CHAPTER 20 | Opioids

Question 1

Intermediate group of OPIOIDS are the following EXCEPT:

A. Morphine
B. Methadone
C. Oxycodone
D. Sufentanil

Answer 1

D. Sufentanil

Opioids can be classified according to strength or potency based on the plasma concentrations at which they exert their
effects (C50 or the plasma concentration causing a 50% effect).

Strong opioids include fentanyl, sufentanil, and remifentanil.

An intermediate group includes morphine, methadone, oxycodone, and buprenorphine.

Weak opioids include codeine and tramadol

Question 2

It is a paradoxical opioid effect whereby pain sensitivity increases during or following escalating opioid treatment?

Answer 2

Opioid-induced hyperalgesia

Question 3

TRUE or FALSE

Tolerance to opioid-induced respiratory depression develops more slowly than tolerance to pain relief

Answer 3

TRUE

Tolerance is a dynamic process and after a long period of abstinence from opioids, the risk of opioid toxicity increases.

Question 4

TRUE of Context-Sensitive halftime:

A. This is the time needed for the
opioid’s plasma concentration to decrease by 50% from a steady-state concentration.

B. The value of context-sensitive halftime is ALWAYS constant but is dependent on the duration of the infusion of the opioid.

C. The CSt½ of remifentanil is DEPENDENT of the infusion duration due to its rapid elimination from plasma by nonspecific plasma esterases in plasma

Answer 4

A. This is the time needed for the
opioid’s plasma concentration to decrease by 50% from a steady-state concentration

Question 5

Which of the following opioid has the FASTEST ONSET?

A. Alfentanil
B. Fentanyl
C. Remifentanil
D. Hydromorphone

Answer 5

A. Alfentanil

ALFENTANIL has the FASTEST onset time of all opioids (~90 seconds);

pKa = 6.5

It crosses the blood-brain barrier rapidly despite high protein binding.

Question 6

The analgesia produced by mu (μ) opioid receptor agonism in the brain is specifically located in:

Answer 6

Question 7

OPIOID receptors:

Answer 7

Question 8

The capacity to experience withdrawal when opioids are tapered or when an opioid reversal agent is given:

A. Addiction
B. Tolerance
C. Dependence
D. Withdrawal

Answer 8

C. Dependence

Question 9

TRUE or FALSE

Opioids reduce the requirement of inhalational anesthetics and propofol during anesthesia

Answer 9

TRUE

Question 10

Serotonin syndrome is manifested as a triad of SOMATIC, AUTONOMIC, and NEUROPSYCHIATRIC derangements. In cases of Serotonin syndrome, which of the following should NOT be used:

A. Lorazepam

B. Ondansetron

C. Midazolam

D. Cyproheptadine

Answer 10

A. Ondansetron