Final Exam Pcol1 Tth 1-2:30pm

1. 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

Codeine

Dextromethorphan

Diphenoxylate

Loperamide

Tramadol

2. Clinical Manifestation of Physical Dependence on Opioids

Rhinorrhea

Lacrimation

Chills

Hostility

All of the above

3. Duration of action of Fentanyl patches.

24 hours

12 hours

72 hours

1 week

4. Naloxone

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

5. Naltrexone

Strong agonist

Partial gonist

Mixed agonist-antagonist

Antagonist

6. Endogenous peptides that act on opioid receptors.

Opioid peptides

Opioid agonist

Partial agonist

Opioid antagonist

7. Nalmefene

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

8. Morphine

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

9. Oxymorphone

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

10. Choose the correct statement about Fibromyalgia.

It is a Maladaptive or pathophysiologic pain.

It results from damage or abnormal functioning of nerves in the CNS or PNS

It is a chronic pain.

All of the above

11. A drug that blocks some or all opioid receptor subtypes.

Opioid antagonist

Opiate

Opioid

Opioid peptides

12. A drug derived from alkaloids of the opium poppy.

Opiate

Opioid

Opioid peptides

Opioid agonist

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

Opioid

Mixed agonist-antagonist

Opioid antagonist

Partial agonist

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

Opioid agonist

Partial agonist

Opioid antagonist

Mixed agonist-antagonist

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

Partial agonist

Opiate

Opioid

Opioid peptides

16. This type of opioid receptor is involved in sedative actions.

Beta

Delta

Kappa

None of the above

17. Dextromethorphan

Strong agonist

Partial agonist

Expectorant

Antitussives

18. Nalbuphine

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

19. Meperidine

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

20. Methadone

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

21. Endorphins have highest affinity for _______________ receptors

Mu

Kappa

Delta

Enkephalins

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

Codeine

Fentanyl

Meperidine

Methadone

Tramadol

23. Fibromyalgia is

Acute

Chronic

Adaptive Pain

Physiologic Pain

24. Inhibitory postsynaptic potential

Depolarization

Hyperpolarization

Repolarization

Rest

25. Buprenorphine

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

26. Hydromorphone

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

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

Mixed agonist-antagonist

Opioid antagonist

Partial agonist

Opioid agonist

28. 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?

Acetaminophen

Codeine

Diazepam

Methadone

Naltrexone

29. Fentanyl

Strong agonist

Partial agonist

Antagonist

Antitussives

30. The following are acute effects of Opioids except:

Tolerance

Analgesia

Sedation

Euphoria

Respiratory Depression

31. Kappa receptors has strong affinities on which Opioid peptide?

5HT

Dynorphins

Beta Endorphins

Adrenaline

32. The most appropriate oral medication for his increasing pain is

Buprenorphine

Codeine plus aspirin

Levorphanol

Pentazocine

Propoxyphene

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

Posaconazole

Lansoprazole

Pantoprazole

Esomeprazole

Omeprazole

34. It used in case of Opioid Dependence

Methadone

Fentanyl

Buprenorphine

Methadone and Buprenorphine

Fentanyl and Buprenorphine

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?

The patient had injected methamphetamine

The patient has hepatitis B

The patient has overdosed with an opioid

The signs and symptoms are those of the opioid abstinence syndrome

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

36. Which statement about dextromethorphan is accurate?

Activates κ receptors

Analgesia equivalent to pentazocine

Highly effective antiemetic

Less constipation than codeine

No abuse potential

37. Which statement about butorphanol is accurate?

Activates μ receptors

Does not cause respiratory depression

Is a nonsedating opioid

Pain-relieving action is not superior to that of codeine

Response to naloxone in overdose may be unreliable

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

Mu

Delta

Kappa

Both Mu and Delta

39. 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

Biliary smooth muscle

Constipation

Nausea and vomiting

Sedation

Urinary retention

40. 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?

Alprazolam

Bupropion

Isocarboxazid

Lithium

Mirtazapine

41. Enkephalins have highest affinity for ______________ receptors

Mu

Kappa

Delta

Beta Endorphins

42. Codeine

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

43. Tramadol

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

Antitussives

44. Hydrocodone

Strong agonist

Partial agonist

Mixed agonist-antagonist

Antagonist

45. 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?

Amphetamine

Buprenorphine

Naloxone

Naltrexone

Propoxyphene

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

Na+

K+

Cl-

Ca++

47. Goals of Treatment for Chronic or noncancer pain.

Pain relief that allows for attainment of defined functional goals.

Improve level of functioning, decrease pain, reduce medication use if possible and improve quality of life.

All of the above

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

Main action is from the Medulla

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

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

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

Opioid analgesics are relatively contraindicated in patients with head injuries.

Submit

49. 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?

Refrigerate Biaxin suspension

Continue Nexium 40 mg for a total of 10 days.

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

Taste disturbances are common with Biaxin.

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

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

Azithromycin

Cefaclor

Clindamycin

Metronidazole

Vancomycin

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

Mu

Delta

Kappa

Mu and Delta

Mu and Kappa

52. 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):

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

Ibuprofen may injure the gastric mucosa directly.

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

Submit

53. 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?

12.5%

25.0%

50.0%

75.0%

87.5%

54. 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?

Ranitidine

Cimetidine

Nizatidine

Famotidine

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

Kappa

Mu

Delta

Kappa and Mu

56. The following are acute effects Opioids except:

Constipation

Nausea and Vomiting

Spasm

Antitussive

Dependence

57. 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?

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

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

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

Option 4

Submit

Final Exam Pcol1 Tth 1-2:30pm

1. 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

2.

What first name or nickname would you like us to use?

2. Clinical Manifestation of Physical Dependence on Opioids

3. Duration of action of Fentanyl patches.

4. Naloxone

5. Naltrexone

6. Endogenous peptides that act on opioid receptors.

7. Nalmefene

8. Morphine

9. Oxymorphone

10. Choose the correct statement about Fibromyalgia.

11. A drug that blocks some or all opioid receptor subtypes.

12. A drug derived from alkaloids of the opium poppy.

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

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

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

16. This type of opioid receptor is involved in sedative actions.

17. Dextromethorphan

18. Nalbuphine

19. Meperidine

20. Methadone

21. Endorphins have highest affinity for _______________ receptors

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

23. Fibromyalgia is

24. Inhibitory postsynaptic potential

25. Buprenorphine

26. Hydromorphone

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

29. Fentanyl

30. The following are acute effects of Opioids except:

31. Kappa receptors has strong affinities on which Opioid peptide?

32. The most appropriate oral medication for his increasing pain is

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

34. It used in case of Opioid Dependence

36. Which statement about dextromethorphan is accurate?

37. Which statement about butorphanol is accurate?

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

39. 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

41. Enkephalins have highest affinity for ______________ receptors

42. Codeine

43. Tramadol

44. Hydrocodone

45. 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?

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

47. Goals of Treatment for Chronic or noncancer pain.

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

49. 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?

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

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

52. 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):

53. 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?

54. 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?

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

56. The following are acute effects Opioids except:

57. 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?