1.
Directions 1- 6
For each numbered item select the one lettered option which is most closely associated
with it (each lettered option can be selected once, more than once, or not at all).
This drugs is partial agonist at mu receptors and antagonist at kappa receptors
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
I. 
J. 
K. 
2.
Directions 1- 6
For each numbered item select the one lettered option which is most closely associated
with it (each lettered option can be selected once, more than once, or not at all).
This drug is the full opioid agonist with the highest oral bioavailability
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
I. 
J. 
K. 
3.
Directions 1- 6
For each numbered item select the one lettered option which is most closely associated
with it (each lettered option can be selected once, more than once, or not at all).
This drug has very week opioid activity and is used in the treatment of diarrhea
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
I. 
J. 
K. 
4.
Directions 1- 6
For each numbered item select the one lettered option which is most closely associated
with it (each lettered option can be selected once, more than once, or not at all).
This drug is partial agonist at mu receptors and full agonist at kappa receptors
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
I. 
J. 
K. 
5.
Directions 1- 6
For each numbered item select the one lettered option which is most closely associated
with it (each lettered option can be selected once, more than once, or not at all).
This drug has a high affinity but no intrinsic activity at opioid receptors
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
I. 
J. 
K. 
6.
Directions 1- 6
For each numbered item select the one lettered option which is most closely associated
with it (each lettered option can be selected once, more than once, or not at all).
A metabolite of this drug has neuroexcitatory properties and another is still active as
analgesic
A. 
B. 
C. 
D. 
E. 
F. 
G. 
H. 
I. 
J. 
K. 
7.
A 22-year old woman was in labor for 12 hours and was experiencing strong and very
painful contractions. An epidural dose of morphine was ordered for analgesia. Which of
the following neuronal areas was most likely the main site of the analgesic action of
morphine in this setting?
A. 
B. 
C. 
D. 
E. 
F. 
Rostral ventrolateral medulla
8.
A 58-year-old woman with metastasized breast cancer received IM injection of
morphine for pain but she vomited after each dose. Which of the following brain areas is
most likely the main site of this action of morphine?
A. 
B. 
C. 
Median hypothalamic eminence
D. 
E. 
F. 
Rostral ventrolateral medulla
9.
A 61-year-old woman complained of severe pain few hours after an operation to remove
a renal cancer. An IM injection of morphine was made. Which of the following actions
most likely contributed to the analgesic effect of morphine?
A. 
Activation of brain stem neurons that modulate the pain transmission
B. 
Stimulation of substance P release from nerve terminals in the spinal cord
C. 
Induction of dissociative feeling and dysphoria
D. 
Inhibition of adrenergic pathways from locus ceruleus
E. 
Inhibition of serotonergic pathways from raphe nuclei
10.
A 55-year-old man complained of severe pain after surgery to remove a colon cancer.
The physician ordered a drug that is a partial mu opioid agonist, more potent than
morphine and whose effects are not readily antagonized by naloxone. Which of the
following drugs was most likely administered?
A. 
B. 
C. 
D. 
E. 
F. 
11.
A 34-year-old woman was admitted to the emergency room because of multiple
fractures due to a car accident. The patient complained of severe pain and an IM injection
of morphine was made. Which of the following molecular actions most likely mediated the
analgesic effect of the drug in this patient?
A. 
Opening of Ca++ channels on presynaptic nerve terminals
B. 
Closing of chloride channels on postsynaptic neurons
C. 
Stimulation of substance P release from nociceptive nerve terminals
D. 
Opening of K+ channels on postsynaptic neurons
E. 
Closing of Na+channels on presynaptic nerve terminals
F. 
Stimulation of glutamate release from nociceptive nerve terminals
12.
A 52-year-old man admitted to the emergency room with a myocardial infarction still complained of severe pain after an IV injection of nitroglycerin. An IM administration of morphine was made.
Which of the following molecular actions most likely mediated the analgesic effect of the drug?
A. 
Stimulation of release of endogenous opioid peptides
B. 
Activation of mu-receptors
C. 
Blockade of kappa-receptors
D. 
Stimulation of substance P release from nerve terminals
E. 
Activation of glutamate receptors
F. 
Blockade of beta receptors
13.
A 68-year-old patient suffering from metastasized neck cancer, had a characteristic pin
point pupil because of the continuous SC infusion of morphine from an implanted pump.
The activation of which of the following brain areas most likely mediated this drug effect?
A. 
B. 
C. 
D. 
E. 
F. 
14.
A 55-year-old woman suffering from terminal cancer started a spinal morphine infusion
from an implanted subcutaneous pump. Which of the following was the most likely
consequence of the activation of postsynaptic opioid mu receptors on the pain
transmission neurons in the spinal cord?
A. 
An increased firing of those neurons
B. 
The production of an EPSP
C. 
A decrease in membrane k+ conductance
D. 
An increase in membrane Na+ conductance
E. 
The production of an IPSP
15.
A 51-year-old woman visited her physician office because of a strong abdominal pain
of one hour duration. Physical examination showed a red-headed, pale-skinned woman in
obvious distress, with severe pain and tenderness on right flank. A presumptive diagnosis
of renal colic was made and the patient was given an IM injection of an opioid drug which
is a partial agonist at mu receptors and a full agonist at kappa receptors. Which of the
following drug was most likely administered?
A. 
B. 
C. 
D. 
E. 
16.
A 56-year-old woman suffering from osteoarthritis complained to her physician that
the joint pain in her legs and shoulders was increased and the tablets of acetaminophen
she was using didn’t function any more. She was fearful every morning of the incoming
pain and asked for an effective analgesic drug. The physician decided to order an
analgesic that can also lowers the anxiety, fear and suffering evoked by pain. Which of the
following drugs was most likely prescribed?
A. 
B. 
C. 
D. 
E. 
F. 
17.
A 64-year-old man suffering from advanced heart failure was admitted to the
emergency room because of extreme dyspnea of one hour duration. After physical
examination a diagnosis of impending pulmonary edema was made and an appropriate
therapy was ordered which included the IM injection of morphine. Which of the following
cardiovascular actions most likely contributed to the therapeutic effect of the drug in the
patient’s disorder?
A. 
Increased systolic pressure
B. 
Constriction of renal vascular bed
C. 
D. 
Peripheral venous dilation
E. 
Increased left ventricular end-diastolic pressure
18.
A 67-year-old woman complained to her physician of obstinate constipation. The
woman, who had been suffering bone pain from metastatic breast cancer, started a
therapy with morphine two weeks previously. Which of the following actions most likely
mediated the adverse effect the patient was suffering from?
A. 
Decreased anal sphincter tone
B. 
C. 
Increased intestinal peristalsis
D. 
Increased reflex response to rectal distension
E. 
Increased softening of feces
19.
A 39-year-old woman admitted to the hospital with stage IV ovarian cancer metastatic
to the pelvis, complained of a gripping and burning abdominal pain. A treatment with
sustained release morphine was started. Which of the following effects upon the patient’s
respiratory system could be expected after few days of therapy?
A. 
Stimulation of the cough reflex
B. 
C. 
D. 
E. 
Increased rate of breathing
20.
A 52-year-old man was in his physician office for a control visit. The man, suffering
from metastasized stomach cancer, had started a therapy with morphine three weeks ago.
Which of the following morphine effects was most likely unchanged in that patient after
three weeks of therapy?
A. 
B. 
C. 
D. 
E. 
F.