120 Questions
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?
Narcotic
Which alkaloid is the best known opiate?
Morphine
What is the source of 20 distinct alkaloids?
Opium
Which classification of opioids includes opioid agonists, opioid agonist-antagonists, and opioid antagonists?
Opioids
Which of the following is a possible adverse effect of opioids?
Decreased cough reflex
What is the main cause of death from an opioid overdose?
Apnea
Which factor increases the ventilatory depressant effects of opioids?
Natural sleep
Which opioid property allows for cough suppression without analgesia or depression of ventilation?
Dextrorotatory isomers
Which of the following is a synthetic opioid?
Fentanyl
Which class of opioid receptors is responsible for analgesia?
μ
Which of the following opioids is a partial agonist?
Buprenorphine
Which opioid antagonist is commonly used to reverse opioid overdose?
Naloxone
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?
Periaqueductal gray
Which receptors are antagonized by H1- and H2-receptor antagonists to prevent changes in systemic blood pressure and systemic vascular resistance?
Both H1 and H2 receptors
What is the effect of morphine on the plasma concentration of histamine?
Increases the plasma concentration of histamine
What effect does morphine have on the sympathetic nervous system tone to peripheral veins?
Decreases it
What is the mechanism behind morphine-induced bradycardia?
Increased activity over the vagal nerves
What are the cardiovascular effects of morphine during anesthesia?
Both tachycardia and hypertension, and decreased cardiac output and systemic blood pressure
How can the magnitude of morphine-induced histamine release and subsequent decrease in systemic blood pressure be minimized?
Limiting the rate of morphine infusion
What is the effect of combining an opioid agonist with nitrous oxide on cardiovascular parameters?
Decreased cardiac output and systemic blood pressure
Which areas of the brain are primarily responsible for the presence of opioid receptors?
Periaqueductal gray, locus ceruleus, and the rostral ventral medulla
Where are opioid receptors found in the spinal cord?
Dorsal horn, on interneurons and primary afferent neurons
Which opioid receptor is responsible for supraspinal and spinal analgesia?
μ-Opioid receptor
What is the role of δ opioid receptors?
To modulate the activity of μ receptors
According to the text, what is the reported incidence of difficult ventilation after a moderate dose of sufentanil?
84%
What is the usual recommendation for morphine titration?
Short interval between boluses (5-7 minutes)
What is a common reason to discontinue morphine titration for postoperative analgesia?
Increased sedation
What can opioids cause in the biliary tract?
Epigastric distress
Which opioid increases common bile duct pressure the most?
Fentanyl
What may opioid-induced spasm of the sphincter of Oddi appear as radiologically?
Common bile duct stone
Which term is used to refer to exogenous substances that bind specifically to opioid receptors and produce morphine-like effects?
Opioids
Which of the following is a classification of opioids?
All of the above
Which alkaloid was isolated in 1803 and is the best known opiate?
Morphine
What is the source of 20 distinct alkaloids?
Opium poppy
Which of the following opioids lacks analgesic activity?
Papaverine
Which of the following opioids is a semisynthetic derivative of morphine?
Heroin
Which of the following opioids is a synthetic derivative of morphine?
Levorphanol
Which of the following opioids is widely used as a primary anesthetic drug in very high doses?
Remifentanil
Which brain region is primarily responsible for the release of endogenous opioids and the modulation of pain experience?
Periaqueductal gray
What is the effect of morphine on the sinoatrial node?
Decreased activity leading to bradycardia
What is the effect of morphine on systemic blood pressure?
Decreased blood pressure
What is the effect of positive treatment expectancy on the analgesic benefit of remifentanil?
Increased analgesic benefit
Which of the following areas of the brain is NOT primarily responsible for the presence of opioid receptors?
Substantia gelatinosa
Which of the following is a potential use of intraarticular morphine?
Production of analgesia
Which opioid receptor is responsible for inhibition of neurotransmitter release via N-type calcium channels?
κ-opioid receptor
Which opioid receptor subtype is speculated to produce analgesia, while another subtype is responsible for hypoventilation, bradycardia, and physical dependence?
μ1 and μ2
Which of the following is a potential adverse effect of opioids?
Decreased tidal volume
Which opioid effect is responsible for the decreased frequency of breathing often seen with opioids?
Increased tidal volume
Which opioid property allows for cough suppression without producing analgesia or depression of ventilation?
Dextrorotatory isomers
What is the likely explanation for opioid-induced increased skeletal muscle tone?
Increased striatal release of γ-aminobutyric acid
Which of the following is a characteristic of opioid-induced depression of ventilation?
Decreased responsiveness of ventilation centers to carbon dioxide
Which of the following opioids is commonly administered with inhaled or IV anesthetics to ensure amnesia?
Fentanyl
Which receptors contribute to the cardiovascular responses observed during anesthesia with morphine?
H1 and H2 receptors
Which opioid agonist is associated with significant decreases in mean arterial pressure and systemic vascular resistance when administered after injection of diazepam?
Fentanyl
Which of the following is a common reason to discontinue morphine titration for postoperative analgesia?
Morphine-induced sedation
What can opioids cause in the biliary tract?
Biliary colic
Which opioid increases common bile duct pressure the most?
Fentanyl
What effect does morphine have on the sympathetic nervous system tone to peripheral veins?
Decreases sympathetic nervous system tone
What may opioid-induced spasm of the sphincter of Oddi appear as radiologically?
A sharp constriction at the distal end of the common bile duct
Which factor increases the ventilatory depressant effects of opioids?
All of the above
Opiates and opioids are derived from the same source.
True
Morphine can only be derived from opium.
False
Narcotic is a term used to refer to any substance that produces physical dependence.
False
Opioids can produce analgesia without loss of touch, proprioception, or consciousness.
True
True or false: Morphine is classified as an opioid antagonist?
False
True or false: Codeine is a synthetic opioid?
False
True or false: Naloxone is an opioid agonist?
False
True or false: Fentanyl is a phenylpiperidine derivative?
True
True or false: Opioid receptors are primarily found in the brain.
True
True or false: Activation of κ receptors results in inhibition of neurotransmitter release via N-type calcium channels.
True
True or false: δ receptors respond to the endogenous ligands known as enkephalins.
True
True or false: σ receptors are considered to be true opioid receptors.
False
True or false: The analgesic response to a placebo involves the release of endorphins.
True
True or false: Positive treatment expectancy enhances the analgesic benefit of remifentanil.
True
True or false: Morphine can cause direct myocardial depression.
False
True or false: Morphine-induced histamine release always leads to a decrease in systemic blood pressure.
False
True or false: Pretreatment with H1- and H2-receptor antagonists alters the release of histamine evoked by morphine.
False
True or false: Morphine-induced decreases in systemic blood pressure and systemic vascular resistance are accompanied by increases in the plasma concentration of histamine.
True
True or false: Opioids sensitize the heart to catecholamines and predispose to cardiac dysrhythmias.
False
True or false: The combination of an opioid agonist and nitrous oxide results in cardiovascular depression.
True
True or false: Opioid-induced ventilatory depression can be mitigated by using biased ligands at opioid receptors.
True
True or false: Depression of ventilation produced by opioids manifests as a decreased frequency of breathing accompanied by a compensatory increase in tidal volume.
True
True or false: Opioids can depress cough by affecting the medullary cough centers.
True
True or false: In the absence of hypoventilation, opioids can decrease cerebral blood flow and possibly intracranial pressure.
True
True or false: The reported incidence of difficult ventilation after a moderate dose of sufentanil ranges from 84% to 100%?
True
True or false: Sedation occurs in up to 60% of patients during morphine titration?
True
True or false: Opioids can cause spasm of biliary smooth muscle, resulting in increases in biliary pressure?
True
True or false: Naloxone will relieve pain caused by biliary spasm but not myocardial ischemia?
True
True or false: Nitroglycerin will relieve pain due to either biliary spasm or myocardial ischemia?
True
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?
True
Which of the following is NOT a naturally occurring opium alkaloid?
Oxycodone
Which opioid receptor is responsible for supraspinal analgesia and most of the classic clinical actions of opioid agonists?
Mu
Which opioid receptor is responsible for spinal analgesia and sedation?
Kappa
How many main types of opioid receptors are there in the central nervous system?
3
Which opioid receptor subtype is responsible for analgesia in the central nervous system?
Mu (μ) receptor
Which opioid receptor subtype is associated with sedation and dysphoria?
Kappa (κ) receptor
Which opioid receptor subtype is responsible for miosis?
Mu (μ) receptor
Which opioid receptor subtype is associated with inhibition of peristalsis and nausea?
Delta (δ) receptor
Which term is derived from the Greek word for 'sap' and refers to potent morphine-like analgesics with the potential to produce physical dependence?
Opioid
Which classification system divides opioids into four categories: agonists, partial agonists, agonists-antagonists, and antagonists?
Chemical derivation
What is the effect of opioids on pain pathways in the central nervous system?
Inhibition of neurons
What is the relationship between the stereochemical structure and potency of opioids?
Direct relationship
Which of the following factors can affect the pharmacokinetics and pharmacodynamics of opioids?
Age and body weight
True or false: Advancing age requires higher opioid doses for the treatment of postsurgical pain.
False
Which of the following statements about morphine dosage requirements is true?
Dosage requirements for morphine vary widely within patient groups.
Which of the following is a common clinical effect of opioid agonists?
Decreased gastrointestinal motility
Which substance was isolated from opium in 1803 and named after the Greek god of dreams?
Morphine
What was the goal of synthetic manufacture of analgesics?
All of the above
What term is used to refer to a group of drugs that possess opium-like properties?
Opioids
When were the syringe and needle introduced into clinical practice, allowing for accurate intravenous administration of opioids?
1853
Which enzyme is responsible for metabolizing remifentanil?
nonspecific esterases
Which opioid has a low volume of distribution and a short half-life of approximately 10 minutes?
Fentanyl
Which opioid metabolite is neurotoxic and may accumulate in the elderly or in patients with decreased renal or hepatic function?
Normeperidine
Which opioid is avoided in the elderly or patients with renal or hepatic dysfunction and where chronic use may be needed?
Meperidine
True or false: Physical and psychological dependence occur with repeat administration of opiates.
True
What is the effect of opiates on respiratory rate?
Decrease in frequency
What is the mechanism of tolerance to opiates?
Receptor internalization
What is the effect of opiates on the CO2 response curve for respiration?
Shift to the right
True or false: Opioids sensitize the heart to catecholamines and predispose to cardiac dysrhythmias.
True
Which receptors in the brainstem do opiates affect to produce respiratory depression?
Mu and delta receptors
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.
Quiz: Understanding the Cellular Basis of Opioid-Induced Ventilatory Depression Test your knowledge about the cellular mechanisms behind opioid-induced ventilatory depression. Learn about the role of β-arrestin and the potential use of biased ligands at opioid receptors to mitigate this adverse effect. Explore the rapid and prolonged effects of opioid agonists on ventilation and their impact on carbon dioxide responses.
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