Deck 6: Opioid (Narcotic)Analgesics and Antagonists

Question 1

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

A) Head injury
B) Nausea
C) Respiratory disease
D) Hypertension
E) Near-term pregnancy

Answer 1

Hypertension

Question 2

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

A) They are not addictive.
B) They are antitussive.
C) They are all useful if the patient is pregnant.
D) They cause less fluid retention (edema).

Answer 2

They are not addictive.

Question 3

Oral bioavailability of opioids is primarily limited by:

A) incomplete absorption.
B) first-pass metabolism.
C) side effects of nausea and vomiting.
D) enterohepatic circulation.
E) rapid renal excretion.

Answer 3

first-pass metabolism.

Question 4

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

A) Diarrhea
B) Miosis
C) CNS excitation
D) Hepatotoxicity

Question 5

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

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.

Question 6

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

A) Codeine
B) Hydrocodone
C) Hydromorphone
D) Oxymorphone

Question 7

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

A) Absorption may occur through mucous membranes of the nose but is not possible through intact skin.
B) The opioids are bound to plasma proteins to varying degrees and distributed throughout the body.
C) Given orally, opioids have vastly different durations of action for analgesia, ranging from 1 to almost 12 hours.
D) Metabolized opioids are excreted in urine; however, the unchanged drug is not.

Question 8

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

A) Miosis
B) Analgesia
C) Respiratory depression
D) Nausea
E) Histamine release

Question 9

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

A) pharmacologic action of codeine.
B) hypersensitivity reaction to codeine.
C) placebo effect from receiving codeine.
D) reaction unrelated to codeine administration.

Question 10

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

A) Hydromorphone
B) Methadone
C) Naltrexone
D) Both a and c
E) Both b and c

Question 11

Which is the major symptom of opioid overdose?

A) Miosis
B) Mydriasis
C) Urticaria
D) Respiratory depression

Question 12

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

A) Propoxyphene
B) Meperidine
C) Hydromorphone
D) Methadone

Question 13

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

A) prostaglandins
B) neurotransmitters
C) sedative-hypnotics
D) enzymes

Question 14

_____ is usually the cause of death with an overdose of opioids.

A) Tachycardia
B) Respiratory depression
C) Electrolyte imbalance
D) Cellular necrosis

Question 15

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

A) Diarrhea
B) Depression
C) Infections
D) Hypertension

Question 16

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

A) They are all antiinflammatory.
B) They are all analgesic.
C) They all inhibit platelet aggregation.
D) They are all antipyretic.

Question 17

Tylenol #3 contains _____ mg of codeine.

A) 7.5
B) 15
C) 30
D) 60

Question 18

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

A) Hydrocodone (Vicodin)
B) Morphine
C) Codeine
D) Oxymorphone

Question 19

Which opioid is commonly used as an antitussive?

A) Propoxyphene
B) Codeine
C) Diphenoxylate
D) Pentazocine

Question 20

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.

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

Question 21

Tapentadol is an oral opioid receptor _____ and a _____ reuptake inhibitor.

A) agonist; norepinephrine
B) agonist; acetylcholine
C) antagonist; norepinephrine
D) antagonist; acetylcholine

Question 22

The following statements are false of tramadol except which one?

A) It binds to mu opioid receptors.
B) It inhibits reuptake of serotonin and norepinephrine.
C) It modifies ascending pain pathways.
D) It causes mydriasis.
E) Its analgesic efficacy is equivalent to that of codeine.

Question 23

Which of the following choices is the drug of choice to treat a patient who has taken an overdose of an opioid?

A) 2-pralidoxime
B) Naloxone
C) N-acetylcysteine
D) Activated charcoal
E) Methadone

Question 24

How does adding naloxone to pentazocine reduce the addiction potential of orally administered pentazocine?

A) Naloxone is an opioid agonist that is effective orally but not parenterally.
B) Naloxone is an opioid agonist that is effective parenterally but not orally.
C) Naloxone is an opioid antagonist that is effective orally but not parenterally.
D) Naloxone is an opioid antagonist that is effective parenterally but not orally.
E) Naloxone is a nonsteroidal anti-inflammatory.

Question 25

Which of the following agents is a potent, short-acting, parenterally administered opioid that is commonly used during general anesthesia?

A) Dynorphin
B) Hydromorphone
C) Nalmefene
D) Fentanyl
E) Tramadol

Question 26

Morphine is stronger than oxycodone.

Question 27

Which of the following are classified as mixed opioid? (Select all that apply.)

A) Morphine
B) Pentazocine
C) Naloxone
D) Buprenorphine

Question 28

Combining an opioid with a nonopioid analgesic produces an additive analgesic effect with fewer adverse reactions.

Question 29

A patient who feels nauseated after taking codeine is allergic to it.

Question 30

Codeine activates the chemoreceptor trigger zone.

Question 31

Which of the following types of pain medications is the best choice for management of most dental pain?

A) Antidepressants
B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Aspirin
D) Acetaminophen

Question 32

Dentists prescribed about _____% of all opioids prescribed in the United States in 2002.

A) 2
B) 12
C) 22
D) 32
E) 42

Question 33

Which of the following agents is the only mixed opioid available for oral use?

A) Dezocine
B) Nalbuphine
C) Pentazocine
D) Butorphanol

Question 34

Which opioid analgesic is most likely to produce dysphoria?

A) Meperidine
B) Codeine
C) Pentazocine
D) Oxycodone
E) Hydrocodone

Question 35

Opioids are the first choice for the treatment of chronic pain, such as temporomandibular joint and muscle disorders.