Pcol 1 Final Exam Mw 1-3pm

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Pcol 1 Final Exam Mw 1-3pm - Quiz

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Questions and Answers
  • 1. 

    As noted in Ms. Wiley’s patient profile, she was tested for H. pylori. Which of the following statements is/are true regarding H. pylori?

    • A.

      It is present in the majority of patients with duodenal ulcer.

    • B.

      H. pylori eradication can cure peptic ulcer disease and reduce ulcer recurrence.

    • C.

      An active duodenal ulcer is best managed with a combination of antisecretory therapy plus appropriate antibiotic(s).

    • D.

      Option 4

    Correct Answer(s)
    A. It is present in the majority of patients with duodenal ulcer.
    B. H. pylori eradication can cure peptic ulcer disease and reduce ulcer recurrence.
    C. An active duodenal ulcer is best managed with a combination of antisecretory therapy plus appropriate antibiotic(s).
    Explanation
    H. pylori is a bacteria that is present in the majority of patients with duodenal ulcers. Eradicating H. pylori can cure peptic ulcer disease and reduce the recurrence of ulcers. An active duodenal ulcer is best managed with a combination of antisecretory therapy (to reduce stomach acid production) and appropriate antibiotics to target the H. pylori infection.

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  • 2. 

    In the admission interview, the pharmacist records that the patient has recently completed a regimen of ibuprofen. This information is significant in the patient’s history because (you can tick more than once):

    • A.

      Ibuprofen may cause ulcers even in H. pylori– negative individuals.

    • B.

      Ibuprofen may injure the gastric mucosa directly.

    • C.

      Ibuprofen inhibits synthesis of prostaglandins, thereby compromising the mucosal-protective effect of these substances.

    Correct Answer(s)
    A. Ibuprofen may cause ulcers even in H. pylori– negative individuals.
    B. Ibuprofen may injure the gastric mucosa directly.
    C. Ibuprofen inhibits synthesis of prostaglandins, thereby compromising the mucosal-protective effect of these substances.
    Explanation
    The pharmacist records that the patient has recently completed a regimen of ibuprofen. This information is significant in the patient's history because ibuprofen may cause ulcers even in H. pylori-negative individuals. Additionally, ibuprofen may injure the gastric mucosa directly and inhibit the synthesis of prostaglandins, thereby compromising the mucosal-protective effect of these substances.

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  • 3. 

    If Ms. Wiley were allergic to penicillin, what antiinfective agent should be substituted for the amoxicillin?

    • A.

      Azithromycin

    • B.

      Cefaclor

    • C.

      Clindamycin

    • D.

      Metronidazole

    • E.

      Vancomycin

    Correct Answer
    D. Metronidazole
    Explanation
    If Ms. Wiley were allergic to penicillin, metronidazole should be substituted for the amoxicillin. Metronidazole is an antiinfective agent that is commonly used as an alternative to penicillin in patients with penicillin allergies. It is effective against a wide range of bacteria and parasites, making it a suitable substitute for amoxicillin in this case.

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  • 4. 

    As noted in the profile, Ms. Wiley received ranitidine. The elimination half-life for ranitidine is approximately 2 hours. What percentage of this drug would be eliminated from the body 4 hours after an intravenous (IV) bolus dose?

    • A.

      12.5%

    • B.

      25.0%

    • C.

      50.0%

    • D.

      75.0%

    • E.

      87.5%

    Correct Answer
    D. 75.0%
    Explanation
    The elimination half-life of a drug is the time it takes for the concentration of the drug in the body to decrease by half. In this case, the elimination half-life of ranitidine is approximately 2 hours. After 4 hours, two half-lives have passed. This means that the concentration of the drug would have decreased to 25% of the original dose (50% after the first half-life and another 50% after the second half-life). Therefore, 75% of the drug would have been eliminated from the body after 4 hours.

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  • 5. 

    Ms. Wiley received ranitidine. Of the following H2 antagonists, which one is a particular concern because it interacts with a large number of other medications?

    • A.

      Ranitidine

    • B.

      Cimetidine

    • C.

      Nizatidine

    • D.

      Famotidine

    Correct Answer
    B. Cimetidine
    Explanation
    Cimetidine is a particular concern because it interacts with a large number of other medications. This means that when taken with other drugs, cimetidine may affect their effectiveness or cause harmful side effects. It is important for Ms. Wiley to be cautious when taking cimetidine and to inform her healthcare provider about all the medications she is currently taking to avoid any potential drug interactions.

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  • 6. 

    All of the following reduce acid secretion by inhibiting the proton pump of the parietal cell except:

    • A.

      Posaconazole

    • B.

      Lansoprazole

    • C.

      Pantoprazole

    • D.

      Esomeprazole

    • E.

      Omeprazole

    Correct Answer
    A. Posaconazole
    Explanation
    Posaconazole is not a proton pump inhibitor (PPI), unlike the other options listed. PPIs work by irreversibly blocking the enzyme responsible for acid secretion in the stomach, known as the proton pump. This reduces the production of stomach acid. Posaconazole, on the other hand, is an antifungal medication used to treat certain types of fungal infections. It does not have an effect on acid secretion in the stomach and therefore does not inhibit the proton pump of the parietal cell.

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  • 7. 

    After leaving the hospital, the patient is given prescriptions for Nexium, amoxicillin, and Biaxin to complete the H. pylori eradication regimen. You should counsel the patient regarding all of the following except which one?

    • A.

      Refrigerate Biaxin suspension

    • B.

      Continue Nexium 40 mg for a total of 10 days.

    • C.

      Clarithromycin can be taken with food to minimize GI side effects.

    • D.

      Taste disturbances are common with Biaxin.

    • E.

      Complete a full 10 days of antibiotic/antisecretory therapy for optimal eradication results.

    Correct Answer
    A. Refrigerate Biaxin suspension
    Explanation
    The patient should be counseled regarding all of the following except refrigerating the Biaxin suspension.

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  • 8. 

    A drug that blocks some or all opioid receptor subtypes.

    • A.

      Opioid antagonist

    • B.

      Opiate

    • C.

      Opioid

    • D.

      Opioid peptides

    Correct Answer
    A. Opioid antagonist
    Explanation
    An opioid antagonist is a drug that blocks the effects of opioids by binding to the opioid receptors in the brain. This means that it can prevent or reverse the effects of opioids, such as pain relief or euphoria. Opioid antagonists are often used to treat opioid overdose or addiction, as they can help to reduce the effects of opioids and prevent further harm. They work by competitively binding to the opioid receptors, blocking the opioids from attaching and activating them. This ultimately leads to a decrease in the opioid's effects on the body.

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  • 9. 

    A drug derived from alkaloids of the opium poppy.

    • A.

      Opiate

    • B.

      Opioid

    • C.

      Opioid peptides

    • D.

      Opioid agonist

    Correct Answer
    A. Opiate
    Explanation
    The term "opiate" refers to a drug that is derived from the alkaloids of the opium poppy. This means that it is a natural substance that is extracted from the opium poppy plant. Opiates include drugs such as morphine and codeine, which are commonly used for pain relief. Opiates work by binding to opioid receptors in the brain and spinal cord, reducing the perception of pain.

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  • 10. 

    A drug that can activate an opioid receptor to effect a submaximal response

    • A.

      Partial agonist

    • B.

      Opiate

    • C.

      Opioid

    • D.

      Opioid peptides

    Correct Answer
    A. Partial agonist
    Explanation
    A drug that can activate an opioid receptor to effect a submaximal response is referred to as a partial agonist. This means that the drug has a lower efficacy compared to a full agonist, as it only partially activates the receptor and produces a weaker response. Partial agonists are commonly used in opioid therapy to provide pain relief while reducing the risk of overdose and dependence.

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  • 11. 

    The class of drugs that includes opiates, opiopeptins, and all synthetic and semisynthetic drugs that mimic the actions of the opiates.

    • A.

      Opioid

    • B.

      Mixed agonist-antagonist

    • C.

      Opioid antagonist

    • D.

      Partial agonist

    Correct Answer
    A. Opioid
    Explanation
    The correct answer is "Opioid" because it is the class of drugs that includes opiates, opiopeptins, and all synthetic and semisynthetic drugs that mimic the actions of the opiates.

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  • 12. 

    A drug that activates some opioid receptor subtypes and blocks other opioid receptor subtypes

    • A.

      Mixed agonist-antagonist

    • B.

      Opioid antagonist

    • C.

      Partial agonist

    • D.

      Opioid agonist

    Correct Answer
    A. Mixed agonist-antagonist
    Explanation
    A drug that activates some opioid receptor subtypes and blocks other opioid receptor subtypes is classified as a mixed agonist-antagonist. This type of drug has both agonist and antagonist properties, meaning it can both activate and block certain opioid receptors. This can result in a combination of effects, such as pain relief and reduced risk of addiction or overdose.

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  • 13. 

    Endogenous peptides that act on opioid receptors.

    • A.

      Opioid peptides

    • B.

      Opioid agonist

    • C.

      Partial agonist

    • D.

      Opioid antagonist

    Correct Answer
    A. Opioid peptides
    Explanation
    Opioid peptides are endogenous peptides that act on opioid receptors. These peptides are naturally produced in the body and are involved in regulating pain, mood, and other physiological functions. They bind to opioid receptors in the brain and peripheral tissues, producing analgesic and euphoric effects. Opioid peptides include endorphins, enkephalins, and dynorphins. They are different from opioid agonists, which are synthetic or semi-synthetic drugs that mimic the effects of natural opioids, and opioid antagonists, which block the effects of opioids.

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  • 14. 

    A drug that activates some or all opioid receptor subtypes and does not block any

    • A.

      Opioid agonist

    • B.

      Partial agonist

    • C.

      Opioid antagonist

    • D.

      Mixed agonist-antagonist

    Correct Answer
    A. Opioid agonist
    Explanation
    An opioid agonist is a drug that activates some or all opioid receptor subtypes without blocking any. This means that it binds to the opioid receptors in the body and produces a response, such as pain relief or euphoria. Unlike opioid antagonists, which block the receptors and prevent any response, or mixed agonist-antagonists, which have both agonist and antagonist properties, opioid agonists solely activate the receptors.

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  • 15. 

    This type of opioid receptor plays a major role in the respiratory depressant actions of opioids.

    • A.

      Mu

    • B.

      Delta

    • C.

      Kappa

    • D.

      Both Mu and Delta

    Correct Answer
    A. Mu
    Explanation
    Mu opioid receptors are primarily responsible for the respiratory depressant actions of opioids. When opioids bind to these receptors, it leads to a decrease in the sensitivity of the respiratory centers in the brainstem, resulting in a decrease in respiratory rate and depth. This can lead to potentially dangerous respiratory depression, especially in cases of opioid overdose. Delta and kappa opioid receptors also play a role in the actions of opioids, but they are not as strongly associated with respiratory depression as the mu opioid receptors.

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  • 16. 

    This/these type of opioid receptor/s is/are involved in slowing GI transit

    • A.

      Mu

    • B.

      Delta

    • C.

      Kappa

    • D.

      Mu and Delta

    • E.

      Mu and Kappa

    Correct Answer
    E. Mu and Kappa
    Explanation
    Mu and Kappa opioid receptors are involved in slowing gastrointestinal (GI) transit. These receptors are found in the GI tract and when activated by opioids, they can reduce the movement of the intestines, leading to slower GI transit. This can result in constipation, which is a common side effect of opioid medications. Delta opioid receptors, on the other hand, are not primarily involved in slowing GI transit.

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  • 17. 

    This type of opioid receptor is involved in sedative actions.

    • A.

      Beta

    • B.

      Delta

    • C.

      Kappa

    • D.

      None of the above

    Correct Answer
    C. Kappa
    Explanation
    The kappa opioid receptor is involved in sedative actions. Opioid receptors are a type of protein found in the brain and other parts of the body that are involved in pain regulation. The kappa receptor is one of the three main types of opioid receptors, along with the mu and delta receptors. Activation of the kappa receptor can produce sedative effects, including the reduction of pain perception, as well as other effects such as dysphoria and diuresis. Therefore, the correct answer is kappa.

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  • 18. 

    This type of opioid receptor is involved in the development of tolerance.

    • A.

      Kappa

    • B.

      Mu

    • C.

      Delta

    • D.

      Kappa and Mu

    Correct Answer
    D. Kappa and Mu
    Explanation
    Both the kappa and mu opioid receptors are involved in the development of tolerance. Tolerance occurs when the body becomes less responsive to the effects of a drug over time, leading to the need for higher doses to achieve the same effect. Both kappa and mu receptors play a role in the development of tolerance to opioids, as they are involved in the regulation of pain and reward pathways in the brain. Activation of these receptors leads to desensitization and internalization, ultimately contributing to the development of tolerance.

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  • 19. 

    Endorphins have highest affinity for _______________ receptors

    • A.

      Mu

    • B.

      Kappa

    • C.

      Delta

    • D.

      Enkephalins

    Correct Answer
    A. Mu
    Explanation
    Endorphins have the highest affinity for Mu receptors. Mu receptors are one of the three main types of opioid receptors found in the body. They are primarily located in the central nervous system and are responsible for mediating the analgesic and euphoric effects of endorphins. This high affinity for Mu receptors allows endorphins to bind to these receptors with greater strength and produce their desired effects.

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  • 20. 

    Enkephalins have highest affinity for ______________ receptors

    • A.

      Mu

    • B.

      Kappa

    • C.

      Delta

    • D.

      Beta Endorphins

    Correct Answer
    C. Delta
    Explanation
    Enkephalins have the highest affinity for delta receptors. Delta receptors are a type of opioid receptor found in the central and peripheral nervous systems. Enkephalins are endogenous opioid peptides that bind to these receptors, producing analgesic and other effects. The other options, Mu, Kappa, and Beta Endorphins, are also types of opioid receptors, but enkephalins have the highest affinity for delta receptors specifically.

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  • 21. 

    Kappa receptors has strong affinities on which Opioid peptide?

    • A.

      5HT

    • B.

      Dynorphins

    • C.

      Beta Endorphins

    • D.

      Adrenaline

    Correct Answer
    B. Dynorphins
    Explanation
    Dynorphins have strong affinities for kappa receptors.

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  • 22. 

    Inhibitory postsynaptic potential

    • A.

      Depolarization

    • B.

      Hyperpolarization

    • C.

      Repolarization

    • D.

      Rest

    Correct Answer
    B. Hyperpolarization
    Explanation
    Hyperpolarization is the correct answer because it refers to a change in the membrane potential of a neuron where the inside of the cell becomes more negative than the resting potential. This occurs when inhibitory neurotransmitters bind to receptors on the postsynaptic membrane, causing an influx of negatively charged ions or an efflux of positively charged ions. As a result, the neuron becomes less likely to generate an action potential.

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  • 23. 

    At the presynaptic level, opioid receptor activation can close voltage-gated _____ ion channels to inhibit neurotransmitter release.

    • A.

      Na+

    • B.

      K+

    • C.

      Cl-

    • D.

      Ca++

    Correct Answer
    D. Ca++
    Explanation
    Opioid receptor activation at the presynaptic level can close voltage-gated Ca++ ion channels to inhibit neurotransmitter release. This means that when the opioid receptors are activated, the channels responsible for allowing calcium ions to enter the presynaptic neuron are blocked. As a result, the influx of calcium ions is reduced, which subsequently hinders the release of neurotransmitters from the presynaptic neuron into the synaptic cleft. This inhibition of neurotransmitter release contributes to the overall analgesic and sedative effects of opioids.

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  • 24. 

    The following are acute effects of Opioids except:

    • A.

      Tolerance

    • B.

      Analgesia

    • C.

      Sedation

    • D.

      Euphoria

    • E.

      Respiratory Depression

    Correct Answer
    A. Tolerance
    Explanation
    Tolerance is not an acute effect of opioids. Acute effects refer to the immediate and short-term effects that occur shortly after taking opioids. Tolerance, on the other hand, is a long-term effect that develops over time with repeated use of opioids. It refers to the body's decreased response to the drug, requiring higher doses to achieve the same effect. The other options listed - analgesia, sedation, euphoria, and respiratory depression - are all acute effects commonly associated with opioid use.

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  • 25. 

    The following are acute effects Opioids except:

    • A.

      Constipation

    • B.

      Nausea and Vomiting

    • C.

      Spasm

    • D.

      Antitussive

    • E.

      Dependence

    Correct Answer
    A. Constipation
    Explanation
    Opioids are known to have various acute effects on the body, such as nausea and vomiting, spasm, antitussive (suppressing cough), and dependence. However, constipation is not one of the acute effects of opioids. While constipation is a common side effect of opioid use, it is considered a chronic effect rather than an acute one.

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  • 26. 

    Which statement/s is/are TRUE about Opioids causing Respiratory Depression? (you can tick more than once)

    • A.

      Main action is from the Medulla

    • B.

      Inhibition of the respiratory center will have decreased response to carbon dioxide challenge.

    • C.

      Increase partial pressure of CO2 (PCO2) results to an increase in blood flow.

    • D.

      Increase partial pressure of CO2 (PCO2) results to a decrease intracranial pressure.

    • E.

      Opioid analgesics are relatively contraindicated in patients with head injuries.

    Correct Answer(s)
    A. Main action is from the Medulla
    B. Inhibition of the respiratory center will have decreased response to carbon dioxide challenge.
    C. Increase partial pressure of CO2 (PCO2) results to an increase in blood flow.
    E. Opioid analgesics are relatively contraindicated in patients with head injuries.
    Explanation
    Opioids primarily act on the Medulla, which is responsible for regulating respiration. Inhibition of the respiratory center by opioids leads to a decreased response to carbon dioxide challenge, meaning that the body's ability to detect and respond to high levels of carbon dioxide is impaired. An increase in partial pressure of CO2 (PCO2) results in an increase in blood flow, which can have various effects on the body. Opioid analgesics are relatively contraindicated in patients with head injuries due to the potential for increased intracranial pressure.

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  • 27. 

    Clinical Manifestation of Physical Dependence on Opioids

    • A.

      Rhinorrhea

    • B.

      Lacrimation

    • C.

      Chills

    • D.

      Hostility

    • E.

      All of the above

    Correct Answer
    E. All of the above
    Explanation
    The correct answer is "All of the above" because rhinorrhea (runny nose), lacrimation (excessive tearing), chills, and hostility are all common clinical manifestations of physical dependence on opioids. These symptoms often occur during opioid withdrawal, which is a result of the body becoming dependent on the drug and experiencing withdrawal symptoms when it is discontinued.

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  • 28. 

    Duration of action of Fentanyl patches.

    • A.

      24 hours

    • B.

      12 hours

    • C.

      72 hours

    • D.

      1 week

    Correct Answer
    C. 72 hours
    Explanation
    Fentanyl patches have a duration of action of 72 hours. This means that the patch continuously releases the medication into the body for a period of 72 hours, providing a steady and controlled release of the drug. This extended duration of action allows for longer-lasting pain relief and reduces the need for frequent dosing.

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  • 29. 

    It used in case of Opioid Dependence

    • A.

      Methadone

    • B.

      Fentanyl

    • C.

      Buprenorphine

    • D.

      Methadone and Buprenorphine

    • E.

      Fentanyl and Buprenorphine

    Correct Answer
    D. Methadone and Buprenorphine
    Explanation
    Methadone and Buprenorphine are both medications commonly used in the treatment of opioid dependence. Methadone is a long-acting opioid agonist that helps to reduce withdrawal symptoms and cravings, while Buprenorphine is a partial opioid agonist that also helps to alleviate withdrawal symptoms and cravings. Both medications are used as part of medication-assisted treatment (MAT) programs, which combine medication with counseling and behavioral therapies to provide a comprehensive approach to recovery from opioid addiction. The combination of Methadone and Buprenorphine is an effective treatment option for individuals struggling with opioid dependence.

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  • 30. 

    The most appropriate oral medication for his increasing pain is

    • A.

      Buprenorphine

    • B.

      Codeine plus aspirin

    • C.

      Levorphanol

    • D.

      Pentazocine

    • E.

      Propoxyphene

    Correct Answer
    C. Levorphanol
    Explanation
    Levorphanol is the most appropriate oral medication for the increasing pain because it is a potent opioid analgesic that can effectively manage severe pain. It has a longer duration of action compared to other opioids, providing sustained pain relief. Buprenorphine is also an opioid analgesic, but it is more commonly used for opioid addiction treatment rather than for pain management. Codeine plus aspirin, pentazocine, and propoxyphene are less potent analgesics and may not provide sufficient pain relief for the patient's increasing pain.

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  • 31. 

    It is possible that this patient will have to increase the dose of the analgesic as his condition progresses as a result of developing tolerance. However, tolerance will not develop to a significant extent with respect to

    • A.

      Biliary smooth muscle

    • B.

      Constipation

    • C.

      Nausea and vomiting

    • D.

      Sedation

    • E.

      Urinary retention

    Correct Answer
    B. Constipation
    Explanation
    As the patient continues to take the analgesic, they may develop tolerance, which means that their body will become less responsive to the effects of the medication. However, tolerance is unlikely to develop to a significant extent with respect to constipation. This means that the patient is likely to continue experiencing constipation as a side effect of the analgesic, even if they have been taking it for a long time.

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  • 32. 

    You are on your way to take an examination and you suddenly get an attack of diarrhea. If you stop at a nearby drugstore for an over-the-counter opioid with antidiarrheal action, you will be asking for

    • A.

      Codeine

    • B.

      Dextromethorphan

    • C.

      Diphenoxylate

    • D.

       Loperamide

    • E.

      Tramadol

    Correct Answer
    D.  Loperamide
    Explanation
    Loperamide is the correct answer because it is an over-the-counter opioid with antidiarrheal action. Codeine, Dextromethorphan, Diphenoxylate, and Tramadol are also opioids, but they are not typically available over-the-counter for the treatment of diarrhea. Therefore, Loperamide is the most appropriate choice in this situation.

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  • 33. 

    An emergency department patient with severe pain thought to be of gastrointestinal origin received 80 mg of meperidine. He subsequently developed a severe reaction characterized by tachycardia, hypertension, hyperpyrexia, and seizures. Questioning revealed that the patient had been taking a drug for a psychiatric condition. Which drug is most likely to be responsible for this untoward interaction with meperidine?

    • A.

      Alprazolam

    • B.

      Bupropion

    • C.

      Isocarboxazid

    • D.

      Lithium

    • E.

      Mirtazapine

    Correct Answer
    C. Isocarboxazid
    Explanation
    Isocarboxazid is most likely responsible for the severe reaction experienced by the patient. Isocarboxazid is a monoamine oxidase inhibitor (MAOI) used to treat depression and is known to have potentially dangerous interactions with other medications, including meperidine. MAOIs can inhibit the breakdown of meperidine, leading to increased levels of the drug in the body and an increased risk of adverse effects. The symptoms described, such as tachycardia, hypertension, hyperpyrexia, and seizures, are consistent with a severe reaction to meperidine in the presence of an MAOI.

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  • 34. 

    Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are established to be responsible for variations in analgesic response to

    • A.

      Codeine

    • B.

      Fentanyl

    • C.

      Meperidine

    • D.

      Methadone

    • E.

      Tramadol

    Correct Answer
    A. Codeine
    Explanation
    Genetic polymorphisms in hepatic enzymes involved in drug metabolism can affect the way drugs are processed and metabolized in the body. In the case of codeine, certain individuals may have genetic variations in these enzymes that result in a reduced ability to convert codeine into its active form, morphine. This can lead to decreased analgesic response to codeine, as morphine is responsible for its pain-relieving effects. Therefore, genetic polymorphisms in hepatic enzymes can explain the variations in analgesic response to codeine.

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  • 35. 

    Case:  A young male patient is brought to the emergency department in an anxious and agitated state. He informs the attending physician that he uses “street drugs” and that he gave himself an intravenous “fix” approximately 12 h ago. He now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. The attending physician notes that his pupil size is larger than normal. What is the most likely cause of these signs and symptoms?

    • A.

      The patient had injected methamphetamine

    • B.

      The patient has hepatitis B

    • C.

      The patient has overdosed with an opioid

    • D.

      The signs and symptoms are those of the opioid abstinence syndrome

    • E.

      These are early signs of toxicity due to contaminants in “street heroin”

    Correct Answer
    D. The signs and symptoms are those of the opioid abstinence syndrome
    Explanation
    The patient's symptoms of anxiety, agitation, chills, muscle aches, vomiting, hyperventilation, hyperthermia, and dilated pupils are consistent with opioid abstinence syndrome. Opioid withdrawal can cause these symptoms as the body becomes dependent on the drug and experiences withdrawal when it is not present. The patient's history of using "street drugs" and giving himself an intravenous "fix" suggests opioid use, further supporting the likelihood of opioid abstinence syndrome as the cause of his symptoms.

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  • 36. 

    Case:  A young male patient is brought to the emergency department in an anxious and agitated state. He informs the attending physician that he uses “street drugs” and that he gave himself an intravenous “fix” approximately 12 h ago. He now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation and hyperthermia. The attending physician notes that his pupil size is larger than normal. Which drug will be most effective in alleviating the symptoms experienced by this patient?

    • A.

      Acetaminophen

    • B.

      Codeine

    • C.

      Diazepam

    • D.

      Methadone

    • E.

      Naltrexone

    Correct Answer
    D. Methadone
    Explanation
    Methadone is a long-acting opioid agonist that is commonly used in the treatment of opioid withdrawal. The patient's symptoms, including agitation, chills, muscle aches, vomiting, hyperventilation, hyperthermia, and dilated pupils, are consistent with opioid withdrawal. Methadone can help alleviate these symptoms by providing a stable and controlled dose of opioids, reducing cravings and withdrawal symptoms. Acetaminophen is not effective in treating opioid withdrawal symptoms. Codeine is an opioid and can potentially worsen the patient's condition. Diazepam is a benzodiazepine and may help with anxiety but will not directly alleviate the withdrawal symptoms. Naltrexone is an opioid antagonist and is used to prevent relapse in individuals who have already gone through detoxification.

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  • 37. 

    Which statement about butorphanol is accurate?

    • A.

      Activates μ receptors

    • B.

      Does not cause respiratory depression

    • C.

      Is a nonsedating opioid

    • D.

      Pain-relieving action is not superior to that of codeine

    • E.

      Response to naloxone in overdose may be unreliable

    Correct Answer
    E. Response to naloxone in overdose may be unreliable
    Explanation
    Butorphanol is a synthetic opioid that is commonly used for pain relief. One important characteristic of butorphanol is that its response to naloxone, which is an opioid antagonist used to reverse opioid overdose, may be unreliable. This means that in cases of butorphanol overdose, naloxone may not always effectively reverse the effects of the drug. This is an important consideration when managing cases of butorphanol overdose.

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  • 38. 

    Which drug does not activate opioid receptors, has been proposed as a maintenance drug in treatment programs for opioid addicts, and with a single oral dose, will block the effects of injected heroin for up to 48 h?

    • A.

      Amphetamine

    • B.

      Buprenorphine

    • C.

      Naloxone

    • D.

      Naltrexone

    • E.

      Propoxyphene

    Correct Answer
    D. Naltrexone
    Explanation
    Naltrexone is the correct answer because it does not activate opioid receptors. It has been suggested as a maintenance drug in treatment programs for opioid addicts as it blocks the effects of opioids. With a single oral dose, it can block the effects of injected heroin for up to 48 hours. Amphetamine, Buprenorphine, Naloxone, and Propoxyphene are not the correct answers as they either activate opioid receptors or do not have the same blocking effects on opioids.

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  • 39. 

    Which statement about dextromethorphan is accurate?

    • A.

      Activates κ receptors

    • B.

      Analgesia equivalent to pentazocine

    • C.

      Highly effective antiemetic

    • D.

      Less constipation than codeine

    • E.

      No abuse potential

    Correct Answer
    D. Less constipation than codeine
    Explanation
    Dextromethorphan is an antitussive medication that is commonly used to suppress coughing. Compared to codeine, dextromethorphan is known to cause less constipation. This is because dextromethorphan does not have the same binding affinity to opioid receptors in the gastrointestinal tract, which are responsible for slowing down bowel movements and causing constipation. Therefore, dextromethorphan is a preferred option for individuals who want to avoid or minimize constipation as a side effect of cough medication.

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  • 40. 

    Tramadol

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    • E.

      Antitussives

    Correct Answer
    E. Antitussives
  • 41. 

    Codeine

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    B. Partial agonist
    Explanation
    Codeine is classified as a partial agonist. This means that it has a moderate affinity for and activates certain receptors in the brain, producing a partial response. As a partial agonist, codeine has both agonistic and antagonistic properties. It can bind to opioid receptors and produce analgesic effects, but its efficacy is lower compared to full agonists like morphine. Codeine's partial agonist activity also limits its potential for abuse and overdose, making it a commonly prescribed medication for pain relief and cough suppression.

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  • 42. 

    Fentanyl

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Antagonist

    • D.

      Antitussives

    Correct Answer
    A. Strong agonist
    Explanation
    Fentanyl is classified as a strong agonist. This means that it binds strongly to opioid receptors in the brain and produces a full opioid effect. As a strong agonist, fentanyl is highly potent and has a high affinity for the receptors, resulting in a powerful analgesic and sedative effect. It is commonly used for the management of severe pain, particularly in surgical procedures or for patients with chronic pain.

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  • 43. 

    Hydrocodone

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    B. Partial agonist
    Explanation
    Hydrocodone is classified as a partial agonist. A partial agonist is a substance that binds to a receptor and activates it, but with less efficacy compared to a full agonist. In the case of hydrocodone, it binds to opioid receptors in the brain and spinal cord, producing analgesic (pain-relieving) effects. However, its efficacy is lower than that of a strong agonist, meaning it produces a weaker response. This classification is important in understanding the pharmacological properties and potential therapeutic uses of hydrocodone.

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  • 44. 

    Naloxone

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    D. Antagonist
    Explanation
    Naloxone is an opioid receptor antagonist. It binds to opioid receptors in the brain and blocks the effects of opioids. It does not produce any opioid-like effects itself and instead reverses the effects of opioid overdose, such as respiratory depression. Therefore, it is classified as an antagonist.

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  • 45. 

    Buprenorphine

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    C. Mixed agonist-antagonist
    Explanation
    Buprenorphine is classified as a mixed agonist-antagonist. This means that it can act as both an agonist and an antagonist at different receptor sites in the body. As an agonist, buprenorphine can activate certain receptors, producing a desired effect. However, it also has antagonist properties, which means it can block the activity of other receptors. This dual action makes buprenorphine useful in the treatment of opioid dependence, as it can help reduce cravings and withdrawal symptoms while also blocking the effects of other opioids.

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  • 46. 

    Naltrexone

    • A.

      Strong agonist

    • B.

      Partial gonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    D. Antagonist
    Explanation
    Naltrexone is classified as an antagonist. Antagonists are drugs that bind to specific receptors in the body and block their activity. In the case of naltrexone, it binds to opioid receptors and prevents other opioids from binding to and activating these receptors. This action helps to reduce the effects of opioids and can be used in the treatment of opioid addiction.

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  • 47. 

    Hydromorphone

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    A. Strong agonist
    Explanation
    Hydromorphone is classified as a strong agonist. This means that it binds to and activates opioid receptors in the body, producing a strong analgesic effect. It has a high affinity for these receptors and can fully activate them, resulting in potent pain relief. As a strong agonist, hydromorphone is more effective in producing pain relief compared to partial agonists or mixed agonist-antagonists, which have weaker effects. An antagonist, on the other hand, would block the opioid receptors and have no analgesic effect.

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  • 48. 

    Dextromethorphan

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Expectorant

    • D.

      Antitussives

    Correct Answer
    D. Antitussives
    Explanation
    Dextromethorphan is classified as an antitussive because it is commonly used to suppress coughing. Antitussives are medications that help relieve coughing by blocking the cough reflex. They work by acting on the cough center in the brain, reducing the urge to cough. Dextromethorphan specifically acts as a cough suppressant and is often found in over-the-counter cough and cold medications. Therefore, the correct answer is antitussives.

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  • 49. 

    Nalbuphine

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    C. Mixed agonist-antagonist
    Explanation
    Nalbuphine is classified as a mixed agonist-antagonist. This means that it can both activate and block certain opioid receptors in the brain. As an agonist, it can produce pain relief by activating opioid receptors. However, as an antagonist, it can also block the effects of other opioids, reducing their analgesic properties. This dual action makes nalbuphine useful for managing moderate to severe pain while minimizing the risk of opioid dependence or abuse.

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  • 50. 

    Meperidine

    • A.

      Strong agonist

    • B.

      Partial agonist

    • C.

      Mixed agonist-antagonist

    • D.

      Antagonist

    Correct Answer
    A. Strong agonist
    Explanation
    Meperidine is a strong agonist. This means that it binds to and activates the opioid receptors in the body, producing a strong analgesic effect. As a strong agonist, meperidine has a high affinity for the receptors and can fully activate them, resulting in a potent pain-relieving response.

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