12- ANALGESICS

Item Number: 1684 correct answer: 5 category: Analgesics

1. A child has ingested an unknown substance and has evidence of Respiratory depression.: This symptom is usually found with poisoning due to:

1. amphetamines

2. atropine

3. mushrooms

4. kerosene

5. opioids

Item Number: 2534 correct answer: 3 category: Analgesics

2. The use of methadone in the treatment of heroin addiction continues to be controversial. It would therefore be advantageous to find a substance with the beneficial effects of methadone, but without its undesirable characteristics. The correct statement is that:

1. methadone is not physically addicting and therefore very useful in treating heroin addicts

2. the withdrawal syndrome of methadone is of shorter duration than that of heroin

3. propoxyphene may successfully suppress the withdrawal syndrome in heroin-addicted individuals

4. although propoxyphene does block heroin withdrawal, it itself is not physically addicting

5. propoxyphene may be successfully substituted for heroin in the addicted individual and abruptly discontinued after three to four weeks without signs of an abstinence syndrome

Item Number: 2799 correct answer: 3 category: Analgesics

3. Chronic renal damage resulting from the ingestion of analgesics has been suggested. The FALSE statement is:

1. phenacetin has been implicated

2. salicylates have been implicated

3. meperidine has been implicated

4. acetaminophen is a metabolite of phenacetin

5. combinations may be more harmful

Item Number: 3460 correct answer: 4 category: Analgesics

4. A 20-month old infant is brought to the emergency room with fever, vomiting, stupor, and hyperpnea of 12 hours' duration. His leukocyte count is 6,000/cu mm. The chest roentgenogram is clear. Urinalysis shows albuminuria, a positive test for reducing substance, and acetonuria. Ferric chloride added to the boiled acidified urine shows a persistent purple color. The most likely diagnosis is:

1. acute glomerulonephritis

2. diabetic acidosis

3. acute bacterial meningitis

4. salicylate poisoning

5. phenothiazine poisoning

Item Number: 3870 correct answer: 5 category: Analgesics

5. The gastric mucosa has the important ability to prevent movement of gastric acid from the stomach lumen into the gastric wall. Some diseases and drug regiments have been implicated as causes of increased gastric mucosal permeability to hydrogen ion. Drugs which may increase gastric wall permeability include:

1. erythromycin

2. indomethacin

3. nitrofurantoin

4. aspirin

5. 2,4

Item Number: 3871 correct answer: 4 category: Analgesics

6. In normal patients, the so-called gastric mucosa barrier protects the mucosal lining from back diffusion of hydrogen ions and subsequent destruction.

In some patients even small changes in the gastric barrier allows back diffusion of significant hydrogen ion and subsequent destructive action. Which of the following pharmacologic agents have been implicated as causes of gastric barrier breakdown?

1. caffeine

2. ethanol

3. aspirin

4. 2,3

5. All of the above

Item Number: 3907 correct answer: 5 category: Analgesics

7. Patients with normal platelet counts and normal bleeding time may still bleed severely as a result of aspirin ingestion prior to a dental or surgical procedure. The aspirin interference with normal platelet function may last as long as:

1. 4 hours

2. 12 hours

3. 2 days

4. 5 days

5. 7 days

Item Number: 4099 correct answer: 3 category: Analgesics

8. The appropriate antidote in the treatment of pentazocine overdosage is:

1. nalorphine

2. levallorphan

3. naloxone

4. Any of the above

5. None of the above

Item Number: 4587 correct answer: 4 category: Analgesics

9. Acute hemorrhagic gastritis is one of the most frequent causes of severe upper gastrointestinal bleeding. It is frequently related to recent ingestion of ethanol and/or aspirin and may be life-threatening. Bleeding secondary to aspirin is mainly due to:

1. inhibition of gastric prostaglandin synthesis

2. decreased renal excretion of the salicylate with attendant longer half-

life in serum

3. back diffusion of hydrogen ions across the gastric mucosa

4. 1,3

5. None of the above

Item Number: 4639 correct answer: 3 category: Analgesics

10. Many stimuli may cause vomiting. The chemoreceptor trigger zone of the central nervous system is:

1. located in the cerebral cortex

2. stimulated in all forms of vomiting

3. stimulated by morphine and its congeners

4. All of the above

5. 1,3

Item Number: 5275 correct answer: 1 category: Analgesics

11. A pharmacologic agent which has the potential to cause increased biliary tree pressure is:

1. morphine

2. warfarin

3. phenytoin

4. acetazolamide

5. carbon tetrachloride

Item Number: 6260 correct answer: 4 category: Analgesics

12. Many commonly utilized medications are subject to abuse. Normally nontoxic medications, if ingested in excessive amounts, may cause end-organ damage. Analgesic nephropathy has been associated with:

1. prolonged abuse of phenacetin

2. prolonged abuse of phenacetin-aspirin combinations

3. acetaminophen derived from phenacetin

4. All of the above

5. 1,3

Item Number: 6765 correct answer: 4 category: Analgesics

13. All of the following statements regarding acetaminophen toxicity are true EXCEPT:

1. acetaminophen is the principal metabolic product of phenacetin

2. an overdose of 10 grams or more may produce hepatic necrosis in adults

3. acetaminophen overdose may produce transient azotemia or renal failure

4. forced diuresis may be a useful form of therapy for acetaminophen overdose

5. liver pathology is centrilobular and midzonal necrosis

Item Number: 9774 correct answer: 1 category: Analgesics

14. Opioid analgesics are sometimes associated with the production of pulmonary disease. The most common pulmonary complication after oral ingestion is:

1. pulmonary edema

2. interstitial fibrosis

3. pulmonary calcification

4. bronchoconstriction

5. pleural effusion

Item Number: 6707 correct answer: 1 category: Analgesics

15. Characteristically observed in individuals following acute overdose of opioids.

A. pinpoint pupils

B. depressed respiration

C. coma

D. convulsions

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6708 correct answer: 2 category: Analgesics

16. TRUE statement concerning the actions of opioids on the secretion of pituitary hormones.

A. suppress the secretion of luteinizing hormone and thyrotropin

B. reduce the release of prolactin

C. act as a stimulus for ADH secretion

D. inhibit the secretion of ACTH

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6728 correct answer: 4 category: Analgesics

17. The duration of analgesia is one important characteristic which differentiates one opioid from another. Which opioid possesses the shortest duration of analgesia?

1. morphine

2. hydromorphone

3. codeine

4. meperidine

5. methadone

Item Number: 6733 correct answer: 5 category: Analgesics

18. Which of the following possess(es) some antagonist activity at opioid receptors?

A. naloxone

B. pentazocine

C. butorphanol

D. nalorphine

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6740 correct answer: 1 category: Analgesics

19. TRUE statements concerning the pharmacologic properties of salicylates include:

A. high dose aspirin therapy can lower the serum urate concentration

B. aspirin is metabolized by a combination of 1st and zero order kinetics

C. aspirin exerts its actions primarily by inhibition of cyclooxygenase

D. aspirin overdose causes significant hepatic toxicity if ingested in sufficient quantities

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6754 correct answer: 2 category: Analgesics

20. The opioid expected to have the shortest duration of action following subcutaneous administration of equianalgesic doses:

1. hydromorphone

2. meperidine

3. methadone

4. morphine

5. codeine

Item Number: 6756 correct answer: 2 category: Analgesics

21. A patient you follow in clinic has a well-known heroin abuse problem. Drugs which could potentially prevent an abstinence withdrawal syndrome during hospitalization include:

A. morphine

B. nalbuphine

C. methadone

D. butorphanol

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6760 correct answer: 1 category: Analgesics

22. TRUE statement concerning the pharmacologic effects of salicylates include:

A. salicylates are thought to exert their activity at least partially by inhibiting prostaglandin synthetase

B. high-dose salicylate therapy (> 5 grams/day) lowers the serum uric acid concentration

C. the effect of salicylates upon platelet aggregation is irreversible unlike that of other nonsteroidal anti-inflammator drugs

D. salicylate overdose is potentially fatal; however, prompt administration of acetylcysteine will avert this danger

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 6990 correct answer: 5 category: Analgesics

23. The analgesic most apt to produce dysphoria:

1. morphine

2. meperidine

3. methadone

4. codeine

5. pentazocine

Item Number: 6998 correct answer: 1 category: Analgesics

24. Morphine's affects the eye by:

1. producing miosis through an action on the oculomotor nerve

2. producing mydriasis through an action on the sympathetic system

3. decreasing pupillary responses to light

4. directly acting on the smooth muscles of the iris

5. directly acting on extrinsic muscles of the eye

Item Number: 7004 correct answer: 3 category: Analgesics

25. Aspirin is a nonopioid analgesic which is thought to work by inhibiting:

A. prostaglandin reductase

B. prostaglandin synthetase

C. thromboxane synthetase

D. cyclooxygenase

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 7006 correct answer: 3 category: Analgesics

26. Aspirin may be fatal if taken in sufficient quantity. The syndrome of acute salicylate overdose in children is characterized by:

A. marked hypothermia secondary to an antipyretic effect

B. fever

C. peripheral edema

D. disturbance in acid-base and electrolyte balance

1. A,B,C

2. A,C

3. B,D

4. D only

5. All of the above

Item Number: 11217 correct answer: 3 category: Analgesics

27. Acetaminophen has been used as a safe and effective analgesic/ antipyretic agent for over 80 years. Since it may be purchase without a prescription, it is readily available and as such the recommended dose may be exceeded. The primary toxicity leading to death from an acetaminophen overdose is:

1. papillary necrosis and chronic interstitial nephritis

2. pancytopenia

3. hepatocellular necrosis

4. myocarditis

5. hemolytic anemia

Item Number: 11645 correct answer: 4 category: Analgesics

28. The pharmacologic effects of morphine include all EXCEPT:

1. behavioral changes

2. miosis

3. respiratory depression

4. diarrhea

5. postural hypotension