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IPCS 3 > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Which topical analgesic works by blocking sodium channels, thus inhibiting action potentials from being sent to the brain?
Topical diclofenac
Transdermal lidocaine
Celecoxib
Ketorolac

A

Transdermal lidocaine

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2
Q

SELECT ALL THAT APPLY: Which structural component is found in the drug above AND essential for activity?
A basic amine
A 1,3 propanediol
A carbamate
A secondary alcohol

A

A 1,3 propanediol
A carbamate

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3
Q

A 45 YOF reports osteoarthritis pain in her knee that she states is a 4 out of 10. She has a PMH of peptic ulcer disease and takes pantoprazole 40 mg oral daily. What medication is most appropriate to recommend to manage her pain?
Morphine immediate release
Meloxicam
Pregabalin
Acetaminophen

A

Acetaminophen

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4
Q

A 35 YOF presents to the emergency department following a bicycle accident and has broken several bones in her hand. She reports her pain is an 8 out of 10. She has no significant PMH. What medication is most appropriate to administer to manage this patient’s pain?
Lidocaine patch
Intravenous morphine
Intrathecal bupivacaine
Oral diclofenac

A

Intravenous morphine

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5
Q

Activation of delta receptors leads to ___ effects.
Dysphoric and anxiolytic
Euphoric and antidepressant
Anxiolytic and antidepressant
Analgesia and anxiolytic

A

Anxiolytic and antidepressant

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6
Q

Which of the following is a non-pharmacologic method to manage pain?
Counseling on anticipated pain after surgery
Biofeedback
Electroanalgesia
Exercise
All of the above.

A

All of the above

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7
Q

Di-acetylation of morphine is the synthetic process to produce which molecule?
Codeine
Heroin
Oxycodone
Cocaine

A

Heroin

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8
Q

T/F: In general, drug metabolites are more hydrophilic than their parent drug molecules.

A

True

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9
Q

Which of the following is not an opioid receptor?
Delta
Sigma
Kappa
Mu

A

Sigma

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10
Q

A patient is currently prescribed morphine ER 60 mg PO q8h for management of chronic low back pain and has been on this therapy for several weeks. The patient reports the medication is no longer providing the same pain relief. She rates her pain as a 10 out of 10. On physical exam, she cries out in pain when barely touched. She requests more medications every time she meets with a healthcare provider. Which medication recommendation(s) are most appropriate for this patient?
a. Continue morphine at the same dose and initiate pregabalin 100 mg PO q12h
b. Discontinue morphine and initiate methadone 10 mg PO q8h
c. Continue morphine and initiate capsaicin cream applied topically three times per day to the site of pain
d. Increase the morphine dose to 90 mg PO Q8H

A

b. Discontinue morphine and initiate methadone 10 mg PO q8h

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11
Q

Which of the following is a partial opioid agonist?
a. hydromorphine
b. methadone
c. buprenorphine
d. morphine

A

c. buprenorphine

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12
Q
  1. Which of the following drugs does NOT work via GABA receptors?
    a. Baclofen
    b. Tizanidine
    c. Diazepam
A

b. Tizanidine

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13
Q
  1. Morphine, Codeine, and Thebaine all fall under the classification of
    a. natural opioids or opiates
    b. synthetic opioids
    c. semi-synthetic opioids
    d. esters of morphine
A

a. natural opioids or opiates

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14
Q
  1. Which patient meets criteria for chronic pain?
    A. A patient experiencing pain 2 weeks following a motor vehicle accident
    B. A patient experiencing pain following an appendectomy
    C. A patient reporting pain 1 week following a tibial fracture
    D. A patient undergoing chemotherapy for colorectal cancer reporting pain for 8 weeks
A

D. A patient undergoing chemotherapy for colorectal cancer reporting pain for 8 weeks

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15
Q
  1. Which of the following counseling points is most appropriate for a patient initiated on an extended-release opioid?
    a. You may experience nausea and/or vomiting but will develop tolerance to this effect
    b. You will develop tolerance to the constipation associated with this medication
    c. An EKG is required at baseline for all extended-release opioids
    d. This medication can be taken as needed when experiencing pain
A

a. You may experience nausea and/or vomiting but will develop tolerance to this effect

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16
Q
  1. Which of the following drugs is metabolized into active metabolites?
    a. Carisoprodol
    b. Baclofen
    c. Cyclobenzaprine
    d. Tizanidine
A

a. Carisoprodol

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17
Q
  1. Which of the following options is an optimal nonopioid medication for a person with significant musculoskeletal pain and comorbid depression?
    a. Methocarbamol
    b. Lamotrigine
    c. Amitriptyline
    d. Duloxetine
A

d. Duloxetine

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18
Q
  1. A 74 YOM presents to his primary care physicians for complaints of low back pain that has lasted for the past 6 months. The patient’s PMH is significant for atrial fibrillation and depression. His current medications are rivaroxaban 20 mg PO once daily and sertraline 100 mg PO once daily. What initial therapy is most appropriate to initiate for this patient?
    a. Non-pharm therapy
    b. cyclobenzaprine
    c. morphine
    d. baclofen
A

a. Non-pharm therapy

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19
Q

What is the prevalence of true opioid allergies?
a) Common
b) Uncommon
c) Rare
d) Occasional

A

b) Uncommon

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20
Q

When a patient experiences a true allergy or intolerance to an opioid, what is the recommended course of action?
a) Continue using the same opioid with caution
b) Discontinue opioid therapy altogether
c) Switch to a different opioid within the same class
d) Use an agent from a different opioid class

A

d) Use an agent from a different opioid class

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21
Q

Which neurotransmitter is commonly involved in the mechanism of action of many skeletal muscle relaxants?
a) Dopamine
b) Serotonin
c) GABA (gamma-aminobutyric acid)
d) Glutamate

A

c) GABA (gamma-aminobutyric acid)

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22
Q

Why is it important to consider the mechanism of action of skeletal muscle relaxants when prescribing them?
a) To prevent allergic reactions
b) To avoid interactions with other medications
c) To enhance their efficacy
d) To reduce their side effects

A

b) To avoid interactions with other medications

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23
Q

For a patient using other CNS depressants, what type of muscle relaxant is preferred to minimize the risk of additive CNS depression?
a) Any skeletal muscle relaxant
b) A muscle relaxant with a precaution for use with other CNS depressants
c) A muscle relaxant that does not have a precaution for use with other CNS depressants
d) A centrally-acting muscle relaxant

A

c) A muscle relaxant that does not have a precaution for use with other CNS depressants

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24
Q

When converting from a fentanyl patch to morphine equivalents, what should be done with the morphine milligram equivalents?
a) They should be increased by 50%
b) They should be decreased by 50%
c) They should not be adjusted
d) They should be calculated based on the patient’s weight

A

c) They should not be adjusted

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25
Q

What doses of opioids should be included when calculating morphine milligram equivalents for a fentanyl patch?
a) Only the doses of opioids received from the fentanyl patch
b) Only the doses of opioids received as needed (PRN) by the patient
c) Both the doses of opioids received from the fentanyl patch and any additional PRN doses
d) None of the above

A

c) Both the doses of opioids received from the fentanyl patch and any additional PRN doses

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26
Q

What are the most effective treatments for bone pain?
a) NSAIDs and corticosteroids
b) Bisphosphonates only
c) NSAIDs, corticosteroids, and bisphosphonates
d) Opioids and muscle relaxants

A

) NSAIDs, corticosteroids, and bisphosphonates

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27
Q

When selecting therapies for bone pain, what patient-specific factors should be considered?
a) Liver function only
b) Renal function, cardiac history, and drug-drug interactions
c) Age and gender
d) Blood type and cholesterol levels

A

b) Renal function, cardiac history, and drug-drug interactions

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28
Q

What is the most effective action for managing bone pain?
a) Increasing current opioids
b) Changing the opioid
c) Adding an agent specific for bone pain
d) Adding muscle relaxants

A

c) Adding an agent specific for bone pain

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29
Q

When are fentanyl short-acting products indicated?
a) Only for cancer-related breakthrough pain
b) Only for non-cancer-related breakthrough pain
c) Both for cancer and non-cancer-related breakthrough pain
d) Neither for cancer nor non-cancer-related breakthrough pain

A

a) Only for cancer-related breakthrough pain

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30
Q

According to CDC Chronic Pain Guidance for Opioids, when should naloxone be prescribed?
a) For any opioid dose
b) For ≥50 MME per day or if on concomitant benzodiazepine therapy
c) Only if the patient requests it
d) Only if the patient has a history of overdose

A

b) For ≥50 MME per day or if on concomitant benzodiazepine therapy

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31
Q

According to NCCN guidelines for cancer pain treatment, what is recommended for persistent use of short-acting opioids?
a) Increasing the dose of short-acting opioids
b) Using an extended-release (ER) opioid with breakthrough short-acting medications
c) Using immediate-release (IR) opioids only
d) Stopping opioid therapy altogether

A

b) Using an extended-release (ER) opioid with breakthrough short-acting medications

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32
Q

When converting to a new opioid, what is the recommended dose adjustment?
a) Increase the dose by 50%
b) Decrease the dose by 25%
c) Decrease the dose by 50%
d) Maintain the same dose

A

) Decrease the dose by 50%

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33
Q

Which opioid conversion does not require a dose reduction of 50%?
a) Fentanyl patch to morphine
b) Morphine to oxycodone
c) Oxycodone to hydromorphone
d) Methadone to fentanyl patch

A

a) Fentanyl patch to morphine

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34
Q

What are common symptoms of neuropathic pain?
a) Aching and throbbing
b) Numbness and weakness
c) Burning, tingling, stabbing
d) Dull and persistent

A

c) Burning, tingling, stabbing

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35
Q

Why are opioids not considered first-line treatment for neuropathic pain?
a) They are ineffective in treating neuropathic pain
b) They have too many side effects
c) More effective options are available
d) Patients often develop tolerance quickly

A

c) More effective options are available

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36
Q

Which medication is also helpful for neuropathic pain and concomitant depression?
a) Gabapentin
b) Pregabalin
c) Duloxetine
d) Venlafaxine

A

c) Duloxetine

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37
Q

Methadone and buprenorphine are primarily used for:
a) Acute pain management
b) Opioid withdrawal and maintenance
c) Anxiety disorders
d) Hypertension treatment

A

b) Opioid withdrawal and maintenance

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38
Q

Which of the following statements about methadone is true?
a) It can be prescribed by any healthcare provider
b) It is typically given as an oral liquid
c) It does not require monitoring for QT prolongation
d) It is available over-the-counter

A

b) It is typically given as an oral liquid

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39
Q

When should buprenorphine be initiated for opioid use disorder?
a) At any time during opioid use
b) Only when withdrawal symptoms are severe
c) At the time of opioid discontinuation or significant reduction in use with mild to no withdrawal symptoms
d) After being abstinent from opioids for at least 30 days

A

c) At the time of opioid discontinuation or significant reduction in use with mild to no withdrawal symptoms

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40
Q

What is the recommended route of administration for naltrexone in opioid use disorder maintenance?
a) Oral tablets
b) Intramuscular (IM) injection every 4 weeks
c) Subcutaneous injection
d) Intravenous (IV) infusion

A

b) Intramuscular (IM) injection every 4 weeks

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41
Q

What precaution should be taken when prescribing naltrexone for opioid use disorder?
a) Monitoring renal function
b) Monitoring for QT prolongation
c) Monitoring liver function tests (LFTs) for hepatic injury
d) Monitoring blood pressure

A

c) Monitoring liver function tests (LFTs) for hepatic injury

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42
Q

Which statement accurately describes the difference between anesthetics and analgesics?
a) Anesthetics selectively reduce pain without causing a loss of other sensations.
b) Anesthetics reduce all types of sensation or block consciousness completely, while analgesics reduce pain selectively.
c) Anesthetics and analgesics have similar mechanisms of action.
d) Anesthetics are primarily used for reducing inflammation, while analgesics are used for pain relief only.

A

b) Anesthetics reduce all types of sensation or block consciousness completely, while analgesics reduce pain selectively.

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43
Q

Which medication was synthesized from salicylic acid and was first sold as a prescription drug in the form of a white powder before becoming available over-the-counter in tablet form?
a) Acetaminophen
b) Ibuprofen
c) Naproxen
d) Aspirin

A

d) Aspirin

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44
Q

What is the mechanism of action of acetaminophen in pain relief?
a) Inhibition of nitric oxide pathway
b) Inhibition of prostaglandin synthesis and release in the central nervous system (CNS)
c) Inhibition of cyclooxygenase (COX) enzymes
d) Activation of opioid receptors

A

b) Inhibition of prostaglandin synthesis and release in the central nervous system (CNS)

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45
Q

Which medication is a non-selective inhibitor of cyclooxygenase (COX) enzymes, inhibiting both COX-1 and COX-2, and is associated with antipyretic effects due to its action on the hypothalamus?
a) Aspirin
b) Acetaminophen
c) Ibuprofen
d) Naproxen

A

c) Ibuprofen

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46
Q

What is the primary route of elimination for naproxen and its metabolites?
a) Feces
b) Sweat
c) Urine
d) Saliva

A

c) Urine

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47
Q

Which adverse effect is associated with long-term use of aspirin?
a) Reye’s Syndrome
b) Liver damage
c) Kidney dysfunction
d) Bleeding time prolongation

A

d) Bleeding time prolongation

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48
Q

What is the primary mechanism of action of naproxen?
a) Inhibition of nitric oxide pathway
b) Inhibition of prostaglandin synthesis
c) Stimulation of opioid receptors
d) Activation of COX-2 enzymes

A

b) Inhibition of prostaglandin synthesis

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49
Q

How is acetaminophen primarily metabolized in the body?
a) By sulfate and glucuronide conjugation
b) By hydrolysis into salicylic acid
c) By oxidation in the liver
d) By conversion into a toxic metabolite (NAPQI)

A

a) By sulfate and glucuronide conjugation

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50
Q

Which medication was initially marketed as a prescription-only drug before becoming available over-the-counter in the 1970s?
a) Acetaminophen
b) Naproxen
c) Aspirin
d) Ibuprofen

A

d) Ibuprofen

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51
Q

What is a potential side effect of phenacetin, a medication closely related to acetaminophen?
a) Liver damage
b) Kidney dysfunction
c) Reye’s Syndrome
d) Gastrointestinal bleeding

A

b) Kidney dysfunction

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52
Q

What is the primary mechanism of action of meloxicam?
a) Inhibition of bacterial DNA synthesis
b) Inhibition of cyclooxygenase-2 (COX-2)
c) Inhibition of N-methyl-D-aspartate (NMDA) receptors
d) Activation of opioid receptors

A

b) Inhibition of cyclooxygenase-2 (COX-2)

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53
Q

How is diclofenac primarily metabolized in the body?
a) Metabolized into active compounds
b) Metabolized into inactive compounds
c) Metabolized by CYP2C9 and CYP3A4
d) Metabolized by CYP2D6 only

A

b) Metabolized into inactive compounds

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54
Q

Which medication exhibits bacteriostatic activity by inhibiting bacterial DNA synthesis?
a) Meloxicam
b) Diclofenac
c) Celecoxib
d) Naproxen

A

b) Diclofenac

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55
Q

. What is the main route of elimination for celecoxib?
a) Renal elimination
b) Fecal elimination
c) Both renal and fecal elimination
d) Metabolic conversion into active compounds

A

) Both renal and fecal elimination

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56
Q

Which medication has a half-life of approximately 20 hours?
a) Meloxicam
b) Diclofenac
c) Celecoxib
d) Naproxen

A

a) Meloxicam

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57
Q

How is celecoxib primarily metabolized?
a) By CYP2C9 only
b) By CYP2C9, CYP3A4, and CYP2C8
c) By CYP2D6 only
d) By CYP3A4 and CYP2C8

A

b) By CYP2C9, CYP3A4, and CYP2C8

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58
Q

Which medication has been shown to cross the placenta in laboratory animals, although human data is not available?
a) Meloxicam
b) Diclofenac
c) Celecoxib

A

b) Diclofenac

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59
Q

When does diclofenac typically achieve peak plasma concentrations after oral administration?
a) Within 10-40 minutes
b) Within 1-2 hours
c) Within 3 hours
d) Within 20 hours

A

c) Within 3 hours

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60
Q

What is the primary mechanism of action of ketorolac?
a) Blocks sodium channels
b) Inhibits the activity of COX-1 and COX-2 enzymes
c) Decreases the ability of local neurons to send signals to the brain
d) Helps block pain messages to nerves

A

b) Inhibits the activity of COX-1 and COX-2 enzymes

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61
Q

How is ketorolac primarily eliminated from the body?
a) Metabolized via hydroxylation
b) Renal elimination
c) Metabolized in the liver to less active metabolites
d) Absorbed through the skin

A

b) Renal elimination

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62
Q

Which medication blocks sodium channels to decrease the ability of local neurons to send signals to the brain?
a) Ketorolac
b) Indomethacin
c) Transdermal lidocaine
d) Capsaicin cream

A

c) Transdermal lidocaine

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63
Q

What is the primary mechanism of action of capsaicin cream?
a) Blocks sodium channels
b) Inhibits the activity of COX-1 and COX-2 enzymes
c) Helps block pain messages to nerves
d) Produces a sensation of burning

A

) Helps block pain messages to nerves

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64
Q

. How does topical capsaicin act in the skin to reduce pain?
a) By depleting substance P
b) By increasing the transport of neurotrophic factors
c) By defunctionalization of nociceptive fibers
d) By blocking sodium channels

A

c) By defunctionalization of nociceptive fibers

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65
Q

How long does it take for peak effects to be observed with transdermal lidocaine?
a) 1-2 hours
b) 5-30 minutes
c) 10-60 minutes
d) 2.5-5 hours

A

b) 5-30 minutes

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66
Q

What is the primary route of elimination for ketorolac?
a) Renal elimination
b) Fecal elimination
c) Metabolism in the liver
d) Absorption through the skin

A

a) Renal elimination

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67
Q

Which of the following is not a family of opioid peptides?
a) β-endorphin
b) Enkephalins
c) Nad dynorphins
d) Gamma-endorphin

A

d) Gamma-endorphin

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68
Q

Opioid receptor activation elicits presynaptic and postsynaptic inhibition primarily by altering:
a) Sodium conductance
b) Calcium conductance
c) Potassium conductance
d) Chloride conductance

A

c) Potassium conductance

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69
Q

Which receptor activation is crucial to the rewarding, analgesic, and addictive properties of opioids?
a) Delta
b) Kappa
c) Mu
d) Sigma

A

c) Mu

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70
Q

Which opioid is derived from the opium poppy and used to treat acute and chronic severe pain?
a) Codeine
b) Thebaine
c) Hydrocodone
d) Morphine

A

d) Morphine

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71
Q

What is the primary side effect associated with opioid use that poses the greatest risk of mortality?
a) Nausea
b) Dry mouth
c) Respiratory depression
d) Drowsiness

A

c) Respiratory depression

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72
Q

Thebaine differs from morphine and codeine in that it:
a) Is not derived from opium
b) Has stimulatory effects
c) Is used therapeutically
d) Is a partial opioid agonist

A

b) Has stimulatory effects

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73
Q

Hydromorphone is considered approximately how many times more potent than morphine?
a) 1.5 times
b) 5 times
c) 10 times
d) 20 times

A

b) 5 times

74
Q

. Which opioid is primarily used to treat severe pain of a prolonged duration?
a) Oxycodone
b) Fentanyl
c) Meperidine
d) Buprenorphine

A

a) Oxycodone

75
Q

Buprenorphine acts as a partial opioid agonist at which receptor?
a) Mu
b) Kappa
c) Delta
d) Sigma

A

a) Mu

76
Q

Methadone may be useful in the management of neuropathic pain due to its activity at which receptors?
a) Mu
b) Kappa
c) Delta
d) NMDA

A

d) NMDA

77
Q

Which opioid is primarily metabolized by CYP2D6 into an active metabolite?
a) Tramadol
b) Methadone
c) Oxymorphone
d) Tapentadol

A

a) Tramadol

78
Q

Fentanyl is approximately how many times as potent as morphine?
a) 10 times
b) 50 times
c) 100 times
d) 500 times

A

c) 100 times

79
Q

. What is the primary route of administration for tapentadol?
a) Intravenous
b) Intranasal
c) Oral
d) Transdermal

A

c) Oral

80
Q

Which opioid is associated with a risk of serotonin syndrome when used with serotonergic medications?
a) Methadone
b) Hydrocodone
c) Meperidine
d) Tramadol

A

d) Tramadol

81
Q

. Which opioid is available as a skin patch for slow-release administration?
a) Fentanyl
b) Oxycodone
c) Buprenorphine
d) Methadone

A

a) Fentanyl

82
Q

. Which opioid is metabolized by CYP3A4 and CYP2D6, potentially leading to drug interactions?
a) Oxymorphone
b) Hydromorphone
c) Codeine
d) Tapentadol

A

c) Codeine

83
Q

The most serious side effect associated with opioid use is:
a) Dry mouth
b) Nausea
c) Respiratory depression
d) Drowsiness

A

c) Respiratory depression

84
Q

Which opioid is often used in combination with acetaminophen or NSAIDs for enhanced pain relief?
a) Fentanyl
b) Methadone
c) Oxycodone
d) Buprenorphine

A

c) Oxycodone

85
Q

Which opioid may be used to treat opioid use disorder (OUD)?
a) Tramadol
b) Thebaine
c) Fentanyl
d) Buprenorphine

A

d) Buprenorphine

86
Q

The most common side effect associated with opioid use is:
a) Respiratory depression
b) Nausea
c) Drowsiness
d) Dry mouth

A

b) Nausea

87
Q

Which opioid is a full synthetic opioid?
a) Hydrocodone
b) Morphine
c) Fentanyl
d) Oxycodone

A

c) Fentanyl

88
Q

What is the primary mechanism of action of carisoprodol (Soma)?
a) Activation of GABA receptors
b) Blockage of nerve transmission
c) Inhibition of serotonin reuptake
d) Activation of central adrenergic receptors

A

b) Blockage of nerve transmission

89
Q

Methocarbamol primarily affects muscle spasticity by:
a) Blocking polysynaptic reflexes
b) Inhibiting nerve transmission
c) Increasing GABA activity
d) Activating adrenergic receptors

A

a) Blocking polysynaptic reflexes

90
Q

Cyclobenzaprine is a centrally acting muscle relaxant that acts by:
a) Activating GABA receptors
b) Blocking serotonin receptors
c) Enhancing acetylcholine release
d) Inhibiting dopamine reuptake

A

b) Blocking serotonin receptors

91
Q

Tizanidine reduces muscle spasticity primarily by:
a) Activating GABA receptors
b) Blocking calcium channels
c) Enhancing dopamine release
d) Inhibiting acetylcholinesterase

A

a) Activating GABA receptors

92
Q

Baclofen exerts its muscle relaxant effects mainly by activating:
a) Glutamate receptors
b) Dopamine receptors
c) GABA-B receptors
d) Serotonin receptors

A

c) GABA-B receptors

93
Q

Diazepam is primarily used for treating muscle spasms by:
a) Blocking glutamate receptors
b) Inhibiting dopamine release
c) Enhancing GABA-A receptor activity
d) Stimulating adrenergic receptors

A

c) Enhancing GABA-A receptor activity

94
Q

Which muscle relaxant is metabolized by CYP2C19 into meprobamate, which contributes to its effects?
a) Methocarbamol
b) Tizanidine
c) Baclofen
d) Carisoprodol

A

d) Carisoprodol

95
Q

What is the approximate duration of action of cyclobenzaprine?
a) 1 - 2 hours
b) 4 - 6 hours
c) 8 - 10 hours
d) 12 - 14 hours

A

b) 4 - 6 hours

96
Q

Which muscle relaxant is metabolized by CYP1A2 and excreted primarily by the kidneys?
a) Tizanidine
b) Baclofen
c) Methocarbamol
d) Diazepam

A

a) Tizanidine

97
Q

What is the primary route of metabolism for diazepam?
a) Liver metabolism into inactive metabolites
b) Renal excretion of unchanged drug
c) Conversion into active metabolites by CYP3A4
d) Conjugation and excretion in urine

A

a) Liver metabolism into inactive metabolites

98
Q

Which muscle relaxant has a rapid onset of action and is predominantly excreted unchanged in urine?
a) Carisoprodol
b) Methocarbamol
c) Baclofen
d) Diazepam

A

c) Baclofen

99
Q

What is the main pharmacological action of methocarbamol?
a) Enhancing dopamine release
b) Blocking glutamate receptors
c) Activating GABA-B receptors
d) Blocking polysynaptic reflexes

A

d) Blocking polysynaptic reflexes

100
Q

Which muscle relaxant is extensively metabolized in the liver via oxidative and conjugative pathways?
a) Tizanidine
b) Cyclobenzaprine
c) Diazepam
d) Carisoprodol

A

b) Cyclobenzaprine

101
Q

What is the primary drug interaction concern with carisoprodol?
a) Interaction with CYP3A4 inhibitors
b) Potentiation of opioid effects
c) Serotonin syndrome with SSRIs
d) Increased sedation with alcohol

A

d) Increased sedation with alcohol

102
Q

Which muscle relaxant has the longest duration of action?
a) Tizanidine
b) Methocarbamol
c) Cyclobenzaprine
d) Diazepam

A

d) Diazepam

103
Q

What is a possible treatment goal for substance dependence according to the view that it represents one end of a continuum of use?
a) Total abstinence
b) Controlled use
c) Reducing harm
d) Relapse prevention

A

b) Controlled use

104
Q

What is a major approach used in Alcoholics Anonymous (AA) for addressing alcohol dependence?
a) Individual therapy
b) Medication management
c) Group support
d) Inpatient detoxification

A

c) Group support

105
Q

Motivational Enhancement Therapy (MET) focuses on:
a) Maintaining total abstinence
b) Rewarding drug-free urine samples
c) Shifting focus away from denial and toward motivation to change
d) Administering medications to alleviate withdrawal symptoms

A

c) Shifting focus away from denial and toward motivation to change

106
Q

Contingency Management (CM) involves:
a) Using punishment therapy to discourage drug use
b) Rewarding individuals for providing drug-free urine samples
c) Administering medications to induce cross-tolerance
d) Providing cognitive-behavioral therapy to prevent relapse

A

b) Rewarding individuals for providing drug-free urine samples

107
Q

Cognitive-Behavioral Therapy (CBT) combines:
a) Pharmacotherapy and group support
b) Motivational interviewing and mindfulness techniques
c) Cognitive therapy techniques with behavioral skills training
d) Agonist therapy with antagonist therapy

A

c) Cognitive therapy techniques with behavioral skills training

108
Q

Which phase of treatment involves administering medications to alleviate withdrawal symptoms?
a) Maintenance phase
b) Detoxification phase
c) Contingency management phase
d) Cognitive-behavioral therapy phase

A

b) Detoxification phase

109
Q

What is an example of an antagonist therapy used for maintenance in substance dependence treatment?
a) Methadone
b) Nicotine replacement therapy
c) Naltrexone
d) Disulfiram

A

c) Naltrexone

110
Q

What is the primary focus of the maintenance phase in substance dependence treatment?
a) Achieving controlled use
b) Relapse prevention
c) Inducing cross-tolerance
d) Avoiding withdrawal symptoms

A

b) Relapse prevention

111
Q

What is the goal of punishment therapy in substance dependence treatment?
a) Inducing cross-tolerance
b) Preventing relapse
c) Producing aversive reactions to drug use
d) Rewarding drug-free behavior

A

c) Producing aversive reactions to drug use

112
Q

Which theoretical view of addiction emphasizes total abstinence as the only acceptable treatment goal?
a) Biopsychosocial model
b) Disease model
c) Harm reduction model
d) Cognitive-behavioral model

A

b) Disease model

113
Q

Which drug is more lipid-soluble than morphine and can be administered via injection, sniffing, snorting, or smoking?
a) Morphine
b) Methadone
c) Fentanyl
d) Heroin

A

d) Heroin

114
Q

What is the onset of action for heroin?
a) 1-2 minutes
b) 10-15 minutes
c) Within minutes
d) 30-60 minutes

A

c) Within minutes

115
Q

Which of the following is a long-term effect associated with heroin use?
a) Warm flushing of the skin
b) Heavy arms/legs
c) Severe itching
d) Collapsed veins

A

d) Collapsed veins

116
Q

What is one of the dangers of heroin use related to potential additives?
a) Liver damage
b) Lung complications
c) Increased appetite
d) Reduced sexual dysfunction

A

b) Lung complications

117
Q

What is the primary reason for using clonidine during opioid withdrawal?
a) To induce euphoria
b) To prevent withdrawal symptoms
c) To reverse respiratory depression
d) To increase opioid effects

A

b) To prevent withdrawal symptoms

118
Q

Which of the following symptoms is NOT associated with opioid withdrawal?
a) Craving for drugs
b) Goosebumps
c) Decreased respiratory rate
d) Yawning

A

c) Decreased respiratory rate

119
Q

What is the main component of the opioid overdose triad?
a) Elevated blood pressure
b) Dilated pupils
c) Depressed respiration
d) Increased heart rate

A

c) Depressed respiration

120
Q

What is the primary goal of rapid opioid detoxification?
a) To induce euphoria
b) To prevent withdrawal symptoms
c) To treat liver damage
d) To induce a state of delirium

A

b) To prevent withdrawal symptoms

121
Q

Which medication is commonly used as substitution therapy for opioid dependence?
a) Belladonna
b) Methadone
c) Naloxone
d) Clonidine

A

b) Methadone

122
Q

What is the primary drawback of rapid opioid detoxification?
a) Medical risks
b) Lack of effectiveness
c) High cost
d) Short duration of action

A

a) Medical risks

123
Q

Methadone is metabolized by which enzyme?
a) CYP3A4
b) CYP2B6
c) CYP2D6
d) CYP2C19

A

a) CYP3A4

124
Q

What is the half-life of methadone in opioid-naïve individuals?
a) 8-12 hours
b) 24-36 hours
c) 48-72 hours
d) 55 hours

A

d) 55 hours

125
Q

Which of the following is NOT a side effect of methadone?
a) Weight gain
b) Stomach pain
c) Dry mouth
d) Difficulty urinating

A

d) Difficulty urinating

126
Q

What is the primary advantage of buprenorphine over methadone?
a) Higher potency
b) Longer duration of action
c) Lower risk of respiratory depression
d) Rapid onset of action

A

c) Lower risk of respiratory depression

127
Q

Which of the following is a formulation of buprenorphine combined with naloxone?
a) Sublocade
b) Probuphine
c) Subutex
d) Vivitrol

A

c) Subutex

128
Q

What is the primary function of naloxone?
a) To induce euphoria
b) To treat opioid overdose
c) To relieve pain
d) To prevent withdrawal symptoms

A

b) To treat opioid overdose

129
Q

What is the duration of action for naloxone?
a) 15-30 minutes
b) 1-2 hours
c) 24 hours
d) 48 hours

A

a) 15-30 minutes

130
Q

Naltrexone is primarily used for which type of therapy?
a) Substitution therapy
b) Antagonist therapy
c) Punishment therapy
d) Rapid detoxification

A

b) Antagonist therapy

131
Q

What is the peak effect duration for oral naltrexone?
a) 1 hour
b) 2 hours
c) 24 hours
d) 4 weeks

A

b) 2 hours

132
Q

Which of the following is NOT a side effect of naltrexone?
a) Nausea
b) Headache
c) Tiredness
d) Increased sweating

A

d) Increased sweating

133
Q

What is the primary use of medications like methadone and buprenorphine in treating opioid use disorder?
a) Detoxification
b) Relapse prevention
c) Pain management
d) Liver protection

A

b) Relapse prevention

134
Q

How is buprenorphine administered in extended-release form?
a) Oral tablets
b) Subcutaneous injection
c) Intramuscular injection
d) Transdermal patch

A

b) Subcutaneous injection

135
Q

What is the primary purpose of medications like naloxone and naltrexone in opioid use disorder treatment?
a) Pain management
b) Relapse prevention
c) Inducing euphoria
d) Detoxification

A

b) Relapse prevention

136
Q

Which of the following is NOT a key structural feature of morphine in its SAR?
a) Phenol ring
b) Allylic alcohol
c) Basic nitrogen
d) Amino acid chain

A

d) Amino acid chain

137
Q

What is the main drug target of morphine in the central nervous system (CNS)?
a) δ Opioid receptor
b) κ Opioid receptor
c) μ Opioid receptor
d) Serotonin receptor

A

c) μ Opioid receptor

138
Q

What is the significance of the basic nitrogen in morphine’s SAR?
a) It increases CNS penetration
b) It enhances its analgesic potency
c) It decreases the risk of addiction
d) It prolongs its duration of action

A

a) It increases CNS penetration

139
Q

Which enzyme primarily metabolizes morphine into its active form?
a) CYP2D6
b) CYP3A4
c) Glucuronidase
d) Acetylcholinesterase

A

a) CYP2D6

140
Q

What is the active metabolite of morphine that accumulates in patients with renal insufficiency?
a) Normorphine
b) Morphine 6-glucuronide
c) Norcodeine
d) Morphine 3-glucuronide

A

b) Morphine 6-glucuronide

141
Q

Which synthetic opioid has a structure similar to morphine but contains acetyl protecting groups on alcohols?
a) Fentanyl
b) Codeine
c) Oxycodone
d) Heroin

A

d) Heroin

142
Q

What is the primary function of naloxone in opioid overdose treatment?
a) To induce sleep
b) To provide analgesia
c) To reverse opioid effects
d) To enhance opioid potency

A

c) To reverse opioid effects

143
Q

What is the primary structural feature of fentanyl that contributes to its potency?
a) Phenol ring
b) Allylic alcohol
c) Basic nitrogen
d) 4N-arylpiperidine

A

d) 4N-arylpiperidine

144
Q

What enzyme primarily metabolizes methadone?
a) CYP2D6
b) CYP3A4
c) CYP2C9
d) Glucuronidase

A

b) CYP3A4

145
Q

Which synthetic opioid has the highest potency compared to meperidine?
a) Fentanyl
b) Tramadol
c) Methadone
d) Tapentadol

A

a) Fentanyl

146
Q

What is the primary function of naltrexone in opioid use disorder treatment?
a) To induce euphoria
b) To relieve pain
c) To enhance opioid effects
d) To block opioid receptors

A

d) To block opioid receptors

147
Q

Which of the following is NOT a key structural feature of fentanyl?
a) Extra nitrogen before aryl system
b) Ester or amide with small aliphatic chain
c) Allylic alcohol
d) 4N-arylpiperidine

A

c) Allylic alcohol

148
Q

What is the main reason for the need for repeated naloxone dosing in fentanyl overdose?
a) Rapid metabolism
b) High potency
c) Low receptor affinity
d) Slow onset of action

A

b) High potency

149
Q

Which synthetic opioid has a structure similar to meperidine (Demerol) and contains a 4-phenylpiperidine moiety?
a) Methadone
b) Tramadol
c) Fentanyl
d) Tapentadol

A

a) Methadone

150
Q

Which of the following best describes the mechanism of action of opioids?
a) Inhibition of serotonin reuptake
b) Activation of dopamine receptors
c) Binding to opioid receptors
d) Blockade of NMDA receptors

A

c) Binding to opioid receptors

151
Q

What is the main function of naloxone in opioid overdose treatment?
a) To induce analgesia
b) To reverse opioid effects
c) To potentiate opioid effects
d) To reduce respiratory depression

A

b) To reverse opioid effects

152
Q

What is the significance of the basic nitrogen atom in the structure of opioids?
a) It enhances lipophilicity
b) It increases water solubility
c) It facilitates CNS penetration
d) It decreases receptor affinity

A

c) It facilitates CNS penetration

153
Q

Which opioid is known for its use in treating opioid addiction through maintenance therapy?
a) Methadone
b) Fentanyl
c) Heroin
d) Codeine

A

a) Methadone

154
Q

What is the primary function of buprenorphine in opioid dependence treatment?
a) To induce euphoria
b) To block opioid receptors
c) To enhance opioid effects
d) To relieve pain

A

b) To block opioid receptors

155
Q

Which synthetic opioid is structurally similar to meperidine and contains a 4-phenylpiperidine moiety?
a) Fentanyl
b) Tramadol
c) Methadone
d) Tapentadol

A

) Methadone

156
Q

. What is the main reason for the high potency of fentanyl compared to other opioids?
a) Rapid metabolism
b) Low receptor affinity
c) Extra nitrogen before the aryl system
d) Presence of an allylic alcohol group

A

c) Extra nitrogen before the aryl system

157
Q

Which opioid receptor subtype is primarily responsible for mediating dysphoria and hallucinations?
a) μ Opioid receptor
b) κ Opioid receptor
c) δ Opioid receptor
d) Sigma receptor

A

b) κ Opioid receptor

158
Q

What does a pKa value less than the pH indicate?
A) The deprotonated form is predominant
B) The protonated form is predominant
C) Both forms are present equally
D) None of the above

A

A) The deprotonated form is predominant

159
Q

What does a pKa value greater than the pH indicate?
A) The deprotonated form is predominant
B) The protonated form is predominant
C) Both forms are present equally
D) None of the above

A

B) The protonated form is predominant

160
Q

Which neurotransmitter has the highest ClogP value?
A) Dopamine
B) Epinephrine
C) Serotonin
D) Acetylcholine

A

A) Dopamine

161
Q

What is the main mechanism of action of aspirin?
A) Inhibition of COX enzymes
B) Inhibition of acetylcholinesterase
C) Activation of GABA receptors
D) Inhibition of serotonin reuptake

A

A) Inhibition of COX enzymes

162
Q

What role does glutathione play in detoxification?
A) It promotes ROS production
B) It inhibits enzyme activity
C) It detoxifies reactive species
D) It increases drug efficacy

A

C) It detoxifies reactive species

163
Q

How does ethanol consumption affect GSH levels?
A) Increases GSH levels
B) Decreases GSH levels
C) Has no effect on GSH levels
D) Converts GSH into ROS

A

: B) Decreases GSH levels

164
Q

What is the primary reason for storing aspirin formulations with a desiccant?
A) To prevent hydrolysis
B) To enhance absorption
C) To improve stability
D) To increase solubility

A

A) To prevent hydrolysis

165
Q

Which of the following is NOT a primary insult mechanism associated with NSAIDs?
a) Direct acid damage
b) COX-1 inhibition
c) COX-2 inhibition
d) Gastric damage

A

c) COX-2 inhibition

166
Q

What is the primary metabolite responsible for the activity of Sulindac?
a) Glucuronide
b) Sulfide
c) Sulfoxide
d) Sulfonamide

A

b) Sulfide

167
Q

Which of the following NSAIDs is a prodrug that is converted to an active metabolite in the periphery?
a) Indomethacin
b) Naproxen
c) Diclofenac
d) Sulindac

A

d) Sulindac

168
Q

Which NSAID is widely used and available in 120 countries, known for its high analgesic potency?
a) Ibuprofen
b) Naproxen
c) Diclofenac
d) Etodolac

A

c) Diclofenac

169
Q

Which of the following NSAIDs is primarily metabolized in the liver and has a racemic mixture marketed?
a) Indomethacin
b) Ibuprofen
c) Diclofenac
d) Meloxicam

A

: b) Ibuprofen

170
Q

Celecoxib is known for its selective inhibition of which enzyme?
a) COX-1
b) LOX
c) COX-2
d) PLA2

A

) COX-2

171
Q

What is the primary metabolite of Celecoxib?
a) Glucuronide
b) Sulfide
c) Sulfonamide
d) Hydroxylated metabolite

A

b) Sulfide

172
Q

What is the primary mechanism of action of capsaicin?
a) Inhibition of COX-1
b) Activation of TRPV1
c) Inhibition of LOX
d) Activation of COX-2

A

b) Activation of TRPV1

173
Q

From the choices above, which molecule(s) inhibit COX-1?

A

A only

174
Q

Which of the rankings below is correct based on likelihood of producing GI distress?
a) B>A>D>C
b) A>B>C>D
c) B>A>C>D
d) D>B>A>C
e) None of the above

A

None
B>D>A>C

175
Q

Which of the statements is/are true about aspirin?
a) In the body, it will be poorly bound to plasma proteins
b) One of its mechanisms of action involves irreversible inhibition of a COX active site Serine
c) It is available in tablets, capsules, and suspensions

A

One of its mechanisms of action involves irreversible inhibition of a COX active site Serine

176
Q

T/F: In general, drug metabolites are more hydrophilic than their parent drug molecule.

A

True

177
Q

Which key structural feature is most important for potent analgesic effects of the local anesthetics discussed?
a) An acidic functionality which is ionized at physiologic pH
b) A 1-2 carbon linker
c) An aromatic hydrophobic group
d) A basic amine which is charged at physiological pH

A

b) A 1-2 carbon linker
c) An aromatic hydrophobic group
d) A basic amine which is charged at physiological pH

178
Q

Which type of interaction is most responsible for anchoring opioids to the mu receptor?
a) An ionic bond
b) Van der waals interactions
c) Hydrogen bonds

A

a) An ionic bond

179
Q

The molecule shown has which key structural feature(s) which are involved in potent activity at the mu opioid receptor?
a) A phenolic -OH
b) An allylic -OH
c) A basic amine
d) A carbamate

A

a) A phenolic -OH
b) An allylic -OH

180
Q

Which of the following is true regarding the molecules above?
a) They all contain at least one basic amine
b) Compound c is a flexible synthetic opioid
c) Compound c is an opioid antagonist

A

a) They all contain at least one basic amine
b) Compound c is a flexible synthetic opioid

181
Q

Which structural component is found in the drug shown and is essential for activity?
a) A 1,3 propanediol
b) A secondary alcohol
c) A basic amine

A

a) A 1,3 propanediol

182
Q

Which of the following is true for the drug shown?
a) It is structurally related to GABA
b) It will not be charged at physiological pH
c) It is rapidly metabolized into GABA
d) The majority of it will be excreted unchanged in the urine

A

a) It is structurally related to GABA
d) The majority of it will be excreted unchanged in the urine

IPCS 3 (4 decks)

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