Deck 10: Opioids

Question 1

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.

Answer 1

A

Question 2

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.

Answer 2

C

Question 3

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

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

Answer 3

D

Question 4

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

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

Question 5

Cell bodies of pain neurons from the periphery are located in the ______ neurons; terminals of primary afferent neurons from the periphery synapse 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 6

High densities of opiate receptors are found in the:

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

Question 7

The classical drug laudanum is a combination of opium and:

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

Question 8

Definitive evidence indicates that opium was used as analgesic:

A) 3000 years ago.
B) 5000 years ago.
C) 10,000 years ago.
D) for millennia.

Question 9

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 10

Nociceptors are activated by:

A) noise.
B) pain centers in the brain.
C) pain-inhibiting pathways.
D) mechanical,thermal,or chemical injury.

Question 11

Opioid receptors are best described as:

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

Question 12

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 13

Within the spinal cord,opiates reduce:

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

Question 14

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

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

Question 15

Met-enkephalin is produced from:

A) proenkephalin.
B) pro-dynorphin.
C) pre-enkephalin.
D) POMC.

Question 16

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.

Question 17

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 weaker than,morphine.

Question 18

The stimulus for pain sensation is:

A) pain.
B) pressure.
C) reflexive.
D) tissue damage.

Question 19

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 20

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

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

Question 21

The most common cause of death by Fentanyl overdose is:

A) cardiac arrhythmia.
B) seizure.
C) hypotension.
D) respiratory arrest.

Question 22

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

A) as a sublingual tablet.
B) intramuscular injection.
C) intravenous injection.
D) orally.

Question 23

The metabolism of heroin produces:

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

Question 24

Remoxy and Acurox are different formulations of:

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

Question 25

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 26

Carfentanil is intended for:

A) veterinary use.
B) mild pain.
C) long-term use in treating anxiety.
D) short-term use in treating depression.

Question 27

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

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

Question 28

The use of codeine is problematic because:

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

Question 29

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.

Question 30

Of the following,the most potent opiate is:

A) codeine.
B) morphine.
C) heroin.
D) hydromorphone (Dilaudid).

Question 31

Pentazocine (Talwin)and butorphanol (Stadol)are best described as:

A) opiate agonists.
B) mixed agonist-antagonists.
C) partial agonists.
D) opiate antagonists.

Question 32

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 33

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 34

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 35

Of the following,the major difference between morphine and heroin is in:

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

Question 36

Codeine is metabolized to:

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

Question 37

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 anti-manic drug.
D) has no action at the mu receptor.

Question 38

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 39

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

A) two
B) three
C) five
D) ten

Question 40

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 41

Heroin is absorbed into the CNS more quickly than morphine.

Question 42

Heroin is converted directly into morphine by the liver.

Question 43

Methadone is a natural mu agonist used for treating heroin dependency.

Question 44

Propoxyphene (Darvon)is more potent than codeine.

Question 45

Fentanyl (Sublimaze)is a potent opiate commonly used to relieve surgical pain.

Question 46

The analgesic action of the opiates partially occurs in the spinal cord.

Question 47

The FDA has banned Darvon and the drug is no longer commercially available.

Question 48

The terms opioid and narcotic may be used interchangeably.

Question 49

Opiates are thought to disinhibit dopaminergic neurons thereby increasing dopamine release in the nucleus accumbens.

Question 50

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 51

A new class of opioid drugs aimed at curbing abuse combine opiate agonists with:

A) methadone.
B) 5-HT reuptake inhibitors.
C) constipation-inducing agents.
D) opiate antagonists.

Question 52

Tramadol (Ultram)can increase the toxicity of 5-HT-based antidepressants.

Question 53

Codeine is converted into morphine by the liver.

Question 54

Opiates dilate pupils.

Question 55

Morphine is considered to be the prototype analgesic drug.

Question 56

Opioids are always classified as agonists at opiate receptors.

Question 57

Proenkephalin is a precursor for met-enkephalin.

Question 58

Opiate-induced analgesia occurs without affecting other sensory modalities.

Question 59

Pure opioid antagonists are derivatives of:

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

Question 60

Morphine is a synthetic opiate.

Question 61

Kratom,an herbal drug derived from the leaves of a plant native to Southeast Asia is frequently used in the treatment of opiate addiction in those countries.

Question 62

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

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

Question 63

The archetypal partial opioid agonist:

A) pentazocine (Talwin).
B) buprenorphine.
C) morphine.
D) naltrexone.

Question 64

A developing approach to heroin addiction is the use of vaccines.

Question 65

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 66

Codeine is particularly effective for its ______ effects.

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

Question 67

The classical opioid analgesic is:

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

Question 68

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 69

The street name for Desomorphine is krokodil.

Question 70

Buprenorphine is a natural kappa opioid agonist used in the treatment of opiate addiction.

Question 71

An important advantage of LAAM over methadone is its long duration of action.

Question 72

By definition,any exogenous drug that binds to an opiate receptor,provides relief from pain,and that may be blocked with an opiate antagonist is referred to as a(n):

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

Question 73

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 74

Carissa has become addicted to heroin.She comes from a family with substantial financial resources and it has been suggested that they try a controversial technique for treating her addiction called _____ detoxification.

A) buprenorphine-assisted
B) clonidine-assisted
C) rapid anesthesia-aided
D) fluoxetine-assisted

Question 75

_______ is an agonist at the KOP receptor.

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

Question 76

Nociceptive pain refers to pain caused by:

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

Question 77

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 78

Death associated with an acute opioid overdose is most likely due to:

A) cardiac volitility.
B) effects on the kidneys.
C) respiratory depression.
D) overall depression of brain activity.

Question 79

The subjective experience of pain occurs in the:

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

Question 80

Tolerance and dependence to opioids may be due to receptor:

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