Deck 11: The Opioids

Question 1

The naturally occurring opiates include

A) heroin, hydromorphone, and oxycodone.
B) heroin, fentanyl, and methadone
C) pentazocine, meperidine, and buprenorphine.
D) thebaine, codeine, and heroin.

Answer 1

D

Question 2

The benefit of narcotic analgesics is that they

A) are not highly addictive.
B) are not associated with as many side effects as other classes of analgesic drugs.
C) effectively reduce pain without causing unconsciousness.
D) effectively reduce pain by suppressing CNS functioning.

Answer 2

C

Question 3

All of the following are effects of the class of drugs called narcotic analgesics except

A) relaxation.
B) diarrhea.
C) pain reduction.
D) euphoria.

Answer 3

B

Question 4

Heroin is

A) converted to morphine in the brain.
B) less lipid-soluble than morphine.
C) a partial agonist at the opiate receptor.
D) more potent than morphine if taken by mouth.

Question 5

Which statement about pure opiate antagonists is false?

A) They include drugs like naloxone and nalorphine.
B) They are important in understanding the action of narcotic analgesics.
C) They can reverse the effects of an opiate overdose in approximately two hours.
D) They have structures similar to opiates but produce no activity at the receptor.

Question 6

Which drug would be considered a partial agonist?

A) Codeine
B) Pentazocine
C) Methadone
D) Hydromorphone

Question 7

One common effect of increasing opiate dose is

A) euphoria.
B) elevated respiration rate.
C) increased sex drive.
D) increased awareness of one's surroundings.

Question 8

Opiates are dangerous at high doses due mostly to

A) their effects on cardiac muscle.
B) the increased likelihood of a stroke.
C) the suppression of the brainstem's respiratory center.
D) an overstimulation of the sympathetic nervous system.

Question 9

Peripherally acting opiate drugs have a specific therapeutic use that is also an unfortunate side effect of some opiate medications/drugs. Which of the following is this therapeutic use/side effect?

A) Reduction in saliva
B) Slowing of gastrointestinal function/motility
C) Decrease in body temperature
D) Decrease in appetite

Question 10

Which anti-diarrheal drug do some opioid-addicted individuals use to reduce vomiting and muscle ache associated with opioid withdrawal?

A) Methamphetamine
B) Imipramine
C) Loperamide
D) Aspirin

Question 11

The nociceptin/orphanin FQ receptor (NOP-R)

A) is genetically related to the classical opioid receptors, μ, δ, and κ.
B) has a high binding affinity for the endogenous opioids.
C) is found only in limbic areas and the spinal cord.
D) produces euphoria when activated.

Question 12

The μ-receptor

A) has been linked to hallucinations and dysphoria.
B) overlaps with the κ-receptor in its distribution in the nervous system.
C) is found in the hypothalamus and pituitary.
D) plays a role in analgesia and the rewarding effects of morphine.

Question 13

What do we know about the structure of the opiate receptors from receptor cloning studies?

A) Each receptor has between 650 and 700 amino acids.
B) The receptors appear to be metabotropic.
C) Each receptor has 12 transmembrane proteins.
D) Each receptor will bind to the same ligands in the same way.

Question 14

Which of the following is not one of the ways Pert and Snyder confirmed that they had in fact located and labeled opiate receptors?

A) They showed that the binding of radioactive naloxone increased until all receptors were fully occupied, then it leveled off.
B) They showed that the binding sites have a high affinity for the opiates tested.
C) They demonstrated that the binding and the physiological effects were completely irreversible.
D) They showed that the drug concentrations in the binding assay were similar to those needed to elicit a biological response.

Question 15

Which preparation was initially used to study the effects of pharmacological agents on the opiate receptor?

A) Guinea pig ileum
B) Spinal cord preparation
C) Cortical slice
D) Hippocampal slice

Question 16

Which of the following is a larger propeptide that is broken down into smaller active opioids?

A) PZM21
B) Propoxyphene
C) Pro-opiomelanocortin (POMC)
D) Pro-endomorphin

Question 17

The opioid propeptides

A) are made in the terminal button and cleaved by enzymes into the opiate peptides.
B) are processed by proteases into both opiate and non-opioid peptides.
C) are referred to as the "enkephalins."
D) include the endorphins and the endomorphins.

Question 18

Which statement about POMC is false?

A) POMC is the propeptide for the dynorphins.
B) Foot shock and swim stress increase POMC mRNA.
C) POMC is found in high concentration in the pituitary gland.
D) POMC is implicated in stress-induced analgesia.

Question 19

The peptide nociceptin/orphanin FQ (N/OFQ)

A) enhances opioid-mediated analgesia in supraspinal regions.
B) enhances motor performance.
C) is an analgesic at the spinal level.
D) suppresses feeding behavior.

Question 20

_______ is the natural ligand for the $\delta$ -receptor.

A) Dynorphin
B) Nociceptin/orphanin FQ
C) Endorphin
D) Enkephalin

Question 21

Which statement about the effects of opiates on synaptic transmission is false?

A) They act on receptors that are coupled to G proteins that open potassium channels, close calcium channels, and inhibit adenylyl cyclase.
B) They affect presynaptic autoreceptors and reduce the amount of transmitter released.
C) They cause postsynaptic depolarization by opening potassium channels.
D) They cause less transmitter to be released via axoaxonic inhibition.

Question 22

Postsynaptic inhibition by endorphins is caused by _______ of _______ channels.

A) opening; chloride
B) opening; potassium
C) closing; calcium
D) closing; potassium

Question 23

Which statement about the history of opium is true?

A) It has a long history of recreational use.
B) It was once a popular remedy for women in the form of IV heroin.
C) It did not have wide use until synthetic forms were produced.
D) It was historically restricted to medicinal use, not used recreationally.

Question 24

What was the view toward opiates in the late 1800s and early 1900s?

A) Individual states had begun to exert tight controls over access to opiates.
B) The federal government passed the Harrison Narcotics Act in 1886, essentially controlling all opiate transactions.
C) There was very little concern about safety, addiction, or health issues related to opiate use.
D) Physicians had to report their prescriptions for opiates to the government, but there was no general concern.

Question 25

Opiate drugs used medically are usually administered

A) orally, by IV, or by epidural or intrathecal routes.
B) via inhalation or smoking.
C) intranasally (snorting) or patches.
D) via subcutaneous injection.

Question 26

Nociceptors detect

A) intense pressure.
B) extreme temperature.
C) chemical irritants.
D) All of the above

Question 27

"First" or early pain

A) typically triggers withdrawal and escape responses.
B) provides information about the unpleasantness of the painful sensation.
C) is transmitted by neural pathways to the limbic system.
D) is often accompanied by autonomic responses, such as nausea.

Question 28

When you stub your toe on a hard object, the lingering ache you feel after the initial sharp pain has worn off is caused by

A) pain messages traveling in A $\delta$ fibers.
B) input reaching the somatosensory cortex and then being processed in adjacent areas.
C) information being carried in slowly conducting unmyelinated fibers.
D) rapid adaptation occurring at spinal cord levels.

Question 29

Both "early" and "late" pain are associated with neural activity in the

A) primary somatosensory cortex.
B) anterior cingulate cortex.
C) amygdala.
D) secondary somatosensory cortex.

Question 30

One study using higher spatial resolution magnetoencephalography (MEG) showed that painful stimuli applied to adjacent parts of the body approximately corresponded to activation of adjacent regions on _______ cortex but did not correspond to _______ cortex.

A) somatosensory; primary somatosensory
B) somatosensory; secondary somatosensory
C) cerebral; primary somatosensory
D) cerebral; secondary somatosensory

Question 31

The effects of analgesics on pain are difficult to study because

A) it is impossible to obtain subjective reports of pain.
B) most analgesics show ineffective or inconsistent analgesic effects.
C) ethical guidelines prohibit the application of painful stimuli to animals.
D) the high emotional impact of the pain elicited in a laboratory.

Question 32

Pain transmission in the spinal cord can be blocked by

A) the action of inhibitory spinal interneurons that release endorphins.
B) deactivating descending pathways from the forebrain that enhance the pain pathway.
C) turning off ascending pathways that activate endorphin interneurons.
D) All of the above

Question 33

The most important descending pathways for modulation of spinal cord transmission of pain originate in the

A) thalamus.
B) midbrain PAG.
C) limbic system.
D) anterior cingulate cortex.

Question 34

Electrical stimulation of the PAG

A) produces changes in sensations of touch and pressure.
B) produces a type of analgesia that is not blocked by naloxone.
C) activates dopamine cells in the medulla, which in turn inhibit spinal cord pain transmission.
D) most likely releases endogenous opiates that act on μ- and κ-receptors.

Question 35

Which statement about pain perception and opiate action at supraspinal levels is false?

A) This aspect of pain is often referred to as the affective component of pain.
B) Pain reduction at supraspinal levels is primarily mediated by δ-receptors.
C) Endocrine and autonomic responses to pain are controlled from these levels.
D) PET scans show a negative correlation between μ-receptor activation in several limbic structures and emotional pain scores.

Question 36

Which statement about additional forms of pain control is true?

A) Acupuncture-induced analgesia is blocked by µ-receptor antagonists.
B) Although inhibiting the two peptidases that degrade enkephalin produces significant analgesia, addiction potential is a concern.
C) An initial gene therapy trial used a virus engineered to contain the gene coding for human proenkephalin.
D) Although NOP-R agonists reduce pain, their use is limited by side effects such as constipation and respiratory depression.

Question 37

What is the significance of the finding that a traditional acupuncture session produces the same effect as a fake session (no needles penetrating the skin)?

A) Controlling for acupuncture effects is simple.
B) Acupuncture may produce placebo effects
C) The practitioner's affect is more important the actual acupuncture.
D) Acupuncture is not a useful tool for pain control.

Question 38

Which finding provides evidence that opioid drugs enhance the brain reward system in animal models?

A) Administration of opioids lowers the electrical current threshold for self-stimulation.
B) Administration of opioids raises the electrical current threshold for self-stimulation.
C) Animals self-administer opioids at increasing levels over time.
D) Animals self-administer opioids at decreasing levels over time.

Question 39

Since 1999, overdose deaths involving opioids have increased by more than _______, with the majority of this increase due to deaths related to _______ use.

A) two-fold; codeine
B) four-fold; oxycontin
C) six-fold; fentanyl
D) eight-fold; heroin

Question 40

Some researchers believe that opiates exert their effects on reinforcement by affecting cell bodies in the _______ that release _______.

A) nucleus accumbens; GABA
B) nucleus accumbens; dopamine
C) VTA; GABA
D) VTA; dopamine

Question 41

A model of the neurobiology of opiate reinforcement suggests that opiates produce their effects by inhibiting _______ neurons.

A) dopamine
B) GABA
C) dynorphin
D) β-endorphin

Question 42

Tolerance to opiate effects

A) is primarily due to increased rate of metabolism.
B) develops quite gradually over time.
C) is not specific to a given receptor type.
D) occurs rapidly for analgesic effects and slowly for constipating effects.

Question 43

The opiate withdrawal or abstinence syndrome

A) can be explained as a form of rebound CNS hyperactivity.
B) is considered to be a life-threatening condition.
C) involves intense inhibitory opiate action at all receptors.
D) lasts for about 48 hours; the user is then considered detoxified.

Question 44

Which brain area has not been implicated in the opiate withdrawal syndrome?

A) PAG
B) NAcc
C) Frontal cortex
D) Locus coeruleus

Question 45

Himmelsbach's classic model of opiate dependence as a disruption of homeostasis was confirmed physiologically by studying

A) changes in cAMP synthesis.
B) intracerebral injections of opiate antagonists.
C) place aversion for novel environments.
D) mechanisms underlying classical conditioning tolerance.

Question 46

Which factor does not increase the risk of opioid misuse?

A) Psychosocial stress
B) Older age
C) Genetic variant
D) Chronic pain condition

Question 47

Methadone is an effective treatment for opiate drug abuse because it

A) is short-acting and has a short half-life, making it easy to manage in terms of dose.
B) is cross-tolerant with abused opiates, so it can reduce the effects of morphine and heroin with repeated use.
C) does not interfere with sexual function.
D) does not cause constipation.

Question 48

Which of the following is not an advantage of buprenorphine maintenance compared to methadone maintenance?

A) Buprenorphine's shorter duration of action reduces the chance of overdose.
B) Buprenorphine can be administered with subcutaneous implants.
C) Buprenorphine does not require daily clinic visits.
D) Neonatal abstinence syndrome is milder in buprenorphine withdrawal.

Question 49

CDC federal guidelines for pain control

A) are intended to reduce opioid deaths and opioid abuse.
B) recommend the use of aspirin/ibuprophen or physical therapy rather than opiates.
C) make some physicians uneasy when they cannot relieve their patients' suffering.
D) All of the above

Question 50

Treatment programs for people addicted to opiates

A) have shown that unassisted detoxification, or going "cold turkey," is a very effective method.
B) sometimes employ the opiate antagonist buprenorphine.
C) typically use methadone maintenance strategies.
D) have recently incorporated the use of clonidine for blocking the opiate receptors in people with serious addiction.

Question 51

What is a major advantage of administering buprenorphine via the liquid depot injection method?

A) It is quicker-acting compared to other methods.
B) It provides a sustained blood levels of the drug, thereby reducing sudden cravings.
C) It produces a level of euphoria similar to the effect of opioids.
D) Its side effects diminish with repeated use.

Question 52

Distinguish between naturally occurring opiates, synthetic opiates, semisynthetic opiates, and endogenous opioids. Provide examples of each.

Question 53

Identify the four different types of opiate receptors and the endogenous ligands that show a relative preference for the receptor. List three potential roles for each.

Question 54

How were the endogenous ligands for the opiate receptors discovered? Name the four propeptides and give their approximate location. What is unique about the endomorphins?

Question 55

Describe the three basic ways that endorphins can exert inhibitory effects on synaptic transmission.

Question 56

Distinguish between "first" and "second" pain in terms of the nature of pain information being transmitted, the speed of the transmission, and the neural pathways activated.

Question 57

How has MEG technology helped to distinguish between fast and slow pain systems?

Question 58

Describe the basic ways that opioids can inhibit or reduce the transmission of pain at spinal levels. Where do some of these inhibitory pathways originate?

Question 59

What type of pain is modulated at supraspinal levels? Identify the brain areas that are involved in opiate modulation of pain at the supraspinal level.

Question 60

Provide evidence to show that the analgesic effect of electroacupuncture is dependent on opioids. Which opioid peptide is responsible?

Question 61

What is the rationale for the development of dual µ-receptor/NOP-R agonists? What research findings suggest these agents have clinical potential as analgesics?

Question 62

How do the different constitutive states of the µ-receptor affect different pain signaling pathways, specifically the beta arrestin protein signaling pathway and G-protein mediated signaling? What were the results of studies on these pain signaling pathways in mice and humans?

Question 63

Cite evidence showing that dopamine plays a key role in the reinforcing value of opiates. Identify two dopamine brain areas that are particularly important in this role. Researchers have recently proposed that dopamine is not required for this rewarding effect. Explain this statement.

Question 64

Explain how environmental cues can: (1) contribute to the development of tolerance, and (2) act as secondary reinforcers to strengthen drug-taking behavior and cause relapse.

Question 65

What are the factors that may help clinicians identify individuals who are vulnerable to potential opiate abuse and overdose and minimize that risk?

Question 66

Distinguish between tolerance, cross-tolerance, and sensitization. What physiological mechanism best explains opiate tolerance?

Question 67

Describe the symptoms, time course, and seriousness of opiate withdrawal. What parts of the brain appear to be involved in the abstinence syndrome?

Question 68

Describe the basic components of Himmelsbach's model of tolerance and withdrawal and provide physiological evidence that supports his ideas.

Question 69

Distinguish between the following treatments for opiate abuse: detoxification, maintenance, use of antagonists, and counseling. Mention therapeutic drugs, when relevant.

Question 70

For someone addicted to opiates, what are the advantages of buprenorphine maintenance compared to methadone?

Question 71

Describe the more recent buprenorphine treatments for opioid withdrawal. What are the advantages of these newer types of treatments?