180 Questions
Which of the following is a phenanthrene alkaloid present in opium?
Morphine
Which of the following opioids lacks analgesic activity?
Papaverine
Which of the following opioids is a synthetic opioid?
Fentanyl
Which of the following is a classification of opioid receptors?
μ, δ, κ
Which alkaloid is the best known opiate?
Morphine
What is the source of 20 distinct alkaloids?
Opium
What term is derived from the Greek word for stupor and traditionally used to refer to potent morphine-like analgesics with the potential to produce physical dependence?
Narcotic
What classification of opioids includes substances that bind specifically to any of several subpopulations of opioid receptors and produce at least some agonist effects?
Opioid agonists
Which receptors are primarily found in the periaqueductal gray, locus ceruleus, and the rostral ventral medulla?
μ receptors
Where are opioid receptors found in the spinal cord?
Both on interneurons and primary afferent neurons
What is the principal responsibility of μ-opioid receptors?
Supraspinal and spinal analgesia
What is the role of δ receptors?
Modulate the activity of μ receptors
Which brain regions are associated with the activation of the μ-opioid receptor system?
Cortical and subcortical regions
What is the effect of morphine on systemic blood pressure?
Decreases due to venous pooling
How does morphine affect heart rate during exposure to volatile anesthetics?
Slows heart rate
What is the effect of morphine on vulnerability to ventricular fibrillation?
Decreases vulnerability
Which of the following is a possible adverse effect of opioids on the respiratory system?
Depression of ventilation
Which of the following factors can increase the ventilatory depressant effects of opioids?
All of the above
Which type of opioids can suppress cough without producing analgesia or depression of ventilation?
Dextrorotatory isomers
What is the likely explanation for opioid-induced increased skeletal muscle tone?
Both A and B
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?
Epigastric distress
Which medication can relieve pain caused by biliary spasm but not myocardial ischemia?
Naloxone
What is the percentage increase in common bile duct pressure caused by equal analgesic doses of fentanyl?
99%
What may opioid-induced spasm of the sphincter of Oddi appear as radiologically during surgery?
A sharp constriction at the distal end of the common bile duct
What is the usual recommendation for morphine titration?
A short interval between boluses
Which of the following is true about the administration of morphine and fentanyl anesthesia?
The combination of morphine and fentanyl results in cardiovascular depression.
What is the role of opioids in protecting the myocardium from ischemia?
Opioids enhance the resistance of the myocardium to oxidative and ischemic stresses.
What effect do opioid agonists have on ventilation?
Opioid agonists interfere with pontine and medullary ventilatory centers, leading to prolonged pauses between breaths.
What is the effect of pretreatment with H1- and H2-receptor antagonists on the release of histamine evoked by morphine?
Pretreatment with H1- and H2-receptor antagonists has no effect on the release of histamine evoked by morphine.
Which of the following opioids lacks analgesic activity?
Papaverine
What is the principal responsibility of μ-opioid receptors?
Analgesia
Which type of opioids can suppress cough without producing analgesia or depression of ventilation?
Antagonists
What is the source of 20 distinct alkaloids?
Opium
Which of the following areas of the brain is primarily associated with opioid receptors?
Periaqueductal gray
Where are opioid receptors found in the spinal cord?
Dorsal horn
Which opioid receptor subtype is responsible for supraspinal and spinal analgesia?
μ1
What is the role of δ opioid receptors?
Modulation of μ receptor activity
Which of the following is an opioid antagonist?
Naloxone
What is the source of 20 distinct alkaloids?
Opium poppy
What is the term used to refer to potent morphine-like analgesics with the potential to produce physical dependence?
Narcotics
What is the effect of opioids on touch, proprioception, and consciousness?
No effect on touch, proprioception, and consciousness
Which of the following is a potential adverse effect of opioids on the respiratory system?
Increased PaCO2
Which of the following factors can increase the ventilatory depressant effects of opioids?
All of the above
What is the effect of morphine on cerebral blood flow and intracranial pressure (ICP)?
Decreased cerebral blood flow and ICP
What is the likely cause of opioid-induced increased skeletal muscle tone?
All of the above
Which of the following is a possible adverse effect of opioids on the cardiovascular system?
Orthostatic hypotension and syncope
What is the effect of morphine on systemic blood pressure?
Decreases blood pressure
What is the likely explanation for opioid-induced increased skeletal muscle tone?
Stimulation of opioid receptors in the spinal cord
Which brain regions are associated with the activation of the μ-opioid receptor system?
Periaqueductal gray (PAG)
Which of the following is true about the cardiovascular effects of morphine and fentanyl anesthesia?
Morphine and fentanyl anesthesia cause a decrease in systemic blood pressure and systemic vascular resistance.
Which of the following is true about the combination of an opioid and a benzodiazepine?
The combination of an opioid and a benzodiazepine can cause a decrease in systemic vascular resistance and systemic blood pressure.
What is the effect of opioids on the myocardium?
Opioids enhance the resistance of the myocardium to oxidative and ischemic stresses.
What is the effect of opioid agonists on ventilation?
Opioid agonists depress ventilation and interfere with the regulation of breathing.
Which of the following opioids is reported to have the highest incidence of difficult ventilation after a moderate dose?
Fentanyl
What is the usual recommendation for morphine titration?
Short interval between boluses
What is a common reason to discontinue morphine titration for postoperative analgesia?
Sedation
What can opioids cause in the biliary tract?
Biliary colic
What may opioid-induced spasm of the sphincter of Oddi appear as radiologically during surgery?
Common bile duct stone
Which medication can relieve pain caused by biliary spasm but not myocardial ischemia?
Naloxone
Which of the following opioids is NOT derived from opium?
Fentanyl
What is the term used to refer to drugs that bind specifically to opioid receptors and produce morphine-like effects?
Opioids
Which classification of opioids includes substances that can both activate and block opioid receptors?
Opioid agonist-antagonists
What is the source of the 20 distinct alkaloids that are derived from opium?
Papaver somniferum
Which of the following areas of the brain primarily contains opioid receptors?
Periaqueductal gray
Where are opioid receptors found in the peripheral nervous system?
Sensory neurons
Which opioid receptor subtype is speculated to produce analgesia?
μ1
What is the principal role of κ-opioid receptors?
Inhibition of neurotransmitter release
Which of the following opioids lacks analgesic activity?
Papaverine
Which of the following opioids has the highest analgesic potency compared to morphine?
Fentanyl
Which of the following opioids is a semisynthetic derivative of morphine?
Hydromorphone
Which of the following is a principal phenanthrene alkaloid present in opium?
Thebaine
Which of the following is NOT a potential side effect of morphine?
Increased blood pressure
Which brain region is NOT involved in the opioid-sensitive pain modulation system?
Hippocampus
What is the effect of positive treatment expectancy on the analgesic benefit of remifentanil?
Increased benefit
Which opioid agonist has the highest specificity for receptors and produces little or no side effects?
Placebo
Which of the following is NOT a pharmacologic effect of opioids?
Decreased cardiac output
Which combination of drugs is most likely to result in cardiovascular depression?
Morphine and fentanyl
Which of the following is NOT a mechanism by which opioids protect the myocardium from ischemia?
Activating σ and κ receptors
How do opioid agonists affect ventilation?
Decrease responsiveness to carbon dioxide
What is the effect of opioids on cerebral blood flow and intracranial pressure (ICP)?
Opioids decrease cerebral blood flow and increase ICP
What is the likely cause of skeletal muscle rigidity induced by opioids?
Actions at opioid receptors
What is the effect of opioids on the medullary cough centers?
Opioids depress the medullary cough centers
What is the effect of opioids on ventilation?
Opioids decrease ventilation
Which of the following is a potential side effect of morphine titration for postoperative analgesia?
Sedation
What is the effect of opioids on the biliary tract?
Increase in biliary pressure
Which medication can relieve pain caused by biliary spasm but not myocardial ischemia?
Naloxone
What is the effect of fentanyl on common bile duct pressure?
Increase by 99%
What is the potential misinterpretation of opioid-induced spasm of the sphincter of Oddi during surgery?
Common bile duct stone
What is the effect of morphine on systemic blood pressure?
Not mentioned in the text
Which of the following is a synthetic opioid?
Fentanyl
Which of the following opioids lacks analgesic activity?
Thebaine
Which opioid receptor subtype is responsible for analgesia and euphoria?
μ1
Which opioid antagonist is commonly used to reverse the effects of opioid overdose?
Naloxone
Which of the following is NOT a classification of opioids?
Opioid sympathomimetics
What is the effect of opioids on touch, proprioception, and consciousness?
Selective analgesia without loss of touch, proprioception, or consciousness
Which of the following opioids is a natural derivative of opium?
Morphine
What is the likely cause of opioid-induced increased skeletal muscle tone?
Activation of κ-opioid receptors
Which brain region is primarily associated with opioid receptors?
Periaqueductal gray
What is the effect of opioids on the cardiovascular system?
Decreased blood pressure and decreased heart rate
Which medication can enhance the analgesic response to a placebo?
Remifentanil
What is the most suitable starting point for studying the side effects of opioids?
Morphine
Which of the following is a potential adverse effect of opioid agonists at the cellular level?
Decreased ventilatory responses to carbon dioxide
What is the main cause of death from an opioid overdose?
Depression of ventilation
Which of the following factors can increase the ventilatory depressant effects of opioids?
Advanced age and natural sleep
What is the effect of opioids on cough?
They suppress cough
Where are opioid receptors primarily found in the brain?
Periaqueductal gray, locus ceruleus, and rostral ventral medulla
Where are opioid receptors found in the spinal cord?
Dorsal horn on interneurons and primary afferent neurons
Which opioid receptor subtype is responsible for supraspinal and spinal analgesia?
μ-opioid receptors
Which opioid receptor subtype may serve to modulate the activity of μ receptors?
δ-opioid receptors
Which of the following is a possible adverse effect of opioids on the cardiovascular system?
Increased mean arterial pressure and systemic vascular resistance
What is the role of opioids in protecting the myocardium from ischemia?
Enhancing the resistance of the myocardium to oxidative and ischemic stresses
What is the effect of opioids on touch, proprioception, and consciousness?
No direct effect on touch, proprioception, and consciousness
What is a common reason to discontinue morphine titration for postoperative analgesia?
Decreased sensitivity to carbon dioxide
Which of the following is a potential adverse effect of morphine titration for postoperative analgesia?
Sedation
What is the effect of fentanyl on common bile duct pressure?
Increases by 99%
Which of the following is NOT a potential cause of epigastric distress or biliary colic?
Myocardial ischemia
What is the primary reason to discontinue morphine titration for postoperative analgesia?
Sedation
Which opioid antagonist can relieve pain caused by biliary spasm but not myocardial ischemia?
Naloxone
Which of the following opioids increases common bile duct pressure the least?
Pentazocine
True or false: Opioids are used for perioperative care and pain management.
True
True or false: The term narcotic is derived from the Greek word for stupor.
True
True or false: Opioids produce analgesia without loss of touch, proprioception, or consciousness.
True
True or false: Opioid agonists, opioid agonist-antagonists, and opioid antagonists are three classifications of opioids.
True
Opioid receptors are primarily found in the periaqueductal gray, locus ceruleus, and the rostral ventral medulla.
True
Direct application of opioid agonists to the spinal cord can produce intense analgesia.
True
Activation of κ receptors results in respiratory depression characteristic of μ-receptor activation.
False
True or false: Morphine is classified as an opioid antagonist?
False
δ receptors respond to the endogenous ligands known as enkephalins.
True
True or false: Papaverine is a phenanthrene alkaloid present in opium?
False
True or false: Fentanyl is a synthetic opioid that is widely used as a primary anesthetic drug?
True
True or false: Opioid receptors belong to a superfamily of seven transmembrane-segment guanine protein-coupled receptors?
True
True or false: The analgesic response to a placebo involves the release of endorphins.
True
True or false: The activation of the μ-opioid receptor system is associated with reductions in the sensory and affective ratings of pain.
True
True or false: Positive treatment expectancy can enhance the analgesic benefit of remifentanil.
True
True or false: All opioids have similar side effects that vary only in degree.
True
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: Morphine sensitizes the heart to catecholamines and predisposes to cardiac dysrhythmias.
False
True or false: The combination of an opioid agonist such as morphine or fentanyl with 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: Advanced age and natural sleep can increase the ventilatory depressant effects of opioids?
True
True or false: Opioids depress cough by effects on the medullary cough centers that are distinct from the effects of opioids on ventilation?
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: Equal analgesic doses of fentanyl, morphine, meperidine, and pentazocine increase common bile duct pressure 99%, 53%, 61%, and 15% above predrug levels, respectively?
True
True or false: Opioid-induced spasm of the sphincter of Oddi may appear radiologically as a sharp constriction at the distal end of the common bile duct and be misinterpreted as a common bile duct stone?
True
True or false: Opioids can cause analgesia without loss of touch, proprioception, or consciousness?
True
True or false: The term narcotic is derived from the Greek word for stupor?
True
True or false: Opioids are referred to as opiates because they are derived from opium?
True
True or false: Opioids can produce physical dependence?
True
True or false: Opioid receptors are primarily found in the brain and spinal cord.
True
True or false: Activation of μ-opioid receptors is speculated to produce analgesia.
True
True or false: κ-receptor activation results in respiratory depression.
False
True or false: δ-receptors respond to the endogenous ligands known as enkephalins.
True
True or false: The activation of the μ-opioid receptor system is associated with increases in the sensory and affective ratings of the pain experience.
False
True or false: Positive treatment expectancy can enhance the analgesic benefit of remifentanil.
True
True or false: Morphine-induced histamine release and subsequent decrease in systemic blood pressure can be minimized by optimizing intravascular fluid volume.
True
True or false: Fentanyl infusion can cause the release of histamine in all patients.
False
True or false: Opioid receptors belong to a superfamily of seven transmembrane-segment guanine protein-coupled receptors.
True
True or false: The principal phenanthrene alkaloids present in opium are morphine, codeine, and thebaine.
True
True or false: The active components of opium can be divided into two distinct chemical classes: phenanthrenes and benzylisoquinolines.
True
True or false: Synthetic opioids are manufactured by synthesis rather than chemical modification of morphine.
True
True or false: Opioid-induced ventilatory depression can be mitigated by using 'biased ligands' at opioid receptors?
True
True or false: The miotic effect of morphine can be antagonized by atropine?
True
True or false: Opioids decrease cerebral blood flow and possibly intracranial pressure (ICP)?
True
True or false: Opioids alter the responses to neuromuscular-blocking drugs?
False
True or false: Pretreatment of patients with H1- and H2-receptor antagonists alters 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: Opioid-induced depression of ventilation is characterized by increased responsiveness of ventilation centers to carbon dioxide.
False
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 for postoperative analgesia?
True
True or false: Naloxone will relieve pain caused by biliary spasm but not 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
True or false: Opioid-induced spasm of the sphincter of Oddi may appear radiologically as a sharp constriction at the distal end of the common bile duct and be misinterpreted as a common bile duct stone?
True
True or false: Opioids can cause spasm of biliary smooth muscle, resulting in increases in biliary pressure that may be associated with epigastric distress or biliary colic?
True
Test your knowledge on the cellular level evidence for β-arrestin mediation of opioid-induced ventilatory depression and the use of "biased ligands" at opioid receptors to mitigate this effect. Explore the rapid and persistent depression of ventilation produced by opioid agonists and its impact on ventilatory responses to carbon dioxide.
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