Chapter 30 - Drug Abuse Toxicology Flashcards
In 2003, the leading 2 illicit drugs causing death reported to the Drug Abuse Warning Network (DAWN) were…
A. Heroin and cocaine
B. Methadone and fentanyl
C. Methamphetamine and hydrocodone
D. Cocaine and oxycodone
A. Heroin and cocaine
An estimation of the amount of cocaine use in a community could best come from…
A. Hospital admissions
B. Police arrests
C. Concentration of metabolites in water supply
D. Interviews
C. Concentration of metabolites in water supply
The ratio of cocaine to benzoylecgoninc in a postmortem brain specimen can best be an indicator of…
A. Rate of hepatic drug metabolism
B. Time of ingestion
C. Cause of death
D. Source of drug
B. Time of ingestion
The predominant cocaine analyte measured in human hair is…
A. Cocaine
B. Coacaethylene
C. Norcaine
D. Benzoylecgonine
A. Cocaine
All of the following are true regarding cocaine except…
A. Tolerance to its effects can develop
B. Myocardial fibrosis can occur in chronic users
C. There can be postmortem redistribution
D. There is a good correlation between postmortem levels and cause of death
D. There is a good correlation between postmortem levels and cause of death
All of the following plants produce chemicals that have a stimulant effect except…
A. Oleander
B. Khat
C. Ephedra
D. Absinthe
A. Oleander
All of the following are true regarding methamphetamine except…
A. It is N-demethylated to amphetamine
B. At low doses, it impairs psychomotor performance
C. The urine immunologic screening test is considered positive at 1,000 mg / L or greater
D. Selegiline can be converted in vivo to methamphetamine
B. At low doses, it impairs psychomotor performance
In the presence of ethanol, cocaine will be metabolized to…
A. Norcocaine
B. Methylecgonine
C. Benzoylecgonine
D. Cocaethylene
D. Cocaethylene
The major pyrolysis product of cocaine is…
A. Norcocaine
B. Methylecgonine
C. Anhydroecgonine methyl ester
D. Cocaethylene
C. Anhydroecgonine methyl ester
Cocaine is primarily metabolized by…
A. CYP450 2B6
B. Glucuronidation
C. Esterases
D. Acetylation
C. Esterases
The L isomer of methamphetamine is commercially available as…
A. Pseudoephedrine
B. Phenylephdrine
C. Vicks decongestant
D. Phenylpropanolamine
C. Vicks decongestant
A marker for smoked methamphetamine is…
A. Norephedrine
B. trans-phenylpropene
C. O-hydroxynorphedrine
D. P-hydroxymethamphetamine
B. trans-phenylpropene
The urinary excretion of methamphetamine can be decreased by…
A. Phenobarbital
B. Basic urine
C. Acidic urine
D. Ammonium chloride
B. Basic urine
Eighty percent of methylphenidate is excreted in the urine as…
A. Unchanged drug
B. Ethylphenidate
C. Ritalinic acid
D. Amphetamine
C. Ritalinic acid
Methylphenidate differs from cocaine and amphetamine in that…
A. It blocks the dopamine transporter
B. It blocks the norepinephrine
C. It has a low affinity for the 5HT transporter
D. It has a higher potential for abuse
C. It has a low affinity for the 5HT transporter
GHB has increasingly been used as an agent to…
A. Induce anesthesia
B. Treat status epilepticus
C. Facilitate sexual assault
D. Counteract cocaine-induced delirium
C. Facilitate sexual assault
All of the following are true regarding dextromethorphan except…
A. It has been associated with the serotonin syndrome
B. it is highly first passed
C. It is metabolized by CYP2D6
D. It is a racemic mixture
D. It is a racemic mixture
All of the following are considered benzodiazepines except…
A. Oxazepam
B. Eszopiclone
C. Chlordiazepoxide
D. Clorazepate
B. Eszopiclone
All of the following could be metabolized to oxazepam except..
A. Lorazepam
B. Temazepam
C. Diazepam
D. Prazepam
A. Lorazepam
All of the following are true regarding benzodiazepines except…
A. Withdrawal convulsions can occur
B. Overdose of benzodiazepines alone rarely cause death
C. Lorazepam and oxazepam do not undergo CYP450-mediated biotransformation
D. Ibuprofen can cause a false positive result on urine screen tests
D. Ibuprofen can cause a false positive result on urine screen tests
All of the following are true of normeperidine except…
A. It strongly binds to mu opioid receptors
B. More is formed after oral meperidine administration than through intravenous administration
C. It causes serotonin excess in the CNS
D. It is responsible for possible precipitation of the serotonin syndrome when merperidine is given concurrently with a MAO inhibitor
A. It strongly binds to mu opioid receptors
All of the following are metabolites of oxycodone except…
A. Codine
B. Oxymorphone
C. Noroxycodone
D. Oxycodone glucuronide
A. Codine
An opiate not metabolized by the P450 system is…
A. Buprenorphine
B. Fentanyl
C. Oxymorphone
D. Propoxyphene
C. Oxymorphone
Propoxyphene is a derivative of…
A. Meperidine
B. Methadone
C. Fentanyl
D. Morphine
B. Methadone
The cardiac toxicity of propoxyphene results from..
A. Dextropropoxyphene
B. Levopropoxyphene
C. EDDP
D. Norpropoxyphene
D. Norpropoxyphene
The mechanism of action of phencyclidine is…
A. Agonist at the glycine receptor
B. Noncompetitive antagonist at glutamate-NMDA receptor
C. Blockade of dopamine release
D. Stimulation of central acetylcholine release
B. Noncompetitive antagonist at glutamate-NMDA receptor
Blood levels of phencyclidine…
A. Strongly correlate with psychedelic effects
B. Are present only for minutes before being converted to an active metabolite
C. Could be present from phencyclidine use weeks before the level was drawn
D. Are approximately 10x higher than brain levels
C. Could be present from phencyclidine use weeks before the level was drawn
All of the following are true of phencyclidine except…
A. It is classified as a dissociative anesthetic
B. It can be snorted, smoked, injected or swallowed
C. Glucuronide metabolites are excreted in the urine
D. Alkalinization of the urine enhances its elimi ation
D. Alkalinization of the urine enhances its elimi ation
The reason that ketamine is used for induction of anesthesia in trauma victims is that ketamine causes…
A. Increased blood pressure
B. A blockade of the vomiting center
C. A shortening of the QT interval
D. A stimulation of respiration
A. Increased blood pressure
Postmortem tissue concentrates of GBH have little scientific meaning because…
A. They could be present from months before
B. There is a 10 - 100x postmortem redistribution
C. The conjugated metabolites are rapidly converted back to the parent
D. It forms in the blood as a postmortem artifact
D. It forms in the blood as a postmortem artifact
All of the following are true of fentanyl except…
A. Sufentanil is the principal metabolite
B. Routine urine drug screening for drugs with an opiate nucleus will not detect it
C. When fentanyl patches are used to relieve chronic pain, little drug appears in the systemic circulation for the first 2 hrs
D. Norfentanyl may appear in the urine of surgical patients for greater than 48 hrs
A. Sufentanil is the principal metabolite
All of the following are true of hydrocodone except…
A. An intravenous form is not commercially available
B. It is a metabolite of codine
C. It has a terminal half-life of around 4 hrs
D. It is a mu receptor partial agonist/antagonist
D. It is a mu receptor partial agonist/antagonist
All of the following are true of hydromorphone except…
A. It is more potent than morphine
B. It is a metabolite of morphine
C. It has a terminal half-life of 8 hrs
D. Hydromorhone-3-glucuronide is a metabolite
C. It has a terminal half-life of 8 hrs
All of the following statements are true except…
A. Bupreborphine is more expensive than methadone
B. L-LAAM was taken off the market because of QT prolongation
C. Heroin patients receiving methadone maintenance may have improved immune function
D. Both d and l isomers of methadone have equal potency at the mu receptor
D. Both d and l isomers of methadone have equal potency at the mu receptor
The main metabolite of methadone is…
A. L-LAAM
B. EDDP
C. N-desethyl methadone
D. O-desmethyl methadone
B. EDDP
All of the following are true regarding buprenorphine except…
A. It can interact with HIV medication
B. Death rates with buprenorphine maintenance are higher than with methadone
C. It is more potent than morphine
D. It is classified as a partial opioid agonist
B. Death rates with buprenorphine maintenance are higher than with methadone
The conversion of codine to morphine is mediated by…
A. CYP2A3
B. CYP3A6
C. CYP2D6
D. CYP1A2
C. CYP2D6
All of the following are possible metabolites of codine except…
A. Codine-6-glucutonide
B. Norcodone
C. Hydrocodone
D. 6-acetylmorphine
D. 6-acetylmorphine
The least common route of fentanyl administration is…
A. Intramuscular
B. Transdermal
C. Intravenous
D. Transmucosal
A. Intramuscular
For approximately how many hours following removal of a fentanyl patch is drug still released into the systemic circulation?
A. 1
B. 4
C. 12
D. 24
C. 12