Part 6.3.2 - Drugs for Rheumatologic Disorder - Narcotic Analgesics

b. Stupor & insensibility

It is toxic effect of narcotics

Narcosis

a. Therapeutic effect of narcotics

b. Stupor & insensibility

c. Both

d. None

f. All

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

Papaver somniferum (opium poppy): morphine

Narcotic analgesics.

a. Opioid agonists

b. Obtained from Papaver somniferum

c. Causes narcosis

d. a and b

e. b and c

f. All

b. Crude opium

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

a. 10%

Morphine concentration in Papaver somniferum

a. 10%

b. 12%

c. 15%

d. 20%

f. All

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

b. Enkephalins

Opioid pentapeptide

a. Endorphins

b. Enkephalins

c. Dynorphins

d. a and b

e. b and c

f. All

d. a and b

Enkephalins types.

a. Methionine-enkephalin

b. Leucine-enkephalin

c. Proline-enkephalin

d. a and b

e. b and c

f. All

f. All

Opioid receptors.

a. Mu-receptors

b. Kappa-receptors

c. Delta-receptors

d. a and b

e. b and c

f. All

a. Mu-receptors

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

d. Diarrhea - should be constipation

(ileus - decreased peristalsis)

Opioid mediated effects by Mu-receptor except:

a. Analgesia

b. Euphoria

c. Miosis

d. Diarrhea

e. Respiratory depression

f. None

b. Kappa-receptors

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. Enkephalins

Opioid peptide with highest affinity to Kappa-receptor.

a. Endorphins

b. Enkephalins

c. Dynorphins

c. Delta-receptors

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. Dynorphins

Opioid peptide with highest affinity to Delta-receptor.

a. Endorphins

b. Enkephalins

c. Dynorphins

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

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

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

Narcotics can reduce

a. Sensory pain

b. Affective pain

c. Both

d. None

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

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

f. None

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

a. Tramadol

Opioid agonist used for mild pain.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

b. Codeine

Opioid agonist used for moderate pain.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

c. Morphine

Opioid agonist used for severe pain

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

d. Diphenoxylate - and Loperamide

Opioid agonist used as antidiarrheal.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

e. Dextromethorphan

Opioid agonist used as antitussive.

a. Tramadol

b. Codeine

c. Morphine

d. Diphenoxylate

e. Dextromethorphan

b. False

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

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

a. True

b. False

a. True

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

a. True

b. False

f. None

CPR

Constipation

Pinpoint pupils

Respiratory depression

Toxicity of opioids except:

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal syndrome

f. None

a. Respiratory Depression

Toxicity of opioids with greatest threat.

a. Respiratory Depression

b. Increase in Intracranial Pressure

c. Tolerance

d. Physical Dependence

e. Withdrawal syndrome

b. Increase in Intracranial Pressure

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

c. Tolerance

Phenomenon whereby repeated doses of opiates 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

e. Withdrawal symptoms

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

f. None

Opioid withdrawal symptoms except:

a. Frequent yawning

b. Hyperventilation

c. Mydriasis

d. Rhinorrhoea

e. Enhanced Hostility

f. None

f. All

Partial agonists would act as an antagonist with full agonists

Contraindications of opioids

a. Head trauma

b. Pregnancy

c. Full with partial agonists

d. a and b

e. b and c

f. All

c. Both

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

a. Opiates

Derived from natural opium alkaloids.

a. Opiates

b. Opioids

c. Opiades

d. Opioits

b. Opioids

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

a. Opiates

b. Opioids

c. Opiades

d. Opioits

d. Apomorphine - this is semisynthetic opioids

Opiates except:

a. Morphine

b. Codeine

c. Thebaine

d. Apomorphine

e. None

a. Morphine

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

a. Morphine

b. Codeine

c. Thebaine

c. Thebaine

Precursor in the synthesis of Naloxone.

a. Morphine

b. Codeine

c. Thebaine

f. All

codeine (metabolized by CYP2D6) → morphine

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

e. Methadone - this is synthetic opioid

Semi-synthetic opioids excerpt:

a. Heroin

b. Apomorphine

c. Hydromorphone

d. Hydrocodone

e. Methadone

f. None

a. Heroin

Diacetylmorphine/Diamorphine

Common drug of abuse

a. Heroin

b. Apomorphine

c. Hydromorphone

d. Hydrocodone

e. Methadone

b. Apomorphine

Used in the management of Parkinsonism.

a. Heroin

b. Apomorphine

c. Hydromorphone

d. Hydrocodone

e. Methadone

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

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

e. a and b

Semisynthetic morphine derivatives.

a. Hydromorphone

b. Oxymorphone

c. Hydrocodone

d. Oxycodone

e. a and b

f. c and d

f. c and d

Semisynthetic codeine derivatives.

a. Hydromorphone

b. Oxymorphone

c. Hydrocodone

d. Oxycodone

e. a and b

f. c and d

a. True

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

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. Methadone

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

b. Meperidine

Aka Pethidine; Branded as Demerol in the Philippines.

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

f. All

used for acute pancreatitis (does not constraint biliary tract)

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

b. Meperidine

if converted to Normeperidine

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

a. Methadone

b. Meperidine

c. Levorphanol

d. Loperamide & Diphenoxylate

e. Tramadol

c. Levorphanol

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: Dextromethorphan

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

a. Methadone

b. Meperidine

c. Levorphanol: Dextromethorphan

d. Loperamide & Diphenoxylate

e. Tramadol

d. a and b

Used as antidiarrheals.

a. Loperamide

b. Diphenoxylate

c. Tramadol

d. a and b

e. b and c

f. All

a. Loperamide

Safer antidiarrheals.

a. Loperamide

b. Diphenoxylate

c. Tramadol

d. a and b

e. b and c

f. All

e. Diphenoxylate

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

a. Tramadol

Derivative of codeine used for mild pain.

a. Tramadol

b. Fentanyl

c. Petazocine

d. Meperidine

b. Fentanyl: Alfentanyl & Sulfentanyl

100x more potent than morphine thus administered at minute doses

a. Tramadol

b. Fentanyl

c. Petazocine

d. Meperidine

c. Pentazocine

Partial kappa agonist.

a. Tramadol

b. Fentanyl

c. Pentazocine

d. Meperidine

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

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

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

e. None

Mild to Moderate Full Opioid Agonists except:

a. Codeine and related drugs

b. Hydrocodone

c. Tramadol

d. Oxycodone

e. None

e. Meperidine - this is strong full agonist

Partial opioid agonist except:

a. Nalbuphine

b. Pentazocine

c. Butorphanol

d. Buprenorphine

e. Meperidine

f. None

e. Nalbuphine - this is partial agonist.

Opioid antagonist except:

a. Naloxone

b. Naltrexone

c. Nalorphine

d. Nalmefene

e. Nalbuphine

f. Levallorphan

B. Morphine-3-glucuronide (M3G)

Which metabolite of Morphine is responsible for its neurotoxic side effects?

A. Morphine-6-glucuronide (M6G)

B. Morphine-3-glucuronide (M3G)

C. NAPQI

D. Normorphine

B. Morphine-3-glucuronide (M3G)

Which metabolite of Morphine is responsible for its analgesic effect?

A. Morphine-6-glucuronide (M6G)

B. Morphine-3-glucuronide (M3G)

C. NAPQI

D. Normorphine

B. CYP2D6

Which liver enzyme converts Codeine into its active analgesic form (Morphine)?

A. CYP2E1

B. CYP2D6

C. CYP3A4

D. Xanthine oxidase

B. Podagra

What is the characteristic clinical presentation of acute gouty arthritis in the 1st metatarsophalangeal joint called?

A. Tophi

B. Podagra

C. Heberden's node

D. Swan-neck joint

B. Tophi

What are the characteristic subcutaneous uric acid deposits seen in chronic gout called?

A. Podagra

B. Tophi

C. Malar deposits

D. Rheumatoid nodules

B. Tumor Lysis Syndrome

Besides gout, for what acute condition is Allopurinol used as prophylaxis?

A. Reye Syndrome

B. Tumor Lysis Syndrome

C. Samter's Triad

D. Anti-phospholipid syndrome

B. Inhibition of Calcineurin

What is the mechanism of action of Cyclosporine and Tacrolimus?

A. Inhibition of mTOR

B. Inhibition of Calcineurin

C. Inhibition of IMP dehydrogenase

D. Inhibition of Dihydroorotate dehydrogenase

B. Gingival hyperplasia

What characteristic oral side effect is associated with Calcineurin inhibitors like Cyclosporine?

A. Stomatitis

B. Gingival hyperplasia

C. Oral candidiasis

D. Dry mouth (Xerostomia)

A. Guanine analogue that inhibits IMP dehydrogenase

What is the mechanism of action of Mycophenolate Mofetil?

A. Guanine analogue that inhibits IMP dehydrogenase

B. Pyrimidine analogue that inhibits dihydroorotate dehydrogenase

C. Cytokine release inhibitor

D. Calcineurin inhibitor

B. mTOR inhibitor -- Watch-out: Dyslipidemia

What is the mechanism of action and primary watch-out effect of Sirolimus?

A. Calcineurin inhibitor -- Watch-out: Gingival hyperplasia

B. mTOR inhibitor -- Watch-out: Dyslipidemia

C. DHFR inhibitor -- Watch-out: Bone marrow suppression

D. TLR inhibitor -- Watch-out: QT prolongation

A. Anakinra targets IL-1; Tocilizumab targets IL-6

Which specific Interleukins are targeted by Anakinra and Tocilizumab, respectively?

A. Anakinra targets IL-1; Tocilizumab targets IL-6

B. Anakinra targets IL-6; Tocilizumab targets IL-1

C. Anakinra targets TNF-alpha; Tocilizumab targets IL-2

D. Anakinra targets IL-17; Tocilizumab targets IL-23

B. T-cell costimulation receptor

What target receptor is inhibited by Abatacept?

A. CD20 receptor

B. T-cell costimulation receptor

C. Janus Kinase (JAK)

D. TNF-alpha receptor

A. Targets CD20 -- Watch-out: Hepatitis B reactivation

What target surface antigen is blocked by Rituximab, and what major viral watch-out risk is associated with it?

A. Targets CD20 -- Watch-out: Hepatitis B reactivation

B. Targets CD4 -- Watch-out: HIV reactivation

C. Targets TNF-alpha -- Watch-out: Tuberculosis reactivation

D. Targets IL-6 -- Watch-out: Cytomegalovirus reactivation

B. Janus Kinase (JAK) inhibitor

What drug class does Tofacitinib belong to?

A. TNF-alpha inhibitor

B. Janus Kinase (JAK) inhibitor

C. Interleukin-1 receptor antagonist

D. Anti-CD20 monoclonal antibody