
C)increased price of illicit narcotics
D)increased toxicity and lethality associated with using illicit narcotics

Question 41

Opioid antagonists have been found to be useful in

A)reducing the likelihood of relapse in some recovering opiate addicts
B)blocking acute opiate overdoses
C)the treatment of Alzheimer's disease symptoms
D)only a and b Chapter 12 Answers to multiple choice questions and

Question 42

The FDA has recently approved the use of Suboxone, which is a combination of buprenorphine and naloxone, in the treatment of opiate addiction.The addition of naloxone to buprenorphine

A)enhances the actions of buprenorphine on opiate receptors
B)decreases the likelihood of illicit use of Suboxone
C)increases the duration of action of buprenorphine