Deck 10: Opioid Analgesics

Question 1

Ancient use of opium was probably primarily for its _____ effect.

A)constipating
B)stimulating
C)calming
D)antidepressant

Answer 1

A

Question 2

The use of pure opiate antagonists,such as naltrexone,on opiate-dependent subjects is intended to:

A)increase pain threshold.
B)decrease pain threshold.
C)enhance the analgesic effects of heroin.
D)block the euphoric effects of heroin.

Answer 2

D

Question 3

Compared with a pure agonist,a partial agonist in drug-naive subjects:

A)has no effect.
B)has effects opposite to the agonist.
C)will produce analgesia.
D)will trigger depression.

Answer 3

C

Question 4

Neuropathic pain is caused by all of the following EXCEPT:

A)a lesion of the nervous system.
B)neuronal injury.
C)infection.
D)tissue damage.

Question 5

The _____ requires that manufacturers list the ingredients of their products on their labels.

A)Internal Revenue Service
B)Food and Drug Administration
C)Pure Food and Drug Act
D)Harrison Narcotic Act

Question 6

The mixed agonist-antagonist pentazocine (Talwin)has its greatest effect at the _______ receptor.

A)mu
B)delta
C)kappa
D)sigma

Question 7

In any given year,approximately _____ million people report chronic pain in the United States.

A)6
B)12
C)24
D)48

Question 8

Compared with a pure agonist,a mixed agonist-antagonist in drug-naive subjects has:

A)no effect.
B)effects opposite to the agonist.
C)lower efficacy.
D)higher efficacy.

Question 9

__________ is the classical opioid analgesic.

A)Heroin
B)Morphine
C)Codeine
D)Opium

Question 10

Definitive evidence indicates that opium was used as an analgesic:

A)3000 years ago.
B)5000 years ago.
C)10,000 years ago.
D)since the third century BCE.

Question 11

By definition,any exogenous drug that binds to an opiate receptor provides relief from pain.Therefore,any exogenous drug may be blocked by a(n)_____ antagonist.

A)narcotic
B)opiate
C)opioid
D)morphine

Question 12

For health care professionals,__________ is the greatest concern when prescribing opioid pain relievers.

A)addiction
B)efficacy rate
C)overdose deaths
D)other adverse effects

Question 13

__________ is the archetypal partial opioid agonist.

A)Pentazocine (Talwin)
B)Buprenorphine
C)Morphine
D)Naltrexone

Question 14

In the United Sates,approximately _____ million people suffer from pain each year.

A)25
B)50
C)75
D)100

Question 15

Documented opioid abuse,dating back to the __________,reveals how long it has existed in the United.

A)late 1700s.
B)early 1800s.
C)late 1800s.
D)early 1900s.

Question 16

__________ is the stimulus for pain sensation.

A)The CNS
B)Pressure
C)A muscle reflex
D)Tissue damage

Question 17

In opiate-dependent subjects,a mixed agonist-antagonist opiate would:

A)precipitate withdrawal symptoms.
B)stimulate euphoria.
C)encourage compulsive use of the drug.
D)trigger mania.

Question 18

The _____ mandated that only licensed physicians and dentists could prescribe opioids.

A)Internal Revenue Service
B)Food and Drug Administration
C)Pure Food and Drug Act
D)Harrison Narcotic Act

Question 19

The classical drug laudanum combines _____ and opium.

A)cocaine
B)ethanol
C)cholinergic blockers
D)aspirin

Question 20

In morphine-dependent subjects,administration of a mixed agonist-antagonist:

A)produces effects similar to morphine.
B)produces no effects.
C)induces withdrawal.
D)produces effects similar to,but is weaker than,morphine.

Question 21

The existence of a nociceptin (NOP)receptor has been questioned because it does not respond to:

A) $\beta$ -endorphin.
B)dynorphin-A.
C)dynorphin-B.
D)naloxone.

Question 22

__________ activates the nociceptors.

A)Noise
B)Pain centers in the brain
C)Pain-inhibiting pathways
D)Mechanical,thermal,or chemical injury

Question 23

Exogenous and endogenous opiates exert effects in all of the following sites EXCEPT the:

A)dorsal horn of the spinal cord.
B)rostral ventral medulla.
C)caudal medulla.
D)periaqueductal gray.

Question 24

Relief from pain via opioid analgesia is thought to be due to activity at _____ receptors in the brain.

A)KOP
B)delta
C)kappa
D)mu

Question 25

Death from __________ is most often associated with an acute opioid overdose,

A)cardiac volatility
B)kidney damage
C)respiratory depression
D)overall depression of brain activity

Question 26

_______ is an agonist at the KOP receptor.

A)Met-enkephalin
B)Dynorphin-A
C)POMC
D)Endomorphin-1

Question 27

Opioid receptors are best described as:

A)directly gated.
B)G-protein coupled.
C)voltage gated.
D)mechanically gated.

Question 28

The major analgesic effects of opiates are the result of action at the ______ receptor.

A)mu
B)delta
C)kappa
D)sigma

Question 29

Opiates reduce __________ within the spinal cord,.

A)presynaptic dopamine receptors
B)the release of GABA
C)ascending pain signals
D)mu receptors

Question 30

The reward effects of opiates is thought to be due to:

A)effects on the glutamatergic system.
B)excitation of GABAergic neurons in the ventral tegmental area.
C)increased dopamine release in the nucleus accumbens.
D)enhanced dopamine binding at presynaptic receptors.

Question 31

Analgesic drugs can modulate pain by all the following processes EXCEPT to:

A)reduce inflammation.
B)reduce the excitatory input from primary afferent axons.
C)activate descending fibers from the brain to the dorsal horn of the spinal cord.
D)inhibit endorphin-secreting neurons in the dorsal horn of the spinal cord.

Question 32

Tolerance and dependence to opioids may be due to receptor:

A)sensitization.
B)upregulation.
C)downregulation.
D)desensitization.

Question 33

The cell bodies of pain neurons from the periphery are located in the ______ neurons,whereas the terminals of primary afferent neurons from the periphery synapse are located in the ______.

A)dorsal horn; brain stem
B)dorsal root ganglia; dorsal horn
C)dorsal horn; dorsal root ganglia
D)dorsal root ganglia; brain stem

Question 34

Within the spinal cord,opiates:

A)bind to receptors on presynaptic terminals nociceptive afferents.
B)inhibit GABA.
C)facilitate the release of substance P.
D)stimulate the release of CGRP.

Question 35

Pain caused by a(n)__________ is nociceptive pain.

A)neuronal injury
B)dysfunction within the nervous system
C)tissue damage
D)infection

Question 36

Codeine is particularly effective for its ______ effects.

A)analgesic
B)antitussive
C)chemoreceptive
D)constipating

Question 37

Neural pathways mediating analgesia from the brain to the dorsal horn of the spinal cord are classic examples of:

A)ascending transmission.
B)presynaptic facilitation.
C)descending inhibition.
D)reflect arcs.

Question 38

__________ produces met-enkephalin.

A)Proenkephalin
B)Prodynorphin
C)Preenkephalin
D)POMC

Question 39

The subjective experience of pain occurs in the:

A)dorsal root ganglion.
B)thalamus.
C)periaqueductal gray.
D)cortex.

Question 40

High densities of opiate receptors are found in the:

A)cortex.
B)hypothalamus.
C)periaqueductal gray.
D)hippocampus.

Question 41

__________ is a long-acting formulation of morphine.

A)MS-Contin
B)Rylomine
C)Fentanyl
D)Monoacetylmorphine

Question 42

In comparison to morphine,heroin is ______ times more potent.

A)CYP-3A4.
B)CYP-2D6.
C)CYP-2P6.
D)CYP-3D4.

Question 43

In urine tests,heroin use is confirmed by the presence of:

A)6-monoacetylmorphine.
B)morphine-6-glucuronide.
C)morphine.
D)codeine.

Question 44

The metabolism of heroin produces:

A)monoacetylmorphine.
B)morphone.
C)morphine.
D)monoacetylmorphine and morphine.

Question 45

Remoxy and Acurox are different formulations of:

A)morphine.
B)oxycodone.
C)heroin.
D)hydrocodone.

Question 46

Selective serotonin reuptake inhibitors:

A)have no interaction with codeine.
B)can potentiate the effectiveness of codeine.
C)can block the receptor for codeine.
D)can inhibit the metabolism of codeine,thereby blocking pain relief.

Question 47

An important issue for depressed patients prescribed codeine for pain is that:

A)several common SSRIs block the conversion of codeine to morphine.
B)decreased number of SSRIs cause codeine to be converted to heroin.
C)it causes significant respiratory depression in these individuals.
D)drug combinations reduce the effectiveness of codeine down to about 1 hour.

Question 48

Of the following,the __________ is the major difference between morphine and heroin.

A)efficacy
B)ceiling effect
C)rate of elimination
D)rate of absorption

Question 49

The first-pass metabolism of morphine produces:

A)inactive metabolites only.
B)an active metabolite.
C)codeine.
D)both an active metabolite and codeine.

Question 50

Carissa has become addicted to heroin.She comes from a family with substantial financial resources.Following a suggestion,her parents want her to try ______-aided or -assisted detoxification treatment,a controversial form of therapy.

A)buprenorphine
B)clonidine
C)rapid anesthesia
D)fluoxetine

Question 51

The use of codeine is problematic because:

A)it is metabolized into heroin.
B)20 percent of Americans have a genetic variation that causes codeine to be metabolized very slowly.
C)10 percent of Americans possess a genetic variation causing codeine to be rapidly metabolized.
D)5 percent of Americans are unable to metabolize the drug resulting in toxic effects.

Question 52

Clonidine (Catapress)is a potent alpha-2-agonist that suppresses activity of locus coeruleus neurons.Based on your knowledge of the physiology of withdrawal,you would expect clonidine to:

A)have no effect on opiate withdrawal.
B)increase the severity of opiate withdrawal.
C)decrease the severity of opiate withdrawal.
D)have different effects depending on dopamine levels.

Question 53

______ is no longer sold in the United States because of reports of potential fatal heart rhythm abnormalities induced by the drug.

A)Percodan
B)Fentanyl
C)Demerol
D)Darvon

Question 54

Codeine is metabolized to:

A)morphone.
B)cocaine.
C)morphine.
D)heroin.

Question 55

The main difference between OxyContin and Percodan is that OxyContin:

A)is short-acting.
B)is rarely abused.
C)affects different opiate receptor subtypes.
D)is long-acting.

Question 56

Which of the following statement is TRUE?

A)Morphine crosses the blood-brain barrier rapidly.
B)Morphine is more water soluble.
C)Morphine is more lipid soluble.
D)Morphine causes a euphoric "rush" when injected that users describe as orgasmic.

Question 57

Of the prescription pain medications,_______ is currently the most commonly abused drug.

A)Vicodin
B)Lortab
C)Percodan
D)Dilaudid

Question 58

To curb prescription drug abuse,all of the following represent approaches that the pharmaceutical industry is trying EXCEPT:

A)reformulating existing opioid drugs.
B)developing new compounds that do not work through the typical opiate pathways.
C)investigating novel opiate substances that are more resistant to tampering.
D)developing online continuing education programs for physicians that treat patients with chronic pain.

Question 59

All of the following alkaloids (plant-derived amines)can be isolated from the poppy plant EXCEPT:

A)papaverine.
B)heroin.
C)morphine.
D)codeine.

Question 60

Of the following,__________ is the most potent opiate.

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

Question 61

Pure opioid antagonists are derivatives of:

A)oxymorphone.
B)heroin.
C)morphine.
D)codeine.

Question 62

__________ best describes the drugs pentazocine (Talwin)and butorphanol (Stadol).

A)Opiate agonists
B)Mixed agonist-antagonists
C)Partial agonists
D)Opiate antagonists

Question 63

The effects of naloxone (Narcan)on drug-naïve subjects:

A)is a decreased pain threshold.
B)causes dysphoria.
C)produces analgesia.
D)is nonexistent.

Question 64

Naloxone (Narcan)is typically given in any of the following forms EXCEPT:

A)a sublingual tablet.
B)an intramuscular injection.
C)an intravenous injection.
D)an oral form.

Question 65

__________ are a new class of opioid drugs aimed at curbing abuse.

A)Methadone formulations
B)5-HT reuptake inhibitors
C)Constipation-inducing agents
D)Opiate antagonists

Question 66

Tramadol (Ultram)is a unique analgesic in that it:

A)is both an opiate analgesic,a serotonin,and a norepinephrine reuptake blocker.
B)is both an opiate analgesic and an anxiolytic.
C)is both an opiate analgesic and an antimanic drug.
D)has no action at the mu receptor.

Question 67

__________ is the most common cause of death due to fentanyl overdose.

A)Cardiac arrhythmia
B)Seizure
C)Hypotension
D)Respiratory arrest