PART V Narcotic analgesics
01. Narcotics analgesics should:
a) Relieve severe pain
b) Induce loss of sensation
c) Reduce anxiety and exert a calming effect
d) Induce a stupor or somnolent state
02. Second-order pain is:
a) Sharp, well-localized pain
b) Dull, burning pain
c) Associated with fine myelinated A-delta fibers
d) Effectively reduced by non-narcotic analgesics
03. Chemical mediators in the nociceptive pathway are all of the following EXCEPT:
a) Enkephalins
b) Kinins
c) Prostaglandins
d) Substance P
04. Indicate the chemical mediator in the antinociceptive descending pathways:
a) BETA-endorphin
b) Met- and leu-enkephalin
c) Dynorphin
d) All of the above
05. 5. Which of the following mediators is found mainly in long descending pathways from the midbrain to the dorsal horn?
a) Prostaglandin E
b) Dynorphin
c) Enkephalin
d) Glutamate
06. Select the brain and spinal cord regions, which are involved in the transmission of pain?
a) The limbic system, including the amygdaloidal nucleus and the hypothalamus
b) The ventral and medial parts of the thalamus
c) The substantia gelatinosa
d) All of the above
07. Mu (μ) receptors are associated with:
a) Analgesia, euphoria, respiratory depression, physical dependence
b) Spinal analgesia, mydriasis, sedation, physical dependence
c) Dysphoria, hallucinations, respiratory and vasomotor stimulation
d) Analgesia, euphoria, respiratory stimulation, physical dependence
08. Which of the following opioid receptor types is responsible for euphoria and respiratory depression?
a) Kappa-receptors
b) Delta-receptors
c) Mu-receptors
d) All of the above
09. Indicate the opioid receptor type, which is responsible for dysphoria and vasomotor stimulation:
a) Kappa-receptors
b) Delta-receptors
c) Mu-receptors
d) All of the above
10. Kappa and delta agonists:
a) Inhibit postsynaptic neurons by opening K+ channels
b) Close a voltage-gated Ca2+ channels on presynaptic nerve terminals
c) Both a and b
d) Inhibit of arachidonate cyclooxygenase in CNS
11. Which of the following supraspinal structures is implicated in pain-modulating descending pathways?
a) The midbrain periaqueductal gray
b) The hypothalamus
c) The aria postrema
d) The limbic cortex
12. Indicate the neurons, which are located in the locus ceruleus or the lateral tegmental area of the reticular formation:
a) Dopaminergic
b) Serotoninergic
c) Nonadrenergic
d) Gabaergic
13. Which of the following analgesics is a phenanthrene derivative?
a) Fentanyl
b) Morphine
c) Methadone
d) Pentazocine
14. Tick narcotic analgesic, which is a phenylpiperidine derivative:
a) Codeine
b) Dezocine
c) Fentanyl
d) Buprenorphine
15. Which of the following opioid analgesics is a strong mu receptor agonist?
a) Naloxone
b) Morphine
c) Pentazocine
d) Buprenorphine
16. Indicate the narcotic analgesic, which is a natural agonist:
a) Meperidine
b) Fentanyl
c) Morphine
d) Naloxone
17. Select the narcotic analgesic, which is an antagonist or partial mu receptor agonist:
a) Fentanyl
b) Pentazocine
c) Codeine
d) Methadone
18. Which of the following agents is a full antagonist of opioid receptors?
a) Meperidine
b) Buprenorphine
c) Naloxone
d) Butorphanol
19. The principal central nervous system effect of the opioid analgesics with affinity for a mu receptor is:
a) Analgesia
b) Respiratory depression
c) Euphoria
d) All of the above
20. Which of the following opioid analgesics can produce dysphoria, anxiety and hallucinations?
a) Morphine
b) Fentanyl
c) Pentazocine
d) Methadone
21. Indicate the opioid analgesic, which has 80 times analgesic potency and respiratory depressant properties of morphine, and is more effective than morphine in maintaining hemodynamic stability?
a) Fentanyl
b) Pentazocine
c) Meperidine
d) Nalmefene
22. Which of the following opioid analgesics is used in combination with droperidol in neuroleptanalgesia?
a) Morphine
b) Buprenorphine
c) Fentanyl
d) Morphine
23. Fentanyl can produce significant respiratory depression by:
a) Inhibiting brain stem respiratory mechanisms
b) Suppression of the cough reflex leading to airway obstruction
c) Development of truncal rigidity
d) Both a and c
24. Most strong mu receptor agonists cause:
a) Hypertension
b) Increasing the pulmonary arterial pressure and myocardial work
c) Cerebral vasodilatation, causing an increase in intracranial pressure
d) All of the above
25. Which of the following opioid analgesics can produce an increase in the pulmonary arterial pressure and myocardial work?
a) Morphine
b) Pentazocine
c) Meperidine
d) Methadone
26. Morphine causes the following effects EXCEPT:
a) Constipation
b) Dilatation of the biliary duct
c) Urinary retention
d) Bronchiolar constriction
27. Therapeutic doses of the opioid analgesics:
a) Decrease body temperature
b) Increase body temperature
c) Decrease body heat loss
d) Do not affect body temperature
28. Which of the following opioid analgesics is used in obstetric labor?
a) Fentanyl
b) Pentazocine
c) Meperidine
d) Buprenorphine
29. Indicate the opioid analgesic, which is used for relieving the acute, severe pain of renal colic:
a) Morphine
b) Naloxone
c) Methadone
d) Meperidine
30. Which of the following opioid analgesics is used in the treatment of acute pulmonary edema?
a) Morphine
b) Codeine
c) Fentanyl
d) Loperamide
31. The relief produced by intravenous morphine in dyspnea from pulmonary edema is associated with reduced:
a) Perception of shortness of breath
b) Patient anxiety
c) Cardiac preload (reduced venous tone) and afterload (decreased peripheral resistance)
d) All of the above
32. Rhinorrhea, lacrimation, chills, gooseflesh, hyperventilation, hyperthermia, mydriasis, muscular aches, vomiting, diarrhea, anxiety, and hostility are effects of:
a) Tolerance
b) Opioid overdosage
c) Drug interactions between opioid analgesics and sedative-hypnotics
d) Abstinence syndrome
33. The diagnostic triad of opioid overdosage is:
a) Mydriasis, coma and hyperventilation
b) Coma, depressed respiration and miosis
c) Mydriasis, chills and abdominal cramps
d) Miosis, tremor and vomiting
34. Which of the following opioid agents is used in the treatment of acute opioid overdose?
a) Pentazocine
b) Methadone
c) Naloxone
d) Remifentanyl
35. Indicate the pure opioid antagonist, which has a half-life of 10 hours:
a) Naloxone
b) Naltrexone
c) Tramadol
d) Pentazocine
36. In contrast to morphine, methadone:
a) Causes tolerance and physical dependence more slowly
b) Is more effective orally
c) Withdrawal is less severe, although more prolonged
d) All of the above
37. Which of the following opioid analgesics is a partial mu receptor agonist?
a) Morphine
b) Methadone
c) Buprenorphine
d) Sufentanyl
38. Indicate a partial mu receptor agonist, which has 20-60 times analgesic potency of morphine, and a longer duration of action:
a) Pentazocine
b) Buprenorphine
c) Nalbuphine
d) Naltrexone
39. Which of the following opioid analgesics is a strong kappa receptor agonist and a mu receptor antagonist?
a) Naltrexone
b) Methadone
c) Nalbuphine
d) Buprenorphine
40. Which of the following drugs has weak mu agonist effects and inhibitory action on norepinephrine and serotonin reuptake in the CNS?
a) Loperamide
b) Tramadol
c) Fluoxetine
d) Butorphanol
