NSAIDS + Opioids Flashcards
A 55-year-old woman is having a colonoscopy. Aside from other medications for sedation, it is likely she will receive which of the following analgesics?
A
Methadone
B
Meperidine
C
Buprenorphine
D
Fentanyl
E
Pentazocine
D
Fentanyl
A 42-year-old man with chronic pain is brought to the emergency room because of over-sedation and respiratory depression while using fentanyl patches. He is given intravenous naloxone. He is not given oral naloxone because naloxone
A
is not absorbed from the GI tract.
B
undergoes first-pass metabolism in the liver.
C
is metabolized to an inactive metabolite in the GI lining.
D
is excreted unchanged in the urine.
E
is destroyed by stomach acid.
B
undergoes first-pass metabolism in the liver.
48-year-old man is being treated with a long-acting opiate for pain associated with terminal cancer. He is also prescribed a transmucosal fentanyl formulation (lollipop) for “breakthrough” pain. The transmucosal formulation is an effective analgesic because it
A
avoids first pass metabolism of fentanyl.
B
avoids nausea and vomiting that is associated with the systemic use of fentanyl.
C
delivers fentanyl directly to opiate receptors in the mouth.
D
avoids constipation.
E
avoids respiratory depression.
A
avoids first pass metabolism of fentanyl.
A 50-year-old woman with back pain is administered an opiate agonist. After 2 weeks of therapy, she notices that she needs to increase the dose to get the same analgesic effect. She is experiencing
A
physical dependence.
B
addiction.
C
tolerance.
D
withdrawal.
E
drug-seeking behavior.
C
tolerance.
A 43-year-old man with postsurgical pain is placed on an intravenous patient-controlled analgesia pump with morphine as the analgesic. This form of analgesic administration is preferred to oral administration because morphine
A
is not absorbed orally.
B
administered orally is rapidly eliminated in the urine.
C
administered orally does not penetrate the brain.
D
administered orally causes more severe constipation.
E
administered parenterally bypasses first-pass metabolism.
E
administered parenterally bypasses first-pass metabolism.
The morphine metabolite that may be responsible for most of morphine’s analgesic activity is
A
desmethylmorphine.
B
morphine-6-glucuronide.
C
morphine sulfate.
D
N-acetylmorphine.
E
hydroxymorphine.
B
morphine-6-glucuronide.
A 20-year-old man is given codeine to relieve the pain of a sprained ankle. After two days the man returns to his doctor saying that the codeine is not effective. A likely cause is due to
A
poor absorption.
B
rapid urinary excretion.
C
poor metabolism.
D
high protein binding.
E
poor brain penetration.
C
poor metabolism.
A 53-year-old man is requesting meperidine for his chronic back pain. His physician is reluctant to use meperidine for the treatment of chronic pain because of
A
metabolite toxicity.
B
poor oral absorption.
C
increased addiction potential.
D
patient noncompliance.
E
likelihood that meperidine will be diverted for sale on the street.
A
metabolite toxicity.
A 32-year-old woman has been taking an oxycodone-acetaminophen product for chronic arthritic pain. On a follow-up appointment her serum aminotransferases are elevated and she is slightly jaundiced. She admits to increasing the dose of the oxycodone combination product over the past several weeks. The most likely cause of her liver injury is
A
oxycodone.
B
hepatitis A.
C
hepatitis C.
D
arthritis.
E
acetaminophen.
E
acetaminophen.
Which NSAID has the least anti-inflammatory efficacy?
A
Aspirin
B
Acetaminophen
C
Ibuprofen
D
Naproxen
E
Celecoxib
B
Acetaminophen
Which NSAID permanently inactivates TxA2 synthesis by platelets?
A
Aspirin
B
Acetaminophen
C
Ibuprofen
D
Naproxen
E
Celecoxib
A
Aspirin
What is the primary mechanism of action of allopurinol in treating gout?
A
It is an analgesic agent.
B
It is an anti-inflammatory agent.
C
It blocks inflammatory responses to urate crystals.
D
It inhibits urate formation.
E
It augments urate excretion.
D
It inhibits urate formation
The cardiovascular risk associated with celecoxib results from
A
inhibition of prostaglandin production in the gastric epithelium.
B
inhibition of platelet thromboxane production.
C
effects on myocardial ion channels.
D
inhibition of prostaglandin in the kidney.
E
enhanced prostacyclin production by vascular endothelium.
D
inhibition of prostaglandin in the kidney
Diclofenac has a t1/2 in plasma of 1 to 2 hours, yet its therapeutic effects in treating rheumatoid arthritis last for much longer. This prolongation of therapeutic effect is due to
A
irreversible inhibition of COX-1 and COX-2.
B
its relative selectivity for COX-2.
C
its accumulation in synovial fluid.
D
the formation of a long-lived active metabolite.
E
CNS effects unrelated to inhibition of prostaglandin synthesis.
C
its accumulation in synovial fluid.
Most clinically used opioid analgesics are selective for
which type of opioid receptor?
(A) kappa (κ)
(B) alpha (α)
(C) beta (β)
(D) mu (μ)
(E) delta (δ)
(D) mu (μ)
