McGraw-Hill Specialty Board Review Pain Medicine

Salahadin Abdi, Pradeep Chopra, Howard Smith

Chapter 4 Pharmacology - all with Video Answers

Educators

Chapter Questions

Problem 1

In humans, methadone acts as
(A) an agonist-antagonist
(B) a pure $\mu$-agonist
(C) a $\mu$-agonist but also with significant actions at the $\delta$-opioid receptor
(D) a $\mu$-agonist but also with significant actions at the $\mathrm{K}$-receptor
(E) a $\mu-, \&$-, and $\kappa$-agonist

Caroline Jones

Numerade Educator

01:30

Problem 1

Which of the following is true about antiepileptic drugs (AED)?
(A) AEDs have analgesic effect in all subjects with neuropathic pain
(B) If one AED is ineffective, it is not necessary to try another one
(C) Newer AEDs have more side effects than older ones
(D) AEDs could be combined with antidepressants to treat neuropathic pain
(E) All of the above

Maryam Riaz

Numerade Educator

Problem 15

An cpioid specific five-question self-administered tool which can be completed in less than 5 minutes to help predict patients at high-risk for exhibiting aberrant opioid-related behavior is
(A) Prescription Drug Use Questionnaire (PDUQ)
(B) Opioid Risk Tool (ORT)
(C) Screener and Opioid Assessment for Patients with Pain (SOAPP)
(D) Screening Instrument for Substance Abuse Potential (SISAP)
(E) Severity of Opiate Dependence Questionnaire (SODQ)

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01:44

Problem 16

Oral transmucosal fentanyl citrate (OTFC) is applied against the buccal mucosa. The percentage of the total dose which is absorbed from the gastrointestinal (GI) tract but escapes hepatic and intestinal first-pass elimination is
(A) $25 \%$
(B) $33 \%$
(C) $50 \%$
(D) $65 \%$
(E) $75 \%$

Willis James

Numerade Educator

Problem 131

Scenarios in which the adjunct use of NSAIDs can be beneficial in postoperative pain:
(1) Use of opioids
(2) No history of induced-opioid side effects
(3) Preexisting ventilatory compromise
(4) History of Gl bleeding

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03:14

Problem 141

Which of the following is true about the analgesic properties of TCAs?
(1) The analgesic effects of TCA are independent of their effects on clinical depression
(2) Onset of analgesia with TCA ranges from 3 to 7 days
(3) Analgesia tends to occur at lower doses and plasma levels than that needed for antidepressant effects
(4) TCA's analgesic property is superior to that of SSRI's

Maryam Riaz

Numerade Educator

01:17

Problem 145

What is the main mechanism by which opioids produce analgesia?
(A) Coupling of opioid receptors to sodium and potassium ion channels, therefore inhibiting neurotransmitter release (presynaptic) and inhibiting neuronal firing (postsynaptically)
(B) Coupling of opioid receptor to potassium and calcium channels, inhibiting neurotransmitter release (presynaptic), and inhibiting neuronal firing (postsynaptically)
(C) Coupling of opioid receptors to sodium and calcium channels, inhibiting neurotransmitter release (presynaptic), and inhibiting neuronal firing (postsynaptically)
(D) Coupling of opioid receptors to potassium and calcium channels, inhibiting neuronal firing (presynaptically), and inhibiting neurotransmitter release (postsynaptically)
(E) All the options are true

Asma Venkitta

Numerade Educator

01:17

Problem 146

Main mechanics of spinal opioid analgesia is via
(A) activation of presynaptic opioid receptors
(B) activation of postsynaptic opioid receptors
(C) activation of opioid receptors on the midbrain
(D) activation of opioid receptors on the RVM
(E) all of the above

Asma Venkitta

Numerade Educator

03:35

Problem 147

Opioids act on what type of receptors targets?
(A) $\mu^{-}, \delta^{-}, \mathrm{k}-$, And ORL receptors
(B) Voltage-dependent sodium channels
(C) $\alpha_{28}$-Adrenoreceptors
(D) NMDA receptors
(E) All of the above

Asma Venkitta

Numerade Educator

Problem 148

Which of the following statements is true regarding the use of oxycodone?
(A) Analgesic efficacy is not comparable with that of morphine
(B) Typically has been used in combination with nonopioids
(C) Not available as a long-acting preparation
(D) Lower bioavailability than that of morphine
(E) Consistently shows a higher induced rate of hallucinations and itching when compared with morphine

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Problem 149

One important characteristic of methadone that has to be considered when prescribing it on an outpatient basis:
(A) Usually there is a low chance for interactions on patients taking multiple medications
(B) Withdrawal symptoms are as severe as with morphine
(C) Rarely used in opioid addiction
(D) Sedation and respiratory depression can outlast the analgesic action
(E) Allows rapid titration

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01:17

Problem 150

What property of methadone makes it a good option for opioid rotation, when tolerance develops?
(A) Serotonin agonist
(B) $\alpha_{2 B}$-Adrenoreceptor agonist
(C) $\mu$-Agonist
(D) NMDA agonist
(E) NMDA antagonist

Asma Venkitta

Numerade Educator

Problem 151

Which one of the following is the only opioid with prolonged activity not achieved by controlled-released formulation?
(A) Oxycodone
(B) Fentanyl
(C) Morphine
(D) Codeine
(E) Methadone

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Problem 152

Which of the following opioids is used in the office-based treatment of addiction?
(A) Naloxone
(B) Morphine
(C) Tramadol
(D) Buprenorphine
(E) Meperidine

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Problem 153

Pharmacologic properties of fentanyl that make it an ideal drug for transdermal and transmucosal administration is
(A) high lipid solubility, high molecular weight, and high potency
(B) low lipid solubility, high molecular weight, and high potency
(C) low lipid solubility, low molecular weight, and low potency
(D) high lipid solubility, low molecular weight, and high potency
(E) high lipid solubility, low molecular weight, and low potency

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05:27

Problem 154

Opioids can have drug interactions with
(A) tricyclic antidepressants (TCAs)
(B) selective serotonin reuptake inhibitor (SSRIs)
(C) monoamine oxidase inhibitors (MAOIs)
(D) metoprolol
(E) all of the above

Asma Venkitta

Numerade Educator

Problem 155

Which of the following is a long and cumbersome research tool for substance abuse and is very good but not very practical in the setting of a busy pain clinic?
(A) Screening Tool for Addiction Risk (STAR)
(B) Severity of Opiate Dependence Questionnaire (SODQ)
(C) Screening Instrument for Substance Abuse Potential (SISAP)
(D) Addiction Severity Index (ASI)
(E) Prescription Drug Use Questionnaire (PDUQ)

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Problem 157

The opioid which is largely metabolized by CYP3.A4 is
(A) morphine
(B) fentanyl
(C) methadone
(D) hydromorphone
(E) oxymorphone

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Problem 158

Which of the following is correct regarding patients who are prescribed and taking hydrocodone and found to have different opioid in their urine drug-testing results?
(A) Norfentanyl, which is expected
(B) Hydrocodeine, which is expected as a normal metabolite
(C) Hydromorphone, which is expected as a normal metabolite
(D) Hydromorphone, which is unexpected and patient is probably taking another opioid
(E) Hydrocodeine, which is unexpected and patient is probably taking another opioid

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04:36

Problem 159

An opioid-specific instrument which may be useful in predicting opioid misuse and is available as a 5-, 14-, or 24 -item questionnaire as well as a revised version designed to be less susceptible to overt decoption than the original version is
(A) Prescription Drug Use Questionnaire (PDUQ)
(B) Opioid Risk Tool (ORT)
(C) Screener and Opioid Assessment for Patients with Pain (SOAPP)
(D) Screening Instrument for Substance Abuse Potential (SISAP)
(E) Severity of Opiate Dependence Questionnaire (SODQ)

Ana Carolina Da Cruz

Numerade Educator

Problem 160

A classic example of an opioid partial agonist is
(A) naltrexone
(B) butorphanol
(C) nalbuphine
(D) buprenorphine
(E) pentazocine

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05:49

Problem 161

A popular mnemonic for following relevant domains of outcome in pain management for patients on long-term opioid therapy is the socalled $4 \mathrm{~A}$ 's which include all the following, EXCEPT
(A) analgesia
(B) activities of daily living
(C) adverse events
(D) affect
(E) aberrant drug-taking behaviors

Katharina Boser

Numerade Educator

Problem 162

A popular pain assessment scale which is utilized by preverbal toddler and nonverbal children through age 7 years who may be treated with opioids is
(A) CRIES
(B) APPT
(C) FACES
(D) FLACC
(E) N-PASS

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Problem 163

The opioid which has some component of metabolism by CYP1A2 is
(A) morphine
(B) fentanyl
(C) methadone
(D) hydromorphone
(E) oxymorphone

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Problem 164

The opioid which is a metabolite of oxycodone via 3-0-demethylation is
(A) hydrocodone
(B) morphine
(C) codiene
(D) hydromorphone
(E) oxymorphone

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01:01

Problem 165

Which of the following two opioids are inherently, pharmacologically, and relatively longacting?
(A) Morphine and oxycodone
(B) Morphine and oxymorphone
(C) Oxycodone and fentanyl
(D) Methadone and levorphanol
(E) Methadone and oxymorphone

Narayan Hari

Numerade Educator

01:32

Problem 167

OTFC is applied against the buccal mucosa. The total apparent bioavailability is
(A) $25 \%$
(B) $33 \%$
(C) $50 \%$
(D) $65 \%$
(E) $75 \%$

Qudsiya Anis

Numerade Educator

01:44

Problem 168

The fentanyl buccal tablet (FBT) utilizes an effervescent drug delivery system and achieves an absolute bioavailability of
(A) $25 \%$
(B) $33 \%$
(C) $50 \%$
(D) $65 \%$
(E) $75 \%$

Willis James

Numerade Educator

01:19

Problem 169

After intramuscular administration of fentanyl citrate, the time to onset of analgesia is roughly
(A) 1 to 3 minutes
(B) 7 to 15 minutes
(C) 15 to 30 minutes
(D) 20 to 40 minutes
(E) 30 to 50 minutes

Anand Jangid

Numerade Educator

03:44

Problem 170

The oral bioavailability of morphine is roughly
(A) $10 \%$ to $20 \%$
(B) $25 \%$ to $35 \%$
(C) $35 \%$ to $45 \%$
(D) $40 \%$ to $55 \%$
(E) $50 \%$ to $60 \%$

Dr. Satish Ingale

Numerade Educator

02:35

Problem 172

A tool which documents a quantitative assessment of various opioid-adverse effects is the
(A) Pain Assessment and Documentation Tool (PADT)
(B) Translational Analgesic Score (TAS)
(C) SAFE score
(D) Numerical Opioid Side Effect (NOSE)
(E) Severity of Opioid Dependence Questionnaire (SODQ)

Asma Venkitta

Numerade Educator

Problem 173

Which of the following is the best opioid to administer for analgesia in a patient with chronic kidney disease stage $\mathrm{V}$ ?
(A) Codeine
(B) Meperidine
(C) Morphine
(D) Fentanyl
(E) Propoxyphene

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Problem 174

Which of the following is the most prescribed opioid in the United States, which also undergoes O-demethylation to dihydromorphine and its major metabolites excreted into the urine are dihydrocodeine and nordihydrocodeine?
(A) Codeine
(B) Dihydrocodeine
(C) Hydrocodone
(D) Hydromorphone
(E) Morphine

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03:46

Problem 175

Which of the following is essentially responsible for opioid-induced respiratory depression?
(A) $\mu$-Receptor
(B) 8 -Receptor
(C) $\kappa$-Receptor
(D) $\sigma$-Receptor
(E) ORL 1 receptor

Braedyn Mclaughlin

Numerade Educator

02:54

Problem 176

Propoxyphene napsylate has a higher maximum daily dose than propoxyphene hydrochloride because
(A) propoxyphene napsylate is less potent than propoxyphene hydrochloride
(B) propoxyphene napsylate is less toxic than propoxyphene hydrochloride
(C) propoxyphene napsylate is cleared faster than propoxyphene hydrochloride
(D) the napsylate salt tends to be absorbed more slowly than the hydrochloride
(E) the napsylate salt makes propoxyphene less active

Ronald Prasad

Numerade Educator

Problem 177

When considering opioid rotation to methadone, which of the following is the most appropriate next step?
(A) Maintain the equianalgesic dose
(B) Reduce the dose by $10 \%$ to $25 \%$
(C) Reduce the dose by $25 \%$ to $50 \%$
(D) Reduce the dose by $50 \%$ to $75 \%$
(E) Reduce the dose by $75 \%$ to $90 \%$

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Problem 178

When considering opioid rotation to fentanyl, which of the following is the most appropriate step?
(A) Maintain the equianalgesic dose
(B) Reduce the dose by $10 \%$ to $25 \%$
(C) Reduce the dose by $25 \%$ to $50 \%$
(D) Reduce the dose by $50 \%$ to $75 \%$
(E) Reduce the dose by $75 \%$ to $90 \%$

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02:15

Problem 179

The equianalgesic conversion ratio of oral oxymorphone to intravenous morphine is
(A) 1 to 1
(B) 1 to 2
(C) 1 to 3
(D) 1 to 4
(E) 1 to 5

Anand Jangid

Numerade Educator

05:40

Problem 180

By approximately what percentage is codeine ineffective as an analgesic in the Caucasian population owing to genetic polymorphisms in CYP2D6 (the enzyme necessary to $\mathrm{O}$ methylate codeine to morphine)?
(A) $2 \%$
(B) $5 \%$
(C) $10 \%$
(D) $25 \%$
(E) $33 \%$

Ian Kaigh

Numerade Educator

08:33

Problem 181

Which of the following is the correct statement regarding the pharmacologic properties of NSAIDs?
(A) They readily cross the blood-brain barrier
(B) Their chemical structure consists of aromatic rings connected to basic functional groups
(C) They act mainly in the periphery
(D) They have a high renal clearance
(E) They are not metabolized by the liver

Caroline Jones

Numerade Educator

02:17

Problem 182

What are the advantages of $\mathrm{COX}-2$ inhibitors versus NSAIDs?
(A) Protective renal effects
(B) Less GI side effects
(C) Protective cardiovascular effects
(D) Inhibits production of thromboxane A2
(E) Increases production of lipooxygenase

Joanna Quigley

Numerade Educator

Problem 183

Which of the following best fits the pharmacologic mechanisms of action of "traditional" NSAIDs?
(A) Inhibition of phospholipase A2
(B) Inhibition of COX-2
(C) Inhibition of lipoxygenase
(D) Inhibition of arachidonic acid
(E) Inhibition of prostaglandin G/H synthase enzymes

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02:56

Problem 184

The main role of prostaglandins in pain is
(A) as important primary pain mediators
(B) sensitization of central nociceptors
(C) sensitization of peripheral nociceptors
(D) facilitation of the production of pain mediators (ie, bradykinin, somatostatin, histamine)
(E) stimulation of $\mathrm{\kappa}$-receptors on the spinal cord

Cody Delk

Numerade Educator

01:38

Problem 185

The effects of NSAIDs on the kidneys function or renal function may include
(A) increase in renal blood flow
(B) promotion of salt and water excretion
(C) chronic interstitial nephritis
(D) increased glomerular filtration rate (GFR)
(E) chronic papillary necrosis

Qudsiya Anis

Numerade Educator

01:52

Problem 186

Platelet dysfunction secondary to the use of NSAIDs is a known effect, in long-term treatment with standard NSAIDs. What laboratory value is most compatible with these effects?
(A) Prolonged prothrombin time (PT)
(B) Prolonged partial thromboplastin time (PTT)
(C) Prolonged activated clotting time (ACT)
(D) Severely prolonged bleeding time
(E) Below the upper limits of normal to mildly prolonged bleeding time

Katie Haasch

Numerade Educator

Problem 187

The duration of aspirin effect is related to the turnover rate of $\mathrm{COX}$ in different target tissues, because aspirin
(A) competitively inhibits the active sites of COX enzymes
(B) nonirreversibly inhibits COX activity
(C) irreversibly inhibits COX activity
(D) noncompetitively inhibits the active sites of COX enzymes
(E) acetylates COX-1

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01:52

Problem 188

The unique sensitivity of platelets to inhibition by low doses of aspirin (as low as $30 \mathrm{mg} / \mathrm{d}$ ) is related to
(A) first pass of aspirin through the liver
(B) presystemic inhibition of platelets in the portal circulation
(C) irreversible inhibition of $\mathrm{COX}$
(D) constitutively expression of $\mathrm{COX}-1$ in platelets
(E) good oral absorption

Katie Haasch

Numerade Educator

Problem 189

How long before surgery NSAIDs are advised to be stopped?
(A) 12 hours
(B) 2 to 3 days
(C) 7 days
(D) 10 days
(E) 14 days

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00:23

Problem 190

Which of the following NSAIDs is as effective as morphine?
(A) Ketoprofen
(B) Indomethacin
(C) Ibuprofen
(D) Ketorolac
(E) Diclofenac

Nicole Smina

Numerade Educator

Problem 191

Rare side effect of NSAIDs is
(A) GI side effects
(B) platelet dysfunction
(C) potentially fatal hepatic necrosis
(D) renal dysfunction/failure
(E) all of the above

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Problem 192

Which of the following is (are) true regarding oxcarbazepine?
(A) It has more adverse effects than carbamazepine
(B) It is a sodium channel blocker
(C) Oxcarbazepine's dose adjustment is unnecessary for renal insufficiency
(D) Its most frequent adverse effects is weight loss and dizziness
(E) none of the above

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Problem 193

Which of the following is a typical adverse effect of pregabalin?
(A) Constipation
(B) Dizziness
(C) Blurred vision
(D) Dry mouth
(E) All of the above

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Problem 194

Which of the following is (are) false regarding gabapentin?
(A) It is a first-line drug for the treatment of PHN and PDN (painful diabetic neuropathy)
(B) Its dose should be reduced in renal insufficiency
(C) It blocks NMDA receptors
(D) It is thought to inhibit voltagedependent calcium channels
(E) It has a chemical structure similar to that of GABA

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01:31

Problem 195

Which of the following is true about zonisamide?
(A) It is a sulfonamide drug
(B) It is a sodium channel blocker
(C) It is $40 \%$ to $50 \%$ protein bound
(D) It may potentially lead to renal calculi
(E) All of the above

Joanna Quigley

Numerade Educator

Problem 197

The antidepressant with the least anticholinergic and least sedating effect is
(A) trazodone
(B) desipramine
(C) imipramine
(D) doxepin
(E) amitriptyline

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Problem 198

Which of the following antidepressant agent selectively inhibits serotonin reuptake with minimal effect on norepinephrine reuptake?
(A) Duloxetine
(B) Protriptyline
(C) Paroxetine
(D) Amoxapine
(E) Desipramine

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Problem 199

The most common adverse effects associated with TCA are (is)
(A) anticholinergic effects
(B) seizures
(C) arrhythmias
(D) hepatotoxicity
(E) nephrotoxicity

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Problem 200

The least common adverse effects associated with TCA are (is)
(A) dry mouth
(B) seizure
(C) urinary retention
(D) blurred vision
(E) aconstipation

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00:56

Problem 201

Compared to TCAs, SSRIs
(A) are more effective in the treatment of pain
(B) have more side effects
(C) have less side effects
(D) have more serious consequence of overdosage
(E) none of the above

Jessica Reyna

Numerade Educator

Problem 202

. Which of the following is false regarding tramadol?
(A) It has opioid characteristics
(B) There is a dose limit of $400 \mathrm{mg} / \mathrm{d}$
(C) It is a centrally acting analgesic
(D) No effect on norepinepherine or serotonin
(E) Inhibits the reuptake of norepinephrine and serotonin

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01:34

Problem 203

The benzodiazepine which is used to treat various neuropathic pain syndromes is
(A) diazepam
(B) midazolam
(C) clonazepam
(D) flunazepam
(E) lorazepam

Keronhica Desir

Numerade Educator

Problem 204

Which of the following about carisoprodol is true?
(A) Naloxone may be a useful antidote to its toxicity
(B) Flumazenil may be a useful antidote to its toxicity
(C) It is safe to use as a long-term treatment of musculoskeletal disorders
(D) It is a GABA $\mathrm{B}$ receptor agonist
(E) It has no abuse potential

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Problem 205

Which of the following is true regarding tizanidine?
(A) It is structurally related to clonipine
(B) It is $\mathrm{GABA}_{\mathrm{B}}$ receptor agonist
(C) It is $\mathrm{GABA}_{\mathrm{A}}$ receptor agonist
(D) Its excretion occurs primarily through the liver
(E) It is $\alpha_2$ agonist

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00:49

Problem 206

Which of the following is a false statement about ziconotide?
(A) It is derived from conus sea snail venom
(B) It is the synthetic form of cone snail peptide (conotoxin)
(C) It is effective when given intravenously or orally
(D) It is N-type calcium channel blocker
(E) Its common side effects are dizziness, confusion, and headache

Eleanor Behling

Numerade Educator

01:05

Problem 207

Which of the following is true regarding capsaicin?
(A) It is a member of the vanilloid family which binds to the TRPV1 receptor
(B) It is commercially available in $0,025 \%$ and $0.075 \%$ concentrations
(C) It is the active component of chili peppers
(D) It depletes presynaptic substance $\mathrm{P}$
(E) All of the above

Barbara Kipreos

Numerade Educator

Problem 208

The following are some of the side effects of lidocaine $5 \%$ patches, EXCEPT
(A) methemoglobin
(B) edema
(C) erythema
(D) abnormal sensation
(E) exfoliation

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01:28

Problem 209

Calcitonin may be used as an adjuvant drug for all the following, EXCEPT
(A) phantom limb pain
(B) sympathetically maintained pain
(C) cancer bone pain
(D) postoperative pain
(E) osteoporosis pain

Joanna Quigley

Numerade Educator

05:18

Problem 210

Regarding the effects produced by the different subtypes of opioid receptors, which of the following is (are) true?
(1) $\kappa$-Receptors produce more respiratory depression than $\mu$-receptors
(2) Opioid receptors mostly affect phosphorylation through $\mathrm{G}$ protein coupling
(3) The stimulation of $\mu_2$-receptors to produce analgesia without respiratory depression, has been supported by several studies
(4) Opioid receptors act both presynaptically and postsynaptically

Rehana Riaz

Numerade Educator

Problem 211

The use of pure opioid agonists are preferred in chronic pain patients because of their
(1) low association with addiction
(2) superior analgesic efficacy
(3) low potential for nausea and vomiting
(4) easier titratable nature

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Problem 212

The systemic administration of opioids exerts its analgesic effects at what level(s)?
(1) Brain cortex
(2) Brainstem and medulla
(3) Dorsal horn of the spinal cord
(4) Sensory neuron (peripheral nervous system)

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Problem 213

Which of the following condition(s) increase the likelihood of opioid-related toxicity?
(1) Pregnancy
(2) Renal disease
(3) Cardiac heart failure
(4) Cirrhotic liver discase

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Problem 214

Which of the following is (are) true concerning the use of epidural morphine?
(1) A biphasic respiratory depression pattern can develop, with the initial phase within 30 minutes of the bolus dose and a second phase 2 to 4 hours later
(2) Initial phase within 2 hours of the bolus dose and a second phase 6 to 12 hours later
(3) Patients should be closely monitored for 48 hours after the administration of epidural morphine
(4) Patients should be closely monitored for 24 hours after the administration of epidural morphine

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Problem 215

Opioids should be used with caution in which of the following scenarios?
(1) Emphysema
(2) Kyphoscoliosis
(3) Chronic obstructive pulmonary disease (COPD)
(4) Obstructive sleep apnea

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03:04

Problem 216

Indicate what part differs largely among the $\mu$-, $\delta$-, $\mathrm{k}$-, and ORL (opioid-receptor-like) receptors?
(1) Transmembrane domains
(2) Extracellular loops
(3) Intracellular loops
(4) $\mathrm{N}$ or $\mathrm{C}$ terminal tails

Bryan Valdivia

Numerade Educator

06:25

Problem 217

Opioids modify and relieve the perception of pain without detriment of other sensory mode types. While the pain is still present there is a dissociation of the emotional and sensory aspects of pain, making the patients feel more comfortable. Select the best reason(s) from the following:
(1) Action of opioids on supraspinal structures, brainstem [ie, PAG (periaqueducta] gray) the RVM (rostroventral medulla)]. and midbrain
(2) Action of opioids on peripheral structures via presynaptic receptors
(3) Enhanced inhibitory activity on descending controls terminating in the dorsal horn of the spinal cord
(4) Pronounced reduction in activity of $\mathrm{OFF}$ cells and decreased activity of $\mathrm{ON}$ cells

Allison Krajewski

Numerade Educator

Problem 218

Opioids exert their analgesic effects through
(1) their central action within the central nervous system (CNS), inhibiting directly the ascending transmission of painful stimuli from the dorsal horn at the spinal cord
(2) their central action within the CNS activating pain control circuits descending from the midbrain via the RVM to the spinal cord dorsal hom(3) their peripheral actions on opioid receptors and the release of endogenous opioid-like substances
(4) their action on the spinal cord at a presynaptic level only

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Problem 219

Which of the following is (are) true regarding pharmacologic characteristics of opioids?
(1) Opioids are the primary pain medication with ceiling effects
(2) Opioids are the primary pain medication with no ceiling effects
(3) There are sex related differences in opioid-mediated responsiveness
(4) There are no sex related differences in opioid-mediated responsiveness

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01:12

Problem 220

Tramadol has some different characteristics when compared to some other opioids induding
(1) same side effects as morphine
(2) risk of respiratory depression is lower at equianalgesic doses from that produce with conventional opioids
(3) less incidence of nausea and vomiting
(4) low abuse potential

Lottie Adams

Numerade Educator

Problem 221

Morphine should be used with caution in which situations/conditions?
(1) Short bowel syndrome
(2) Mild liver dysfunction
(3) Vomiting or severe diarrhea
(4) Renal dysfunction

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Problem 222

The transdermal fentanyl patch has differences versus sustained-release morphine in patients with canoer and chronic pain:
(1) It can be used when the oral route can not be used
(2) It is 80 times as potent as morphine
(3) It causes less constipation than sustained-release morphine
(4) Peak plasma concentration occurs in 6 to 12 hours

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03:35

Problem 223

Which of the following is (are) correct regarding the use of meperidine?
(1) The use of meperidine should be limited to 1 to 2 days in the management of acute pain
(2) Normeperidine is a neurotoxic metabolite of meperidine
(3) Meperidine should be avoided in the management of chronic pain
(4) The use of meperidine is recommended in elderly patients

Hunza Gilgit

Numerade Educator

02:59

Problem 224

Which of the following is (are) true regarding opioids distribution and biotransformation (metabolism)?
(1) Fentanyl is highly protein bound
(2) Fentanyl distributes to fat tissue and redistributes from there into the systemic circulation
(3) Opioids are metabolized by the liver, CNS, kidney, lungs, and placenta
(4) Opioid distribution is independent of protein binding and lipophilicity

Qudsiya Anis

Numerade Educator

Problem 225

What is (are) the neuroendocrine effects produced by opioids?
(1) Hypogonadism
(2) Hypothyroidism
(3) Decreased cortisol levels
(4) Decreased pituitary release of prolactin

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Problem 226

Which of the following drugs may show interactions with NSAIDs/COX-2 inhibitors?
(1) Angiotensin-converting enzyme (ACE) inhibitors
(2) Furosemide
(3) Warfarin
(4) Lithium

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01:21

Problem 227

Which of the following is (are) contraindicated in patients allergic to sulfonamides?
(1) Rofecoxib
(2) Valdecoxib
(3) Meloxicam
(4) Celecoxib

Maryam Riaz

Numerade Educator

Problem 228

Anti-inflammatory agent(s) which may possess advantages when $\mathrm{GI}$ side effects are a concern include
(1) ibuprofen
(2) nabumetone
(3) diclofenac
(4) coxibs

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Problem 229

Which of the following is (are) true for coxibs versus NSAIDs?
(1) Coxibs are associated with less GI side effects
(2) Coxibs have similar renal effects
(3) Coxibs are not associated with platelet dysfunction
(4) Coxibs are associated with increased incidence of nonunion and delayed bone healing

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00:23

Problem 230

Which of the following NSAIDs have higher potency (either analgesic or anti-inflammatory or both) compared to ASA?
(1) Diflunisal
(2) Indomethacin
(3) Ketorolac
(4) Diclofenac

Nicole Smina

Numerade Educator

Problem 232

Options that can be offered to patients with increased risk of GI toxicity:
(1) Diclofenac with enteric coat
(2) NSAIDs combined with GI prophylaxis
(3) NSAIDs combined with antacids
(4) Coxibs

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Problem 233

Which of the following is (are) NSAID's role in cancer?
(1) Synergistic effect of NSAIDs and opioids
(2) Bone and soft tissue pain relief
(3) Ability to reduce the side effects of opioids
(4) Visceral pain relief

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00:17

Problem 234

Anti-inflammatory agent(s) which do not interfere with the cardioprotective effects of "lowdose" aspirin include
(1) naproxen
(2) ibuprofen
(3) ketorolac
(4) celecoxib

Emily Marty

Numerade Educator

01:01

Problem 235

Which of the following is (are) true regarding carbamazepine?
(1) It blocks voltage-dependent sodium channels
(2) Bicuculline antagonizes its antinociceptive effect
(3) It was first used for trigeminal neuralgia
(4) All of the above

Narayan Hari

Numerade Educator

03:29

Problem 236

Pregabalin is Food and Drug Administration (FDA) approved for
(1) diabetic neuropathy
(2) postherpetic neuralgia (PHN)
(3) fibromyalgia
(4) none of the above

Ian Kaigh

Numerade Educator

Problem 237

Which of the following is (are) true regarding gabapentin?
(1) It has chemical a structure similar to GABA
(2) It acts directly at GABA-binding site in the CNS
(3) It inhibits voltage-dependent calcium channels
(4) It is the drug of choice for fibromyalgia

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03:14

Problem 238

Which of the following is (are) true regarding clonazepam?
(1) It is a benzodiazepine
(2) It is effective as anxiolytic and musclerelaxing agent
(3) It may be useful for phantom limb pain
(4) It has short half-life

Maryam Riaz

Numerade Educator

04:18

Problem 239

Which of the following is true about lamotrigine?
(1) It is an anticonvulsive agent
(2) It is an NSAID
(3) A rapid titration may result in skin rash
(4) More than $300 \mathrm{mg} / \mathrm{d}$ is always needed for analgesia

Maryam Riaz

Numerade Educator

01:01

Problem 240

The antidepressant(s) which is (are) tertiary amine(s) TCA:
(1) Imipramine
(2) Nortriptyline
(3) Doxepin
(4) Desipramine

Narayan Hari

Numerade Educator

Problem 242

Which of the following is (are) true about TCAs?
(1) They interact significantly with the opioid and benzodiazepine
(2) They do not have potential for addiction
(3) They block calcium channels
(4) They can cause insomnia, restlessness and dry mouth

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Problem 243

Symptoms of TCA toxicity includes which of the following?
(1) Hyperthermia
(2) Tachycardia
(3) Seizures
(4) Hypertension

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Problem 244

When prescribing antidepressants for pain
(1) explain to the patient that you are primarily treating the pain not depression
(2) explain to the patient that it will not work immediately
(3) explain to the patient that it may help sleep
(4) none of the above

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03:14

Problem 245

Which of the following is (are) true regarding acetaminophen?
(1) It is an aniline derivative
(2) Induced analgesia is centrally mediated
(3) It has peripheral mechanism of action
(4) It is a drug of choice for relieving mild to moderate musculoskeletal pain

Maryam Riaz

Numerade Educator

Problem 246

Which of the following is (are) true regarding acetaminophen toxicity?
(1) The liver gets the major insult
(2) The heart gets the major insult
(3) N-acetylcysteine is beneficial for treatment
(4) Adrenergic agonists are beneficial for treatment

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03:14

Problem 247

Which of the following is (are) true about badofen?
(1) It is good for muscle rigidity and spasticity
(2) It is used for neuropathic pain
(3) It is $\mathrm{GABA}_B$ receptor agonist
(4) It is GABA receptor agonist

Maryam Riaz

Numerade Educator

Problem 248

Which of the following is (are) true regarding botulinum toxin $\mathrm{A}$ ?
(1) The analgesic mechanism of action is well known
(2) It can be administered intrathecally
(3) Botox, Myobloc, and Dysport are available in the United States
(4) Its effect lasts for about 3 to 6 months

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01:04

Problem 249

Which of the following is false regarding cyclobezaprine?
(1) It is structurally similar to anticonvulsive agents
(2) It has cholinergic side effects
(3) It does not require dose adjustment for elderly patients
(4) It can produce sinus tachycardia

Varsha Aggarwal

Numerade Educator

04:18

Problem 250

Which of the following is (are) false about lidocaine $5 \%$ topical patch?
(1) Treatment for postherpetic neuralgia
(2) It may not use more than 1 patch per day
(3) It is used 12 hours ON and 12 hours OFF
(4) High plasma levels are normally achieved through the skin

Maryam Riaz

Numerade Educator

Problem 251

Steroids produce analgesia by
(1) anti-inflammatory effects
(2) suppressing ectopic discharge from injured nerves
(3) reducing edema
(4) blocking sodium channels

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