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Principles 2 Pharmacology Review > Narcotics > Flashcards

Narcotics Flashcards

1
Q

Which of the following statements describe the mechanism of action of Morphine? (Select 2)

a. Beta-adrenergic agonist
b. Opioid agonist
c. Anticholinergic agent
d. Decreases PVR with high doses

A

b. Opioid agonist
d. Decreases PVR with high doses

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2
Q

The post-operative pain dose for Morphine is typically _______ mg, administered intravenously and titrated.

A) 1-5 mg
B) 10-25 mg
C) 5-20 mg
D) 15-30 mg

A

C) 5-20 mg

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3
Q

Which of the following is a known side effect of Morphine when administered intrathecally?

A) Immediate respiratory depression
B) Delayed respiratory depression (up to 24 hours)
C) Anaphylaxis
D) Tachycardia

A

B) Delayed respiratory depression (up to 24 hours)

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4
Q

Which adverse effects are associated with high doses of Morphine? (Select 2)

a. Histamine release
b. Hypotension without histamine release
c. Decreased PVR
d. Increase in cardiac output

A

a. Histamine release
c. Decreased PVR

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5
Q

Morphine has a prolonged half-life in patients with conditions such as ________, ________, and ________.

A) Diabetes, anemia, hypokalemia
B) Elderly, liver failure, renal failure
C) COPD, heart failure, hypertension
D) Stroke, pneumonia, asthma

A

B) Elderly, liver failure, renal failure

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6
Q

How many active metabolites does Morphine have?

A) None
B) One
C) Two
D) Three

21

A

C) Two

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7
Q

Morphine administration can cause dose-dependent ________ release.

A) Serotonin
B) Histamine
C) Dopamine
D) Epinephrine

A

B) Histamine

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8
Q

Morphine primarily acts on which type of receptor?

A) Dopamine receptors
B) GABA receptors
C) Opioid receptors
D) Adrenergic receptors

A

C) Opioid receptors

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9
Q

Which of the following statements are true about delayed effects of Morphine when administered intrathecally?

a. Respiratory depression can be delayed up to 24 hours
b. Respiratory depression occurs immediately
c. The effect is only delayed in pediatric patients
d. There is no risk of respiratory depression with intrathecal administration

A

a. Respiratory depression can be delayed up to 24 hours

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10
Q

Morphine can cause a ________ in pulmonary vascular resistance (PVR) when administered in high doses.

A) Increase
B) Decrease
C) No change
D) Fluctuation

A

B) Decrease

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11
Q

In which patient populations should Morphine be used with caution due to prolonged half-life? (select all that apply)

A. Elderly
B. Patients with liver failure
C. Patients with renal failure
D. Pediatric patients

A

A. Elderly
B. Patients with liver failure
C. Patients with renal failure

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12
Q

For patients with liver or renal failure, how is Morphine metabolism affected?

A) Shortened half-life
B) No effect on half-life
C) Prolonged half-life
D) Rapidly eliminated

A

C) Prolonged half-life

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13
Q

Hydromorphone primarily acts by binding to which receptors?

A) Dopamine receptors
B) Opioid receptors
C) GABA receptors
D) Adrenergic receptors

A

B) Opioid receptors

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14
Q

Hydromorphone is approximately _______ times more potent than Morphine.

A) Three
B) Five
C) Seven
D) Ten

A

C) Seven

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15
Q

When dosing Hydromorphone, which considerations are important? (select all that apply)

A. Administer slowly to avoid delayed response
B. Use lower doses due to its high potency
C. Higher doses needed compared to Morphine
D. Dose aggressively to ensure effectiveness

A

A. Administer slowly to avoid delayed response
B. Use lower doses due to its high potency

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16
Q

Intravenous Hydromorphone provides pain relief with an effect that peaks within _______ minutes.

A) 1-5 minutes
B) 5-20 minutes
C) 20-30 minutes
D) 30-60 minutes

A

B) 5-20 minutes

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17
Q

What is the typical duration of action for Hydromorphone after intravenous administration?

A) 1-2 hours
B) 2-4 hours
C) 4-6 hours
D) 6-8 hours

A

B) 2-4 hours

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18
Q

Which of the following are potential side effects of Hydromorphone? (Select 2)

A. Respiratory depression
B. Increased histamine release
C. Nausea and vomiting
D. Elevated blood pressure

A

A. Respiratory depression
C. Nausea and vomiting

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19
Q

Compared to Morphine, Hydromorphone is associated with:

A) More histamine release
B) Less histamine release
C) The same amount of histamine release
D) No histamine release

A

B) Less histamine release

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20
Q

Due to its potency, Hydromorphone can cause severe _______ if not dosed cautiously.

A) Bronchoconstriction
B) Respiratory depression
C) Tachycardia
D) Hypertension

A

B) Respiratory depression

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21
Q

Why is Hydromorphone favored by some anesthesia providers at the end of surgery?

A. It has a prolonged effect that can provide pain relief post-operatively in PACU
B. It has a very short duration, making it easier to manage
C. Lower doses are effective due to its potency
D. It has fewer respiratory effects than Morphine

A

A. It has a prolonged effect that can provide pain relief post-operatively in PACU
C. Lower doses are effective due to its potency

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22
Q

How many active metabolites does Hydromorphone produce that contribute to its clinical effects?

A) None
B) One
C) Two
D) Three

A

B) One

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23
Q

Due to Hydromorphone’s potency, it is recommended to “dose _______ and _______.”

A) high; slow
B) slow; low
C) low; rapidly
D) frequently; aggressively

A

B) slow; low

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24
Q

Hydromorphone requires cautious dosing due to:

A) Rapid metabolism
B) Risk of immediate response
C) Potential delayed response
D) High risk of immunosuppression

A

C) Potential delayed response

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25
Q

Which characteristics make Hydromorphone a suitable option for pain management?

A. Higher potency allows for lower doses
B. Less histamine release than Morphine
C. Short duration requiring frequent dosing
D. Minimal risk of respiratory depression

A

A. Higher potency allows for lower doses
B. Less histamine release than Morphine

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26
Q

Hydromorphone is metabolized primarily in the _______ and has _______ active metabolite(s).

A) kidneys; one
B) liver; two
C) liver; one
D) kidneys; two

A

C) liver; one

22

27
Q

Which of the following is an important consideration when using Hydromorphone in the PACU?

A) It has a very short duration, requiring redosing
B) It may have a delayed response, requiring close monitoring
C) It causes significant histamine release, leading to flushing
D) It is less potent than Morphine and may need higher doses

A

B) It may have a delayed response, requiring close monitoring

22

28
Q

The duration of Hydromorphone is ___ - ____ hours.
A. 4-6 hours
B. 1-2 hours
C. 6-8 hours
D. 2-4 hours

A

D. 2-4 hours

22

29
Q

Fentanyl primarily provides analgesia by acting as a(n) _______.

A) Opioid antagonist
B) Opioid agonist
C) GABA agonist
D) Dopamine antagonist

A

B) Opioid agonist

23

30
Q

For the first hour of surgery, the recommended dose of Fentanyl is _______ mcg/kg.

A) 0.5-2 mcg/kg
B) 1-5 mcg/kg
C) 5-10 mcg/kg
D) 10-20 mcg/kg

A

B) 1-5 mcg/kg

23

31
Q

What is the recommended infusion rate for Fentanyl during surgery?

A) 1-3 mcg/kg/hour
B) 2-4 mcg/kg/hour
C) 3-6 mcg/kg/hour
D) 5-10 mcg/kg/hour

A

C) 3-6 mcg/kg/hour

23

32
Q

What is the approximate half-life of Fentanyl when administered intravenously?

A) 15-30 minutes
B) 2-4 hours
C) 6-12 hours
D) 24 hours

A

B) 2-4 hours

23

33
Q

The duration of action for a single dose of Fentanyl is generally _______ minutes.

A) 5-10 minutes
B) 15-30 minutes
C) 30-60 minutes
D) 1-2 hours

A

C) 30-60 minutes

23

34
Q

Which of the following are common side effects of Fentanyl? (Select 3)

A. Respiratory depression
B. Increased blood pressure
C. Nausea and vomiting
D. Bradycardia
E. Hypertension

A

A. Respiratory depression
C. Nausea and vomiting
D. Bradycardia

23

35
Q

One of the most serious adverse effects of Fentanyl is:

A) Tachycardia
B) Respiratory depression
C) Hypertension
D) Hyperthermia

A

B) Respiratory depression

23

36
Q

Which considerations should be taken when dosing Fentanyl?

A. Decrease dose in elderly patients
B. Base dose on ideal body weight (IBW)
C. Use actual body weight for all patients
D. Increase dose for patients with high BMI

A

A. Decrease dose in elderly patients
B. Base dose on ideal body weight (IBW)

23

37
Q

Fentanyl is typically administered during surgery as a:

A) Continuous high-dose infusion
B) Single large bolus
C) Low-dose infusion and occasional bolus
D) Transdermal patch

A

C) Low-dose infusion and occasional bolus

23

38
Q

To avoid residual respiratory depression, Fentanyl infusion should be turned off _______ minutes before expected extubation.

A) 30 minutes
B) 45 minutes
C) 60 minutes
D) 90 minutes

A

C) 60 minutes

23

39
Q

How many active metabolites does Fentanyl produce?

A) None
B) One
C) Two
D) Three

A

A) None

23

40
Q

Which statements are accurate regarding the duration and clinical use of Fentanyl? (Select 2)

A.) Duration of action is typically 30-60 minutes for a single dose
B.) Primarily used as a mainstay in intraoperative anesthesia
C. ) Duration of action is prolonged in patients with renal failure
D.) Has significant active metabolites affecting duration

A

A.) Duration of action is typically 30-60 minutes for a single dose
B.) Primarily used as a mainstay in intraoperative anesthesia

23

41
Q

In which population should the Fentanyl dose be decreased due to increased sensitivity?

A) Pediatric patients
B) Elderly patients
C) Patients with chronic pain
D) Patients with high BMI

A

B) Elderly patients

23

42
Q

Which precautions should be taken when administering Fentanyl?

A.) Monitor respiratory status closely due to risk of respiratory depression
B.) Avoid rapid dose escalation to prevent adverse effects
C.) Administer via transdermal route in intraoperative settings
D.) Use in patients with a history of opioid intolerance without caution

A

A.) Monitor respiratory status closely due to risk of respiratory depression
B.) Avoid rapid dose escalation to prevent adverse effects

23

43
Q

Fentanyl is approximately _______ times more potent than Morphine.

A) 10 times
B) 50 times
C) 80 times
D) 100 times

A

B) 50 times

23

44
Q

Fentanyl is typically supplied in what concentration?

A.) 25mcg/mL
B.) 50 mcg/mL
C.) 75 mcg/mL
D.) 100 mcg/mL

A

B.) 50 mcg/mL

23

45
Q

True or False: Fentanyl is dosed based on actual body weight?

A

False: It is based on IBW

23

46
Q

Meperidine acts primarily by binding to which of the following opioid receptors?

A) Mu only
B) Kappa only
C) Mu, kappa, and delta
D) Delta and sigma

A

C) Mu, kappa, and delta

47
Q

The typical intravenous dose of Meperidine for post-operative shivering is _______ mg.

A) 10 mg
B) 12.5 mg
C) 25 mg
D) 50 mg

A

B) 12.5 mg

48
Q

What is the approximate half-life of Meperidine?

A) 1-3 hours
B) 3-5 hours
C) 6-8 hours
D) 12-24 hours

A

B) 3-5 hours

49
Q

The duration of action for a single dose of Meperidine is typically _______ hours.

A) 1-2 hours
B) 2-4 hours
C) 4-6 hours
D) 6-8 hours

A

B) 2-4 hours

50
Q

Meperidine’s active metabolite, which has CNS-stimulating properties, is called:

A) Norfentanyl
B) Nortriptyline
C) Normeperidine
D) Noroxycodone

A

C) Normeperidine

51
Q

Which of the following are common side effects of Meperidine?

A.) Dizziness
B.) Nausea and vomiting
C.) Hypertension
D.) Respiratory depression
E.) Increased salivation

A

A.) Dizziness
B.) Nausea and vomiting
D.) Respiratory depression

52
Q

The active metabolite of Meperidine, Normeperidine, can cause _______ due to its CNS stimulant effects.

A) Respiratory depression
B) Seizures
C) Hypotension
D) Bradycardia

A

B) Seizures

53
Q

Which of the following are contraindications for Meperidine use?

A.) Concurrent use of MAOIs
B.) History of seizures
C.) Cardiac arrhythmias
D.) Severe renal impairment

A

A.) Concurrent use of MAOIs
B.) History of seizures
D.) Severe renal impairment

54
Q

Due to its serotonergic effects, Meperidine should not be combined with:

A) Beta-blockers
B) NSAIDs
C) MAOIs or SSRIs
D) Proton pump inhibitors

A

C) MAOIs or SSRIs

55
Q

Meperidine is particularly effective in treating _______ associated with anesthesia recovery or post-surgical care.

A) Pain
B) Shivering
C) Nausea
D) Insomnia

A

B) Shivering

56
Q

Which of the following mechanisms contribute to Meperidine’s effects? (SATA)

A.) Binding to mu, kappa, and delta opioid receptors
B.) Blocking serotonin reuptake
C.) Inhibition of GABA receptors
D.) Alpha-adrenergic receptor blockade

A

A.) Binding to mu, kappa, and delta opioid receptors
B.) Blocking serotonin reuptake

57
Q

Normeperidine, the active metabolite of Meperidine, primarily causes which of the following CNS effects?

A) Sedation
B) Seizures
C) Respiratory depression
D) Bradycardia

A

B) Seizures

58
Q

Which of the following are true regarding Meperidine’s duration of action and half-life? (SATA)

A.) Duration of action is typically 2-4 hours
B.) Half-life is approximately 3-5 hours
C.) Half-life of Normeperidine is shorter than Meperidine’s
D.) Duration is prolonged in patients with renal impairment

A

A.) Duration of action is typically 2-4 hours
B.) Half-life is approximately 3-5 hours

59
Q

Meperidine inhibits the reuptake of which neurotransmitter, which can increase the risk of serotonin syndrome when combined with certain drugs?

A) Dopamine
B) Norepinephrine
C) Serotonin
D) GABA

A

C) Serotonin

60
Q

In patients with renal impairment, Meperidine should be used cautiously because _______ can accumulate, increasing the risk of seizures.

A) Meperidine
B) Normeperidine
C) Serotonin
D) Dopamine

A

B) Normeperidine

61
Q

Which of the following side effects may occur with Meperidine use? (SATA)

A.) Respiratory depression
B.) CNS stimulation (due to metabolite)
C.) Hypertension
D.) Nausea

A

A.) Respiratory depression
B.) CNS stimulation (due to metabolite)
D.) Nausea

62
Q

In elderly patients, the half-life of Meperidine may:

A) Decrease, requiring higher doses
B) Increase, due to slower metabolism
C) Remain unchanged
D) Be irrelevant to dosing

A

B) Increase, due to slower metabolism

63
Q
A

Principles 2 Pharmacology Review (3 decks)

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