Question 1

A patient presents with itching and urticaria after codeine administration.This response most likely represents a

Accepted Answer

The response is a pharmacologic action of codeine.Opioids can stimulate the release of histamine.Itching and urticaria can result from their administration.Although possible,true opioid allergy is very uncommon.Although a placebo effect may be observed with any drug,this choice is less likely.The reaction is probably related and a pharmacologic action of codeine.

Question 2

Which one of the following conditions can be managed or treated with opioids?

Accepted Answer

The opioids produce constipation by producing a tonic contraction of the gastrointestinal tract.They are used for the treatment of diarrhea.Opioids are not used for the treatment of depression,infections,or hypertension.

Question 3

Tolerance occurs to the following effects of the opioids except which one?

Accepted Answer

Tolerance will not develop to miosis and constipation.The rate is related to the strength of the opioid and its frequency of use.It can develop to all of the other listed effects.Tolerance is normally not a problem for those who take opioid analgesics for no more than 1 to 3 days as is the case with managing dental-related pain.Because the duration of use in dentistry is usually short,addiction does not often pose a problem for the dentist.

Question 4

Which of the following conditions is an adverse reaction to the opioids?

Accepted Answer

The opioid analgesics cause miosis (pinpoint pupils),an important sign in diagnosing an opioid overdose or identifying an addict.Opioids produce constipation and CNS sedation.They are not associated with hepatotoxicity.

Question 5

Tylenol #3 contains _____ mg of codeine.

Accepted Answer

Tylenol #3 contains 30 mg of codeine.Generally,doses greater than 30 to 60 mg of codeine are poorly tolerated by the patient (too much nausea).In pain studies,showing that 30 mg of codeine is any better than a placebo is difficult,and 60 mg of codeine has an analgesic strength approximately the same as 650 mg of aspirin,650 mg of acetaminophen,or 200 mg of ibuprofen.Tylenol #1 contains 7.5 mg of codeine,Tylenol #2 contains 15 mg of codeine,and Tylenol #4 contains 60 mg of codeine.

Question 6

Which of the following drugs can be used to treat heroin addiction?

Accepted Answer

Methadone is used by substituting methadone for heroin and then tapering off or maintaining the addict on oral methadone.Naltrexone,a long-acting opioid antagonist,is used to block the action of usual doses of opioid administered illicitly.Hydromorphone (Dilaudid)is the most potent opioid analgesic on a milligram-for-milligram basis.It is used to treat severe pain.It is a Schedule II narcotic and is not used to treat heroin addiction.

Question 7

Which is the major symptom of opioid overdose?

Accepted Answer

Respiratory depression occurs with opioid overdose,and this symptom can lead to death.Opioids cause miosis,not mydriasis,but the former is not a life-threatening symptom.Urticaria can be caused by opioids,but this is not life threatening in an overdose situation either.

Question 8

Beta-endorphin is a naturally occurring peptide with opioid-like action.It possesses analgesic action but has no addiction potential.

Accepted Answer

Endorphins,enkephalins,and dynorphins are naturally occurring peptides with opioid-like action.Endorphins,enkephalins,and dynorphins possess analgesic action and have addiction potential.An increase in beta-endorphins is associated with "runners high," the enhancement of well-being associated with running.

Question 9

Morphine has its most potent action on the _____ class of opioid receptors,and pentazocine has its most potent action on the _____ class of opioid receptors.

Accepted Answer

The three opioid receptors that have been characterized in more detail and that are stimulated by the opioids are the mu,kappa,and delta receptors.Other opioid receptors include sigma and epsilon.Stimulation of sigma receptors is associated with autonomic stimulation,dysphoria,hallucinations,nightmares,and anxiety.It is thought that stimulation of epsilon receptors may result in analgesia.Morphine is a mu-receptor agonist,and pentazocine is a kappa-receptor agonist.Stimulation of mu receptors produces analgesia.Stimulation of kappa receptors produces dysphoria.Morphine has no effect on the kappa receptor and produces less dysphoria than pentazocine.Pentazocine is a kappa receptor agonist that produces dysphoria.

Question 10

Which opioid is commonly used as an antitussive?

Accepted Answer

Opioids work to suppress cough by depressing the cough center in the medulla.The least potent opioids are effective because the dose that produces the antitussive effect is much lower than the dose needed for analgesia,so the least potent opioids,such as codeine,are effective.Propoxyphene is found in Darvocet N-100.Diphenoxylate is in Lomotil,which is used to treat diarrhea.Pentazocine produces central nervous system (CNS)effects not unlike the opioid agonists,including analgesia,sedation,and respiratory depression.

Question 11

What do aspirin,acetaminophen,ibuprofen,and codeine have in common?

Accepted Answer

All of them are analgesic.Aspirin and ibuprofen are analgesic,antipyretic,and antiinflammatory,and they inhibit platelet aggregation.Acetaminophen is analgesic and antipyretic.Codeine is analgesic.

Question 12

The following are conditions for which opioid analgesics should be used with extreme caution or not at all except which one?

Accepted Answer

Use of opioids is not contraindicated in hypertensive patients.Opioids may stimulate the vagus nerve,which causes bradycardia,a decrease in heart rate.Opioids are contraindicated for patients with head injury because they can increase intracranial pressure,nausea because they can exacerbate nausea,respiratory depression because they are additive,and near-term pregnancy because they are associated with near term fetal respiratory depression.

Question 13

Which of the following opioids is used primarily in the treatment of opioid addiction?

Accepted Answer

Methadone is used either to withdraw the patient gradually or for methadone maintenance.Because it has a longer duration of action,withdrawal from methadone is easier than from heroin.Because it is an opioid analgesic,however,the risk for dependence still exists.Propoxyphene is in Darvocet N-100;its analgesic efficacy has been questioned,and it is certainly no more efficacious than two tablets of aspirin or acetaminophen.Meperidine is intended for the acute management of moderate-to-severe pain.Hydromorphone is reserved for the management of severe pain.

Question 14

Enkephalins,endorphins,and dynorphins probably function as _____,although their exact function has not been elucidated.

Accepted Answer

Enkephalins,endorphins,and dynorphins are endogenous substances with opioid-like action.They probably function as neurotransmitters.They may be involved in the analgesic action of a placebo and the enhancement of well-being that occurs with running.Prostaglandins are produced in the body in response to many different stimuli.Prostaglandins are thought to be mediators of the inflammatory response in oral soft tissues and may be involved in the initial stage of periodontal disease.Sedative-hypnotics produce varying degrees of central nervous system (CNS)depression depending on the dose administered.Examples include benzodiazepines,barbiturates,and nonbenzodiazepine-nonbarbiturate sedative-hypnotics.An enzyme is a substance that catalyzes a chemical reaction without being changed by it.

Question 15

_____ is usually the cause of death with an overdose of opioid analgesics.

Accepted Answer

The opioid analgesic agonists depress the respiratory center in a dose-related manner.This action is usually the cause of death with an overdose.The depression is related to a decrease in the sensitivity of the brainstem to carbon dioxide.Both the rate and the depth of breathing are reduced.Opioids may depress the vasomotor center and stimulate the vagus nerve.Postural hypotension,bradycardia,and even syncope may result with high doses.Opioids can increase the smooth muscle tone in the urinary tract and cause urinary retention;however,this is not the primary cause of death.Cellular necrosis occurs following an injury and is not the predominant cause of death due to an overdose of opioids.

Question 16

Oral bioavailability of opioids is primarily limited by

Accepted Answer

The opioids undergo variable first-pass metabolism in the liver or intestinal cell wall,which reduces their bioavailability.Most opioid analgesic agents are absorbed well when taken orally.Opiates need to be available before they cause the side effects of nausea and vomiting.Most opioids are excreted through the kidneys,but this action does not selectively affect their availability after oral administration.

Question 17

Which of the following opioids is a metabolite of oxycodone that is three times more potent than oral morphine?

Accepted Answer

Oxymorphone is a metabolite of oxycodone that is available as parenteral short- and long-acting oral dose forms.It is three times more potent than oral morphine and provides adequate pain relief in cancer patients that have been switched from long-acting morphine or oxycodone.Codeine has a relatively weak analgesic action compared with morphine,hydromorphone,hydrocodone,or even oxycodone.Hydrocodone is a synthetic opioid that is metabolized to hydromorphone after oral administration.Hydromorphone is more potent that morphine and better absorbed orally,but it tends to produce similar adverse reactions.

Question 18

Which of the following products is the most commonly used opioid in dentistry?

Accepted Answer

Codeine is the most commonly used opioid in dentistry.It is used for moderate pain.It is often combined with acetaminophen (Tylenol #3)for oral administration.When codeine is combined with nonopioid analgesics,there is additive analgesic activity.In the combination products,lower doses of each analgesic may be used and there is potential for a reduction in adverse reactions.Hydrocodone,morphine,and oxymorphone are not the most commonly used opioids in dentistry.Hydrocodone (Valium)is a synthetic opioid used for moderate pain.There is a movement to reclassify hydrocodone combinations to Schedule II from Schedule III.Morphine and oxymorphone are used for severe pain.

Question 19

Which of the following statements is true concerning the pharmacokinetics of opioid analgesics?

Accepted Answer

Drugs such as opioids are bound reversibly to plasma proteins such as albumin and globulin.The drug that is bound to the protein does not contribute to the intensity of the drug action because only the unbound form is biologically active.Absorption occurs through the mucous membranes of the nose and the intact skin.Given orally,most opioids have a similar duration of action for analgesia-4 to 6 hours.Metabolized opioids and the unchanged drug are excreted in the urine.

Question 20

Which is an advantage of the nonsteroidal antiinflammatory drugs (NSAIDs)over the opioids for the management of dental pain in an opioid addict?

Accepted Answer

NSAIDs are not addictive,tolerance does not develop,and no withdrawal syndrome can be induced.NSAIDs should be used to control dental pain in the addict.NSAIDs are not antitussive,some are less useful than others in pregnant women,and NSAIDs can cause decreased renal function,leading to peripheral edema formation.

Quiz 6: Opioid Narcoticanalgesics and Antagonists