IPS2: Pharmacology - Part 6.3.2 - Drugs for Rheumatologic Disorder - Narcotic Analgesics

Narcosis

a. Therapeutic effect of narcotics

b. Stupor & insensibility

c. Both

d. None

b. Stupor & insensibility

It is toxic effect of narcotics

Stupor

a. absence of spontaneous movement

b. greatly diminished responsiveness to stimulation

c. impaired consciousness

d. a and b

e. b and c

f. All

f. All

Narcotic analgesics.

a. Opioid agonists

b. Obtained from Papaver somniferum

c. Causes narcosis

d. a and b

e. b and c

f. All

f. All

White substance obtained from incision of poppy seed pod which turn into a brown gum.

a. Narcotine

b. Crude opium

c. Dover's powder

d. Opium tincture

b. Crude opium

Morphine concentration in Papaver somniferum

a. 10%

b. 12%

c. 15%

d. 20%

a. 10%

Opioid peptides.

a. Endogenous compounds

b. Have opioid-like pharmacologic properties

c. Have overlapping affinities for different opioid receptors

d. a and b

e. b and c

f. All

f. All

Opioid peptides.

a. Endorphins

b. Enkephalins

c. Dynorphins

d. a and b

e. b and c

f. All

f. All

Opioid pentapeptide

a. Endorphins

b. Enkephalins

c. Dynorphins

d. a and b

e. b and c

f. All

b. Enkephalins

Enkephalins types.

a. Methionine-enkephalin

b. Leucine-enkephalin

c. Proline-enkephalin

d. a and b

e. b and c

f. All

d. a and b

Opioid receptors.

a. Mu-receptors

b. Kappa-receptors

c. Delta-receptors

d. a and b

e. b and c

f. All

f. All

Opioid receptor responsible for the majority of opioid-mediated effects.

a. Mu-receptors

b. Kappa-receptors

c. Delta-receptors

d. a and b

e. b and c

f. All

a. Mu-receptors

Opioid mediated effects by Mu-receptor except:

a. Analgesia

b. Euphoria

c. Miosis

d. Diarrhea

e. Respiratory depression

f. None

d. Diarrhea - should be constipation

Opioid receptor responsible for the additional analgesia in women

a. Mu-receptors

b. Kappa-receptors

c. Delta-receptors

d. a and b

e. b and c

f. All

b. Kappa-receptors

Opioid peptide with highest affinity to Kappa-receptor.

a. Endorphins

b. Enkephalins

c. Dynorphins

b. Enkephalins

Opioid receptor responsible for spinal analgesia effect and modulation of hormone and neurotransmitter release.

a. Mu-receptors

b. Kappa-receptors

c. Delta-receptors

d. a and b

e. b and c

f. All

c. Delta-receptors

Opioid peptide with highest affinity to Delta-receptor.

a. Endorphins

b. Enkephalins

c. Dynorphins

c. Dynorphins

Opioid agonist central actions.

I. Analgesia

II. Euphoria

III. Miosis

IV. Cough suppression

V. Respiratory Depression or Hypoventilation

VI. Emesis

a. I, II, III, IV, V, VI

b. I, III, IV, V, VI

c. I, II, IV, V, VI

d. I, II, III, VI

e. I, IV, V, VI

a. I, II, III, IV, V, VI

Narcotics can reduce

a. Sensory pain

b. Affective pain

c. Both

d. None

c. Both - Narcotics can reduce both sensory and also affective or emotional pain unlike NSAIDS.

Opioid agonist peripheral actions.

I. Constipation

II. Hypertension

III. Bradycardia

IV. Histamine release

V. Tocolysis

VI. Biliary contraction

a. I, II, III, IV, V, VI

b. I, III, IV, V, VI

c. I, II, IV, V, VI

d. I, II, III, VI

e. I, IV, V, VI

b. I, III, IV, V, VI - except hypertension - it’s hypotension

Peripheral effect of opioid agonist:

I) Constipation

II) Hypotension

- opioid agonist induce peripheral arteriolar and venous dilation

III) Bradycardia

IV) Histamine release

- Morphine can cause anaphylactic reaction that would eventually lead to pruritus

V) Tocolysis

- Prolong labour

VI) Biliary contraction

- Lead to biliary colic

- Biliary colic: Abdominal pain

Clinical uses of opioid agonist except:

a. Analgesic agent

b. Management of acute Pulmonary Edema

c. Anaesthetic Adjuncts

d. Antidiarrheal agents

e. Antitussives

f. None

f. None

Opioid agonist used for mild pain.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

a. Tramadol

Opioid agonist used for moderate pain.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

b. Codeine

Opioid agonist used for severe pain

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

c. Morphine

Opioid agonist used as antidiarrheal.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

d. Diphenoxylate - and Loperamide

Opioid agonist used as antitussive.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

e. Dextromethorphan

Dose for antitussive effect of opioid analgesics are obtained at higher doses than the dose needed for analgesia.

a. True

b. False

b. False

Dose for antitussive effect of opioid analgesics are obtained at lower doses than the dose needed for analgesia.

Morphine can cause vasodilation of both arteries and veins leading to lower afterload and preload

a. True

b. False

a. True

Toxicity of opioids except:

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal syndrome

f. None

f. None

Toxicity of opioids with greatest threat.

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal syndrome

a. Respiratory Depression

Toxicity of opioids that make it contraindicated to patient with head trauma.

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal symptoms

b. Increase in Intracranial Pressure

Phenomenon whereby repeated doses of opiated have diminishing effect this is usually manifested after 2-3weeks of chronic use.

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal symptoms

c. Tolerance

Usually reflect with an exaggerated rebound from the acute pharmacologic actions of narcotics.

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal symptoms

e. Withdrawal symptoms

Opioid withdrawal symptoms except:

a. Frequent yawing

b. Hyperventilation

c. Mydriasis

d. Rhinorrhoea

e. Enhanced Hostility

f. None

f. None

Contraindications of opioids

a. Head trauma

b. Pregnancy

c. Full with partial agonists

d. a and b

e. b and c

f. All

f. All

True statements:

a. Carbon dioxide retention caused by respiratory depression can cause cerebral vasodilation

b. ↑High Intracranial pressure will lead to lethal alterations in brain function

c. Both

d. None

c. Both

Derived from natural opium alkaloids.

a. Opiates

b. Opioids

c. Opiades

d. Opioits

a. Opiates

Derived from natural ones with chemical modifications to extract them; semi-synthetic or synthetic

a. Opiates

b. Opioids

c. Opiades

d. Opioits

b. Opioids

Opiates except:

a. Morphine

b. Codeine

c. Thebaine

d. Apomorphine

e. None

d. Apomorphine - this is semisynthetic opioids

Standard of comparison as an analgesic; 25% oral bioavailability.

a. Morphine

b. Codeine

c. Thebaine

a. Morphine

Precursor in the synthesis of Naloxone.

a. Morphine

b. Codeine

c. Thebaine

c. Thebaine

Codeine

a. Standard of comparison as an antitussive

b. Less effective analgesic than morphine

c. Lower efficacy value than morphine

d. a and b

e. b and c

f. All

f. All

Semi-synthetic opioids

a. Heroin

b. Apomorphine

c. Hydromorphone

d. Hydrocodone

e. Methadone

f. None

e. Methadone - this is synthetic opioid

Diacetylmorphine/Diamorphine

Common drug of abuse

a. Heroin

b. Apomorphine

c. Hydromorphone

d. Hydrocodone

e. Methadone

a. Heroin

Used in the management of Parkinsonism.

a. Heroin

b. Apomorphine

c. Hydromorphone

d. Hydrocodone

e. Methadone

b. Apomorphine

True about Apomorphine except:

a. Analgesic

b. Action is related to dopaminergic: Dopamine-2 agonist, Dopamine reuptake inhibitor

c. Emetic drug

d. Used in the management of Parkinsonism

e. None

a. Analgesic - it is not an analgesic as it does not interact with opioid receptors

Semisynthetic morphine derivatives.

a. Hydromorphone

b. Oxymorphone

c. Hydrocodone

d. Oxycodone

e. a and b

f. c and d

e. a and b

Semisynthetic codeine derivatives.

a. Hydromorphone

b. Oxymorphone

c. Hydrocodone

d. Oxycodone

e. a and b

f. c and d

f. c and d

Semisynthetic morphine/codeine derivatives require lesser dose in preparations as they are 8-12x more potent than the morphine/codeine

a. True

b. False

a. True

Synthetic opioids

I. Methadone

II. Meperidine

III. Levorphanol

IV. Loperamide & Diphenoxylate

V. Tramadol

VI. Fentanyl & Related Drugs

VII. Petazocine

a. I, II, III, IV, V, VI, VII

b. I, II, III, IV, V, VI

c. II, III, IV, V, VI, VII

d. I, II, III, IV, V

e. III, IV, V, VI, VII

a. I, II, III, IV, V, VI, VII

Similar efficacy with morphine but with longer duration and less rapid development of tolerance.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

a. Methadone

Used for patients recovering from addiction to morphine.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

a. Methadone

Aka Pethidine; Branded as Demerol in the Philippines.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

b. Meperidine

Meperidine

a. Does not promote bradycardia

b. Does not constraint biliary tract

c. Can be converted into a toxic metabolite called "Normeperidine" which cause seizure

d. a and b

e. b and c

f. All

f. All

Used for short-term pain only as it can cause seizure.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

b. Meperidine

5-7x more potent than morphine that has the D-isomer Dextromethorphan.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

c. Levorphanol

Used as a cough reflex suppressant or an anti-toxin.

a. Methadone

b. Meperidine

c. Levorphanol: Dextromethorphan

d. Loperamide & Diphenoxylate

e. Tramadol

c. Levorphanol: Dextromethorphan

Used as antidiarrheals.

a. Loperamide

b. Diphenoxylate

c. Tramadol

d. a and b

e. b and c

f. All

d. a and b

Safer antidiarrheals.

a. Loperamide

b. Diphenoxylate

c. Tramadol

d. a and b

e. b and c

f. All

a. Loperamide

Antidiarrheal that causes addiction, especially at high doses so to reduce its required dose, it is co-administered with atropine.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide

e. Diphenoxylate

f. Tramadol

e. Diphenoxylate

Derivative of codeine used for mild pain.

a. Tramadol

b. Fentanyl

c. Petazocine

d. Meperidine

a. Tramadol

100x more potent than morphine thus administered at minute doses

a. Tramadol

b. Fentanyl

c. Petazocine

d. Meperidine

b. Fentanyl: Alfentanyl & Sulfentanyl

Partial kappa agonist.

a. Tramadol

b. Fentanyl

c. Petazocine

d. Meperidine

c. Petazocine

Strong full opioid agonist

I. Morphine and related drugs

II. Fentanyl

III. Heroin

IV. Hydromorphone

V. Oxymorphone

VI. Methadone

VII. Levorphanol

VIII. Meperidine

IX. Codeine and related drugs

X. Tramadol

a. I, II, III, IV, V, VI, VII, VIII, IX,

b. II, III, IV, V, VI, VII, VIII, IX, X

c. I, II, III, IV, V, VI, VII, VIII

d. III, IV, V, VI, VII, VIII, IX, X

e. I, II, III, VII, VIII, IX, X

f. I, II, III, IV, V, VI, X

c. I, II, III, IV, V, VI, VII, VIII

(IX) Codeine and related drugs and (X) Tramadol are mild to moderate full agonists

Mild to Moderate Full Opioid Agonists except:

a. Codeine and related drugs

b. Hydrocodone

c. Tramadol

d. Oxycodone

e. None

e. None

Partial opioid agonist except:

a. Nalbuphine

b. Pentazocine

c. Butorphanol

d. Buprenorphine

e. Meperidine

f. None

e. Meperidine - this is strong full agonist

Opioid antagonist except:

a. Naloxone

b. Naltrexone

c. Nalorphine

d. Nalmefene

e. Nalbuphine

f. Levallorphan

e. Nalbuphine - this is partial agonist.