opioids book questions
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Questions and Answers

What term is derived from the Greek word for stupor and traditionally refers to potent morphine-like analgesics with the potential to produce physical dependence?

  • Opiate
  • Alkaloid
  • Opioid
  • Narcotic (correct)
  • Which alkaloid is the best known opiate?

  • Opium
  • Papaverine
  • Morphine (correct)
  • Codeine
  • What is the source of 20 distinct alkaloids?

  • Opium (correct)
  • Morphine
  • Poppy juice
  • Codeine
  • Which classification of opioids includes opioid agonists, opioid agonist-antagonists, and opioid antagonists?

    <p>Opioids</p> Signup and view all the answers

    Which of the following is a possible adverse effect of opioids?

    <p>Decreased cough reflex</p> Signup and view all the answers

    What is the main cause of death from an opioid overdose?

    <p>Apnea</p> Signup and view all the answers

    Which factor increases the ventilatory depressant effects of opioids?

    <p>Natural sleep</p> Signup and view all the answers

    Which opioid property allows for cough suppression without analgesia or depression of ventilation?

    <p>Dextrorotatory isomers</p> Signup and view all the answers

    Which of the following is a synthetic opioid?

    <p>Fentanyl</p> Signup and view all the answers

    Which class of opioid receptors is responsible for analgesia?

    <p>μ</p> Signup and view all the answers

    Which of the following opioids is a partial agonist?

    <p>Buprenorphine</p> Signup and view all the answers

    Which opioid antagonist is commonly used to reverse opioid overdose?

    <p>Naloxone</p> Signup and view all the answers

    Which brain region is associated with the activation of the μ-opioid receptor system and reductions in the sensory and affective ratings of pain experience?

    <p>Periaqueductal gray</p> Signup and view all the answers

    Which receptors are antagonized by H1- and H2-receptor antagonists to prevent changes in systemic blood pressure and systemic vascular resistance?

    <p>Both H1 and H2 receptors</p> Signup and view all the answers

    What is the effect of morphine on the plasma concentration of histamine?

    <p>Increases the plasma concentration of histamine</p> Signup and view all the answers

    What effect does morphine have on the sympathetic nervous system tone to peripheral veins?

    <p>Decreases it</p> Signup and view all the answers

    What is the mechanism behind morphine-induced bradycardia?

    <p>Increased activity over the vagal nerves</p> Signup and view all the answers

    What are the cardiovascular effects of morphine during anesthesia?

    <p>Both tachycardia and hypertension, and decreased cardiac output and systemic blood pressure</p> Signup and view all the answers

    How can the magnitude of morphine-induced histamine release and subsequent decrease in systemic blood pressure be minimized?

    <p>Limiting the rate of morphine infusion</p> Signup and view all the answers

    What is the effect of combining an opioid agonist with nitrous oxide on cardiovascular parameters?

    <p>Decreased cardiac output and systemic blood pressure</p> Signup and view all the answers

    Which areas of the brain are primarily responsible for the presence of opioid receptors?

    <p>Periaqueductal gray, locus ceruleus, and the rostral ventral medulla</p> Signup and view all the answers

    Where are opioid receptors found in the spinal cord?

    <p>Dorsal horn, on interneurons and primary afferent neurons</p> Signup and view all the answers

    Which opioid receptor is responsible for supraspinal and spinal analgesia?

    <p>μ-Opioid receptor</p> Signup and view all the answers

    What is the role of δ opioid receptors?

    <p>To modulate the activity of μ receptors</p> Signup and view all the answers

    According to the text, what is the reported incidence of difficult ventilation after a moderate dose of sufentanil?

    <p>84%</p> Signup and view all the answers

    What is the usual recommendation for morphine titration?

    <p>Short interval between boluses (5-7 minutes)</p> Signup and view all the answers

    What is a common reason to discontinue morphine titration for postoperative analgesia?

    <p>Increased sedation</p> Signup and view all the answers

    What can opioids cause in the biliary tract?

    <p>Epigastric distress</p> Signup and view all the answers

    Which opioid increases common bile duct pressure the most?

    <p>Fentanyl</p> Signup and view all the answers

    What may opioid-induced spasm of the sphincter of Oddi appear as radiologically?

    <p>Common bile duct stone</p> Signup and view all the answers

    Which term is used to refer to exogenous substances that bind specifically to opioid receptors and produce morphine-like effects?

    <p>Opioids</p> Signup and view all the answers

    Which of the following is a classification of opioids?

    <p>All of the above</p> Signup and view all the answers

    Which alkaloid was isolated in 1803 and is the best known opiate?

    <p>Morphine</p> Signup and view all the answers

    What is the source of 20 distinct alkaloids?

    <p>Opium poppy</p> Signup and view all the answers

    Which of the following opioids lacks analgesic activity?

    <p>Papaverine</p> Signup and view all the answers

    Which of the following opioids is a semisynthetic derivative of morphine?

    <p>Heroin</p> Signup and view all the answers

    Which of the following opioids is a synthetic derivative of morphine?

    <p>Levorphanol</p> Signup and view all the answers

    Which of the following opioids is widely used as a primary anesthetic drug in very high doses?

    <p>Remifentanil</p> Signup and view all the answers

    Which brain region is primarily responsible for the release of endogenous opioids and the modulation of pain experience?

    <p>Periaqueductal gray</p> Signup and view all the answers

    What is the effect of morphine on the sinoatrial node?

    <p>Decreased activity leading to bradycardia</p> Signup and view all the answers

    What is the effect of morphine on systemic blood pressure?

    <p>Decreased blood pressure</p> Signup and view all the answers

    What is the effect of positive treatment expectancy on the analgesic benefit of remifentanil?

    <p>Increased analgesic benefit</p> Signup and view all the answers

    Which of the following areas of the brain is NOT primarily responsible for the presence of opioid receptors?

    <p>Substantia gelatinosa</p> Signup and view all the answers

    Which of the following is a potential use of intraarticular morphine?

    <p>Production of analgesia</p> Signup and view all the answers

    Which opioid receptor is responsible for inhibition of neurotransmitter release via N-type calcium channels?

    <p>κ-opioid receptor</p> Signup and view all the answers

    Which opioid receptor subtype is speculated to produce analgesia, while another subtype is responsible for hypoventilation, bradycardia, and physical dependence?

    <p>μ1 and μ2</p> Signup and view all the answers

    Which of the following is a potential adverse effect of opioids?

    <p>Decreased tidal volume</p> Signup and view all the answers

    Which opioid effect is responsible for the decreased frequency of breathing often seen with opioids?

    <p>Increased tidal volume</p> Signup and view all the answers

    Which opioid property allows for cough suppression without producing analgesia or depression of ventilation?

    <p>Dextrorotatory isomers</p> Signup and view all the answers

    What is the likely explanation for opioid-induced increased skeletal muscle tone?

    <p>Increased striatal release of γ-aminobutyric acid</p> Signup and view all the answers

    Which of the following is a characteristic of opioid-induced depression of ventilation?

    <p>Decreased responsiveness of ventilation centers to carbon dioxide</p> Signup and view all the answers

    Which of the following opioids is commonly administered with inhaled or IV anesthetics to ensure amnesia?

    <p>Fentanyl</p> Signup and view all the answers

    Which receptors contribute to the cardiovascular responses observed during anesthesia with morphine?

    <p>H1 and H2 receptors</p> Signup and view all the answers

    Which opioid agonist is associated with significant decreases in mean arterial pressure and systemic vascular resistance when administered after injection of diazepam?

    <p>Fentanyl</p> Signup and view all the answers

    Which of the following is a common reason to discontinue morphine titration for postoperative analgesia?

    <p>Morphine-induced sedation</p> Signup and view all the answers

    What can opioids cause in the biliary tract?

    <p>Biliary colic</p> Signup and view all the answers

    Which opioid increases common bile duct pressure the most?

    <p>Fentanyl</p> Signup and view all the answers

    What effect does morphine have on the sympathetic nervous system tone to peripheral veins?

    <p>Decreases sympathetic nervous system tone</p> Signup and view all the answers

    What may opioid-induced spasm of the sphincter of Oddi appear as radiologically?

    <p>A sharp constriction at the distal end of the common bile duct</p> Signup and view all the answers

    Which factor increases the ventilatory depressant effects of opioids?

    <p>All of the above</p> Signup and view all the answers

    Opiates and opioids are derived from the same source.

    <p>True</p> Signup and view all the answers

    Morphine can only be derived from opium.

    <p>False</p> Signup and view all the answers

    Narcotic is a term used to refer to any substance that produces physical dependence.

    <p>False</p> Signup and view all the answers

    Opioids can produce analgesia without loss of touch, proprioception, or consciousness.

    <p>True</p> Signup and view all the answers

    True or false: Morphine is classified as an opioid antagonist?

    <p>False</p> Signup and view all the answers

    True or false: Codeine is a synthetic opioid?

    <p>False</p> Signup and view all the answers

    True or false: Naloxone is an opioid agonist?

    <p>False</p> Signup and view all the answers

    True or false: Fentanyl is a phenylpiperidine derivative?

    <p>True</p> Signup and view all the answers

    True or false: Opioid receptors are primarily found in the brain.

    <p>True</p> Signup and view all the answers

    True or false: Activation of κ receptors results in inhibition of neurotransmitter release via N-type calcium channels.

    <p>True</p> Signup and view all the answers

    True or false: δ receptors respond to the endogenous ligands known as enkephalins.

    <p>True</p> Signup and view all the answers

    True or false: σ receptors are considered to be true opioid receptors.

    <p>False</p> Signup and view all the answers

    True or false: The analgesic response to a placebo involves the release of endorphins.

    <p>True</p> Signup and view all the answers

    True or false: Positive treatment expectancy enhances the analgesic benefit of remifentanil.

    <p>True</p> Signup and view all the answers

    True or false: Morphine can cause direct myocardial depression.

    <p>False</p> Signup and view all the answers

    True or false: Morphine-induced histamine release always leads to a decrease in systemic blood pressure.

    <p>False</p> Signup and view all the answers

    True or false: Pretreatment with H1- and H2-receptor antagonists alters the release of histamine evoked by morphine.

    <p>False</p> Signup and view all the answers

    True or false: Morphine-induced decreases in systemic blood pressure and systemic vascular resistance are accompanied by increases in the plasma concentration of histamine.

    <p>True</p> Signup and view all the answers

    True or false: Opioids sensitize the heart to catecholamines and predispose to cardiac dysrhythmias.

    <p>False</p> Signup and view all the answers

    True or false: The combination of an opioid agonist and nitrous oxide results in cardiovascular depression.

    <p>True</p> Signup and view all the answers

    True or false: Opioid-induced ventilatory depression can be mitigated by using biased ligands at opioid receptors.

    <p>True</p> Signup and view all the answers

    True or false: Depression of ventilation produced by opioids manifests as a decreased frequency of breathing accompanied by a compensatory increase in tidal volume.

    <p>True</p> Signup and view all the answers

    True or false: Opioids can depress cough by affecting the medullary cough centers.

    <p>True</p> Signup and view all the answers

    True or false: In the absence of hypoventilation, opioids can decrease cerebral blood flow and possibly intracranial pressure.

    <p>True</p> Signup and view all the answers

    True or false: The reported incidence of difficult ventilation after a moderate dose of sufentanil ranges from 84% to 100%?

    <p>True</p> Signup and view all the answers

    True or false: Sedation occurs in up to 60% of patients during morphine titration?

    <p>True</p> Signup and view all the answers

    True or false: Opioids can cause spasm of biliary smooth muscle, resulting in increases in biliary pressure?

    <p>True</p> Signup and view all the answers

    True or false: Naloxone will relieve pain caused by biliary spasm but not myocardial ischemia?

    <p>True</p> Signup and view all the answers

    True or false: Nitroglycerin will relieve pain due to either biliary spasm or myocardial ischemia?

    <p>True</p> Signup and view all the answers

    True or false: Equal analgesic doses of fentanyl, morphine, meperidine, and pentazocine increase common bile duct pressure 99%, 53%, 61%, and 15% above predrug levels, respectively?

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a naturally occurring opium alkaloid?

    <p>Oxycodone</p> Signup and view all the answers

    Which opioid receptor is responsible for supraspinal analgesia and most of the classic clinical actions of opioid agonists?

    <p>Mu</p> Signup and view all the answers

    Which opioid receptor is responsible for spinal analgesia and sedation?

    <p>Kappa</p> Signup and view all the answers

    How many main types of opioid receptors are there in the central nervous system?

    <p>3</p> Signup and view all the answers

    Which opioid receptor subtype is responsible for analgesia in the central nervous system?

    <p>Mu (μ) receptor</p> Signup and view all the answers

    Which opioid receptor subtype is associated with sedation and dysphoria?

    <p>Kappa (κ) receptor</p> Signup and view all the answers

    Which opioid receptor subtype is responsible for miosis?

    <p>Mu (μ) receptor</p> Signup and view all the answers

    Which opioid receptor subtype is associated with inhibition of peristalsis and nausea?

    <p>Delta (δ) receptor</p> Signup and view all the answers

    Which term is derived from the Greek word for 'sap' and refers to potent morphine-like analgesics with the potential to produce physical dependence?

    <p>Opioid</p> Signup and view all the answers

    Which classification system divides opioids into four categories: agonists, partial agonists, agonists-antagonists, and antagonists?

    <p>Chemical derivation</p> Signup and view all the answers

    What is the effect of opioids on pain pathways in the central nervous system?

    <p>Inhibition of neurons</p> Signup and view all the answers

    What is the relationship between the stereochemical structure and potency of opioids?

    <p>Direct relationship</p> Signup and view all the answers

    Which of the following factors can affect the pharmacokinetics and pharmacodynamics of opioids?

    <p>Age and body weight</p> Signup and view all the answers

    True or false: Advancing age requires higher opioid doses for the treatment of postsurgical pain.

    <p>False</p> Signup and view all the answers

    Which of the following statements about morphine dosage requirements is true?

    <p>Dosage requirements for morphine vary widely within patient groups.</p> Signup and view all the answers

    Which of the following is a common clinical effect of opioid agonists?

    <p>Decreased gastrointestinal motility</p> Signup and view all the answers

    Which substance was isolated from opium in 1803 and named after the Greek god of dreams?

    <p>Morphine</p> Signup and view all the answers

    What was the goal of synthetic manufacture of analgesics?

    <p>All of the above</p> Signup and view all the answers

    What term is used to refer to a group of drugs that possess opium-like properties?

    <p>Opioids</p> Signup and view all the answers

    When were the syringe and needle introduced into clinical practice, allowing for accurate intravenous administration of opioids?

    <p>1853</p> Signup and view all the answers

    Which enzyme is responsible for metabolizing remifentanil?

    <p>nonspecific esterases</p> Signup and view all the answers

    Which opioid has a low volume of distribution and a short half-life of approximately 10 minutes?

    <p>Fentanyl</p> Signup and view all the answers

    Which opioid metabolite is neurotoxic and may accumulate in the elderly or in patients with decreased renal or hepatic function?

    <p>Normeperidine</p> Signup and view all the answers

    Which opioid is avoided in the elderly or patients with renal or hepatic dysfunction and where chronic use may be needed?

    <p>Meperidine</p> Signup and view all the answers

    True or false: Physical and psychological dependence occur with repeat administration of opiates.

    <p>True</p> Signup and view all the answers

    What is the effect of opiates on respiratory rate?

    <p>Decrease in frequency</p> Signup and view all the answers

    What is the mechanism of tolerance to opiates?

    <p>Receptor internalization</p> Signup and view all the answers

    What is the effect of opiates on the CO2 response curve for respiration?

    <p>Shift to the right</p> Signup and view all the answers

    True or false: Opioids sensitize the heart to catecholamines and predispose to cardiac dysrhythmias.

    <p>True</p> Signup and view all the answers

    Which receptors in the brainstem do opiates affect to produce respiratory depression?

    <p>Mu and delta receptors</p> Signup and view all the answers

    Study Notes

    Opioid Agonists and Antagonists: Key Facts and Classifications

    • Opioids are derived from the opium poppy and have been used for medicinal and religious purposes for centuries.
    • Opiates are drugs derived from opium, such as morphine and codeine.
    • The term "narcotic" refers to potent morphine-like analgesics with the potential for physical dependence.
    • Opioids can be classified into three categories: agonists, agonist-antagonists, and antagonists.
    • The active components of opium can be divided into two chemical classes: phenanthrenes (morphine, codeine) and benzylisoquinolines (papaverine, noscapine).
    • Semisynthetic opioids are derived from modifications of the morphine molecule, resulting in compounds like codeine and heroin.
    • Synthetic opioids are manufactured through synthesis and include compounds like fentanyl and methadone.
    • Opioid receptors are classified as μ, δ, and κ receptors.
    • Opioid receptors are found in the brain, spinal cord, sensory neurons, and immune cells.
    • μ-Opioid receptors are responsible for supraspinal and spinal analgesia, while κ receptors inhibit neurotransmitter release and may produce dysphoria and diuresis.
    • Opioid agonist-antagonists primarily act on κ receptors.
    • Endogenous opioid agonists and receptors play a role in the body's pain-modulating mechanisms.

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