1. Pharmacology Tutoring for Narcotics By Alaina Darby adarby1@uthsc.edu By Alaina Darby adarby1@uthsc.edu

2. Which of the following is a type of pain that is not treated with opiates? a.Affective b.Thermal c.Chemical d.Neuropathic

3. Which of the following describes where opiates act to cause analgesia? a.In the spinal cord b.In the limbic system c.In the brain stem d.In the thalamus

4. Which of the following describes C neurons? a.Myelinated and responds to sharp, localized pain b.Myelinated and responds to dull, burning pain c.Unmyelinated and responds to sharp, localized pain d.Unmyelinated and responds to dull, burning pain

5. Which of the following drugs is a benzylisoquinoline that causes smooth muscle relaxation? a.Morphine b.Thebaine c.Papaverine d.Codeine

6. Which of the following endogenous opioid peptides primarily activates kappa receptors? a.Endomorphin-1 b.Dynorphin c.Orphanin FQ d.Encephalin

7. Which of the following is the least common use of opioids? a.Cough b.Diarrhea c.Analgesia d.Anesthesia

8. Which of the following projects from the spinal cord and leads to inhibition by the action of opiates? a.Cingulate cortex b.Reticular formation c.Periaqueductal gray d.Substantia gelatinosa

9. Which of the following does not describe the mechanism of opioid receptors? a.Opens K channels to cause hypopolarization b.Inhibits Ca channels to reduce neurotransmitter release c.G-protein coupled inhibitor d.Acts to inhibit adenylyl cyclase

10. Which of the following areas of the brain is involved to increase addiction? a.Brain stem b.Periaqueductal gray c.Limbic system d.Substantia gelatinosa

11. On which of the following receptors in the VTA do opioids act? a.Dopamine b.GABA c.Glutamine d.Norepinephrine

12. Which of the following receptors could be selected for to produce analgesia with no respiratory depression or constipation? a.Mu-1 b.Mu-2 c.Kappa-1 d.Kappa-2

13. Which of the following receptors is not currently targeted because there are no agonists available that are able to cross the blood brain barrier? a.Mu b.Delta c.Kappa d.N/OFQ

14. Which of the following types of receptors can provide a normal, basal level of pain while still preventing hyperalgesia? a.Mu b.Delta c.Kappa d.N/OFQ

15. Which of the following receptor types is most involved in the euphoric response from morphine? a.Mu b.Delta c.Kappa d.N/OFQ

16. Which of the following is not a use for morphine? a.Acute pain b.Chronic pain c.Neuropathic pain d.Affective pain

17. Which of the following receptors is responsible for the respiratory depression exhibited by morphine? a.Mu-1 b.Mu-2 c.Kappa-1 d.Kappa-2

18. Which of the following is usually only seen with high doses of morphine? a.Pupillary constriction b.Nausea and emesis c.Seizures and convulsions d.Constipation

19. The release of which of the following hormones is increased by morphine? a.Cortisol b.Prolactin c.Testosterone d.Luteinizing hormone

20. Which of the following receptors is not involved in the increase of biliary tract pressure? a.Mu b.Delta c.Kappa d.N/OFQ

21. Which of the following is not a result of increased histamine release due to morphine administration? a.Flushing b.Miosis c.Bronchoconstriction d.Orthostatic hypotension

22. Which of the following is a mechanism for acute tolerance? a.Receptor down-regulation b.Receptor internalization c.Receptor phosphorylation d.Receptor alteration

23. Which of the following is a sign of addiction when opioids are not available? a.Irritability b.Hyperalgesia c.Craving d.Diarrhea

24. Which of the following is not one of the triad symptoms of overdose? a.Coma b.Pinpoint pupils c.Flaccid muscles d.Low respiration

25. Which of the following is not true for administration of an opioid antagonist? a.Precipitates withdrawal b.Precipitates craving c.Administered IV or PO d.Shorter duration of action

26. Which of the following is not often combined with an opioid for therapeutic effect or to reduce side effects? a.Amphetamine to counteract sedation b.Stool softener to counteract constipation c.Antihistamine to combat flushing d.NSAIDs for additive effects

27. Which of the following is most commonly associated with intranasal administration? a.Morphine b.Sufetanil c.Fentanyl d.Butorphanol

28. Which of the following is not a typical therapeutic use of opiates? a.Cough b.Dyspnea caused by left ventricular failure c.Headache d.Pain

29. Which of the following should not be taken with opiates? a.NSAIDs b.Salicylates c.Phenothiazines d.Amphetamines

30. Brady is a 34 year old male who has constantly struggled with asthma, drinks heavily, and has just suffered a head injury. Which of the following is not a concern for starting him on morphine for the pain from his injury? a.Release of histamine caused by administration b.Likelihood for abuse due to high dose needed to combat the pain c.Impaired hepatic metabolism of the drug due to his drinking d.Inability to recognize progression of effects from his head injury

31. Which of the following is a strong antitussive agent that is used for moderate to severe pain and is superior to morphine due to its decreased risk of dependence? a.Oxymorphone b.Heroin c.Hydromorphone d.Codeine

32. Which of the following causes the least respiratory depression and can be used for labor pain? a.Meperidine b.Tramadol c.Tapentadol d.Morphine

33. Which of the following is least likely to cause serotonin syndrome when combined with MAOI’s? a.Meperidine b.Tramadol c.Tapentadol d.Morphine

34. Which of the following is the most potent of the listed agents that cannot be totally reversed by naloxone? a.Meperidine b.Tramadol c.Tapentadol d. Morphine

35. Which of the following describes the extended release version of oxycodone? a.Combination with a pure antagonist that is metabolized when injected b.Combination with a partial agonist that is metabolized when injected c.Combination with a pure antagonist that is not metabolized when injected d.Combination with a partial agonist that is not metabolized when injected

36. What is the primary use of D-isomer morphianans (levorphanol family)? a.Analgesia b.Antidiarrheal c.Antitussive d.Antiemetic

37. Which of the following is unusual since it produces restlessness at high doses and can be used during labor since its metabolism is not dependent upon conjugation? a.Meperidine b.Tramadol c.Tapentadol d.Morphine

38. Which of the following has a demethylated metabolite that causes hallucinations or convusions? a.Meperidine b.Tramadol c.Tapentadol d.Morphine

39. Which of the following is a use for opiates in the meperidine family that have poor CNS penetration? a.Analgesia b.Antidiarrheal c.Antitussive d.Antiemetic

40. Which of the following is the most potent? a.Fentanyl b.Sufentanil c.Alfentanil d.Remifentanil

41. Which of the following can be given to someone with hepatic dysfunction? a.Fentanyl b.Sufentanil c.Alfentanil d.Remifentanil

42. Which of the following is increased by administration of rifampin with methadone? a.QT prolongation b.Cyclization of methadone c.Duration of action d.Sedation

43. Which of the following is the target of zinconotide? a.Calcium channels b.Sodium channels c.Opioid receptors d.Serotonin receptors

44. Which of the following would be a reason to use a mixed agonist/antagonist over a pure agonist for severe pain? a.Less pronounced respiratory depression b.Ceiling effect for analgesia c.Reduced incidence of withdrawal d.Reduced incidence of dysphoria

45. Which of the following mixed agonists is derived from thebaine and is a partial agonist for mu? a.Butorphanol b.Nalbuphene c.Buprenorphine d.Pentazocine

46. Which of the following has the highest incidence of respiratory depression? a.Butorphanol b.Nalbuphene c.Buprenorphine d.Pentazocine

47. Which of the following would be the most likely effect of taking naloxone alone? a.Diarrhea b.Respiratory depression c.Emesis d.No effect

48. Which of the following is used to treat alcoholism? a.Alvimiopan b.Naltrexone c.Naloxone d.Methylnaltrexone

49. Which of the following is an opiate antitussive that has no analgesic properties? a.Codeine b.Benzonatate c.Levopropoxyphene d.Hydrocodone