Opiates & Analgesics

Question 1

the point the individual perceives the response as pain

Answer 1

pain threshold

Question 2

The ability of the individual to experience pain without initiation of pain responses

Answer 2

Pain tolerance

Question 3

Painful stimuli are sensed by peripheral nociceptive of these types of neurons via ion channels that convert stimuli to membrane potential changes

Answer 3

C or Aδ

Question 4

Mu receptor that functions in analgesia and euphoria

Answer 4

Mu1

Question 5

Mu receptor that functions in bradycardia and respiratory depression

Answer 5

Mu2

Question 6

Component of G protein that modulates ion channels in opioids

Answer 6

Beta and gamma

Question 7

What effect do opioids have on BP?

Answer 7

Causes hypotension
(at moderate to high doses)

Question 8

What effect do opioids have on heart rate?

Answer 8

Causes bradycardia
(at moderate to high doses)

Question 9

What effect do opioids have on repiration?

Answer 9

Depress respiration

Question 10

Opioids can cause respiratory depression and cerebral vessel dilation, so they are contraindicated in this

Answer 10

Head trauma or severe brain injury

Question 11

Opioid use is cautioned in patients with asthma or COPD due to the release of this

Answer 11

Histamine

Question 12

Opioids chronically suppresse hypothalamic-pituitary-gonadal axis to trigger this

Answer 12

Opioid-induce androgen deficiency (OPIAD)

Question 13

Opioids chronically suppress this to trigger opioid-induced androgen deficiency (OPIAD)

Answer 13

Hypothalamic-pituitary-gonadal axis

Question 14

No opioid tolerance develops to either of these effects

Answer 14

Miosis and constipation

Question 15

Peripheral opioid antagonist that is administered orally

Answer 15

Naloxegol

Question 16

Peripheral opioid antagonist that is a subcutaneous injectable

Answer 16

Methylnaltrexone

Question 17

Naloxegol and Methylnaltrexone are antagonists to this

Answer 17

Peripheral opioid antagonists

Question 18

Benzodiazepines should not be used with these drugs due to profound sedation, respiratory depression, coma and risk of death

Answer 18

Opiates

Question 19

This type of drug should not be used with opiates due to profound sedation, respiratory depression, coma and risk of death

Answer 19

Benzodiazepines

Question 20

Is dependence likely when morphine is used for pain?

Answer 20

Rare

Question 21

Does meperidine have a short or long duration of action?

Answer 21

Short

Question 22

Meperidine is converted to this product that is not conjugated, non-analgesic, proconvulsant, and hallucinogenic

Answer 22

Normeperidine

Question 23

Normeperidine is a product of biotransformation of this drug

Answer 23

Meperidine

Question 24

Is Normepederidine (a product of biotransformation of meperidine) analgesic?

Answer 24

No

Question 25

Normepederidine (a product of biotransformation of meperidine) has these two effects

Answer 25

Proconvulsant Hallucinogen

Question 26

Opiate that has anticholinergic activity, and may cause seizures

Answer 26

Meperidine

Question 27

Opiate that has anticholinergic activity, and has potential for serotonin syndrome if combined with serotonin reuptake inhibitors

Answer 27

Meperidine

Question 28

Opiate that is contraindicated in epilepsy, cardiac disease, and use with MAOI (due to malignant hyperthermia)

Answer 28

Meperidine

Question 29

Why is Meperidine contraindicated in patients with epilepsy?

Answer 29

It has anticholinergic activity and cause cause seizures

Question 30

Meperidine use is contraindication with MAOI's because concurrent use can cause this

Answer 30

Malignant hyperthermia

Question 31

Meperidine use is contraindicated with this type of drug due to malignant hyperthermia

Answer 31

MAOIs

Question 32

What is the main issue with use of Fentanyl, Alfentanil, Sufentanil, Remifentanil?

Answer 32

Potency

Question 33

Fentanyl, Alfentanil, Sufentanil, Remifentanil are contraindicated in this

Answer 33

Pregnancy (respiratory depression of mother and newborns; increased sudden infant deaths)

Question 34

Opiates where potency is an issue

Answer 34

Fentanyl et al. (Alfentanil, Sufentanil, Remifentanil)

Question 35

Opiates that may cause respiratory depression of mother and newborns; increased sudden infant deaths

Answer 35

Fentanyl et al. (Alfentanil, Sufentanil, Remifentanil)

Question 36

Synthetic opioid that also is an antagonist at (NMDA) receptor and weak inhibitor of norepinephrine and serotonin uptake

Answer 36

Methadone

Question 37

Methadone is a synthetic opioid that also is an antagonist at this receptor

Answer 37

NMDA

Question 38

Methadone is a synthetic opioid that also is an antagonist at (NMDA) receptor and weak inhibitor of uptake of these 2 compounds

Answer 38

Norepinephrine and serotonin

Question 39

Opioid that may be used in nociceptive pain (mu) and neuropathic pain (NMDA and uptake inhibition)

Answer 39

Methadone

Question 40

Is Methadone short or long lasting?

Answer 40

Long orally active

Question 41

Does Methadone cause euphoria?

Answer 41

No

Question 42

Opioid that is often combined with aspirin or acetaminophen

Answer 42

Codeine

Question 43

Opioid that has a high degree of histamine release and vasodilation

Answer 43

Codeine

Question 44

Codeine has a high degree of release of this

Answer 44

Histamine

Question 45

What effect does Codeine have on vessels?

Answer 45

High degree of vasodilation

Question 46

2 opioids that are weak inhibitors of norepinephrine and serotonin reuptake

Answer 46

Tramadol and Tapentadol

Question 47

Tramadol and Tapentadol are weak inhibitors of reuptake of these two compounds

Answer 47

Norepinephrine and Serotonin

Question 48

With use of Tramadol and Tapentadol, why is respiratory depression less than predicted by analgesic action?

Answer 48

Because they are weak inhibitors of norepinephrine and serotonin reuptake

Question 49

Tramadol and Tapentadol may interact with this type of agent

Answer 49

Monoaminergic agents (especially MAO uptake inhibitors and other reuptake inhibitors)

Question 50

Opiate that has a convulsant metabolite that restricts use to short term

Answer 50

Meperidine

Question 51

This opiate and related compounds are very potent so be careful as small doses are powerful (cannot be used during pregnancy or after surgery)

Answer 51

Fentanyl

Question 52

Opiate that has a long duration of action and allows once daily dosing

Answer 52

Methadone

Question 53

Opiate that has a very high profile of histamine release

Answer 53

Codeine

Question 54

2 opiates that enhance norepinephrine and serotonin activity that may reduce opiate-induced respiratory depression

Answer 54

Tramadol and Tapentadol

Question 55

Yawning is characteristic of this stage of opiate withdrawal syndrome

Answer 55

Stage 1 (also involves anxiety and drug craving)

Question 56

Piloerection ("cold turkey skin") is characteristic of this stage of opiate withdrawal syndrome

Answer 56

Stage 3 (also involves tachycardia, nausea and vomiting, hypertension, tremors, spasms, seizures)

Question 57

Do mixed agonists/antagonists have physical dependence potential?

Answer 57

Low

Question 58

Is withdrawal a problem with mixed agonists/antagonists?

Answer 58

Potential to induce withdrawal in opioid-dependent Is milder (like meperidine/Demerol)

Question 59

Opioid that is both a partial agonist and mixed agonist/antagonist: Low antagonist action (less risk of triggering withdrawal in dependent patient) Low abuse potential

Answer 59

Buprenorphine

Question 60

Does Buprenorphine have abuse potential?

Answer 60

Low

Question 61

Buprenorphine has low action of this; leading to less risk of triggering withdrawal in dependent patient

Answer 61

Low antagonist action

Question 62

Opioid that is both a partial agonist and mixed agonist/antagonist: Respiratory depression that does occur is not easily or fully reversed by naloxone

Answer 62

Buprenorphine

Question 63

QT prolongation has been noted in this opioid that is both a partial agonist and mixed agonist/antagonist

Answer 63

Buprenorphine

Question 64

Opioid that is both a partial agonist and mixed agonist/antagonist: Contraindicated in heart patients or epileptics (contraindications similar to morphine)

Answer 64

Pentazocine

Question 65

Pentazocine is contraindicated in patients with either of these 2 conditions

Answer 65

Heart patients Epileptics

Question 66

Butorphanol, Buprenorphine, Nalbuphine and Pentazocine are opioids that are both partial agonists and this

Answer 66

Mixed agonists/antagonists

Question 67

Butorphanol, Buprenorphine, Nalbuphine and Pentazocine are opioids that are both mixed agonists/antagonists and this

Answer 67

Partial agonists

Question 68

Opioid receptor antagonist that blocks craving and subjective effects of opioids and alcohol

Answer 68

Naltrexone

Question 69

Combining this opioid receptor antagonist with ketoconazole (CYP 3A4 inhibitor) may trigger withdrawal, as levels may increase nearly 13 fold

Answer 69

Naloxegol

Question 70

Combining Naloxegol with this drug may trigger withdrawal, as levels may increase nearly 13 fold

Answer 70

Ketoconazole (CYP 3A4 inhibitor)

Question 71

Are Naloxegol or Methylnaltrexone centrally or peripherally acting for opioid-induced constipation?

Answer 71

Peripherally

Question 72

Opioid receptor antagonist that may be used for alcohol dependence

Answer 72

Naltrexone

Question 73

Naloxone and Naltrexone are this type of drug

Answer 73

Opioid receptor antagonists

Question 74

Naloxegol and Methylnaltrexone are this type of drug

Answer 74

Opioid receptor antagonists (peripherally acting for opioid-induced constipation)

Question 75

Only this isomer of opiates causes most of the action

Answer 75

L isomer

Question 76

Both D or L forms of opiates can have this effect

Answer 76

Antitussive

Question 77

Pinpoint pupils and depressed respiration are highly suggestive of overdose of this

Answer 77

Opiate

Question 78

These 2 effects are highly suggestive of opiate overdose

Answer 78

Pinpoint pupils Decreased respiration

Question 79

What are opioid receptor antagonists used for?

Answer 79

Opiate overdosage and reversal (Naltrexone also used for alcohol dependence)

Question 80

Narcan nasal spray uses this opioid

Answer 80

Naloxone

Question 81

Use of this opiate is associated with increased risk of QT prolongation (sudden cardiac death)

Answer 81

Methadone

Question 82

Codeine is converted to this

Answer 82

Morphine

Question 83

This type of opioid has lower abuse potential and may trigger withdrawal if used in a patient dependent on a different opiate

Answer 83

Mixed agonists/antagonists

Question 84

Opioid that has very low antagonist activity noted, reported to have low levels of euphoria making it less likely to be abused, may be difficult to reverse using naloxone (requires very large doses at times)

Answer 84

Buprenorphine

Question 85

Is withdrawal from opioids usually life-threatening or dangerous?

Answer 85

Rarely

Question 86

Piloerection, mydriasis, diarrhea and yawning are important signs of this

Answer 86

Opioid withdrawal

Question 87

This drug (NOT an opiate) is a selective allosteric inhibitor of voltage-gated sodium channel NaV1.8 that functions peripherally

Answer 87

Suzetrigine

Question 88

This opiate may be difficult to reverse using naloxone (requires very large doses at times)

Answer 88

Buprenorphine

Question 89

Which mixed opioid agonist/antagonist has the lowest risk of abuse?

Answer 89

Buprenorphine

Question 90

What antagonist can reverse the respiratory depression of opiates?

Answer 90

Naloxone