©THEBRIGHT EXAM SOLUTIONS
11/05/2024 12:06 PM
Pharm Opioids- Nagelhout Exam Questions
With Correct Answers
What are the 3 naturally occurring phenanthrenes? - answer✔1) Morphine --> HISTAMINE
2) Codeine ---> HISTAMINE
3) Thebaine
What are the 5 semisynthetic phenanthrenes? - answer✔1) heroin
2) vicodin (Hydrocodone)
3) dialudid (hydromorphone)
4) oxycodone (oxycontin)
5) oxymorphone
What are the 7 synthetic phenanthrenes? - answer✔1) levorphanol
2) butorphanol
3) nalbuphine
4) pentazocine
5) naloxone
6) naltrexone
7) nalmefene
What are the two mixed opioids? (synthetic phenanthrenes) - answer✔1) nalbuphine - can
antagonize respiratory depression and pruritus, but maintain analgesia
2) butorphanol
MU antagonists, Kappa partial agonists, and Delta agonists
, ©THEBRIGHT EXAM SOLUTIONS
11/05/2024 12:06 PM
What are the 6 piperidines? (all are referred to as phenylpiperidines even though this isn't
technically correct) - answer✔1) meperidine --> HISTAMINE
2) loperamide
3) Fentanyl
4) Sufentanil
5) Alfentanil
6) Remifentanil
What is the only diphenylheptane? - answer✔methadone
Which are the 3 specific drugs that are MOST likely to stimulate histamine release? - answer✔1)
codeine
2) morphine
3) meperidine
-general rule = phenanthrines and demerol
Are there cross allergies between classes? - answer✔NO
-just AMONG classes
1) If someone is allergic to Vicodin can they have oxycodone?
2) If someone is allergic to morphine can they have dilaudid?
3) If someone is allergic to codeine can they have demerol?
4) If someone is allergic to fentanyl can they have morphine? - answer✔1) NO
2) NO
3) YES
4) YES
Why do opioids cause analgesia? - answer✔-suppress release of pain chemicals
-PRESYNAPTIC AGONISTS THAT CAUSE INHIBITION OF RELEASE OF SUBSTANCE P and other
neurotransmitters
, ©THEBRIGHT EXAM SOLUTIONS
11/05/2024 12:06 PM
What class includes the drugs of choice for asthmatics? - answer✔-phenylpiperidines EXCEPT
demerol
-ex: FENTANYL is safe
Opioid with equal potency to fentanyl - answer✔remifentanil
Opioid with weakest potency - answer✔codeine
Opioid with strongest potency - answer✔Sufentanil (MU agonist)
What are the 4 endogenous opioid peptides? - answer✔1) enkephalins
2) B-endorphins
3) Dynorphins
4) Endomorphins
What is the MAIN receptor that causes analgesia? - answer✔-MU
-if all do the action write MU because it is the MAIN one
What endogenous receptor causes dysphoria AND sedation? - answer✔-Kappa
-also think SHIVERING for kappa
What 4 factors put pts more at risk for effects of demerol toxic metabolite? - answer✔1) elderly
2) renal disease 3) liver disease 4) chronic use
Where is remifentanil metabolized? - answer✔-hydrolyzed in the plasma by non-specific
esterases (rapid metabolism due to addition of ester group)
Which opioid has a toxic metabolite? - answer✔-demerol --> metabolized to normeperidine
-can be CNS toxic
-seizures with high levels
How is morphine metabolized? - answer✔-demethylation = minor pathway
-conjugation/phase II to nontoxic metabolites morphine 3 & 6 glucoronide ***M6G is ACTIVE
metabolite*** --> no toxic levels in body unless too much accumulated such as with renal
failure = prolonged action/entry into CNS
Which opioid should not be given to children after T&A surgery? - answer✔-codeine
11/05/2024 12:06 PM
Pharm Opioids- Nagelhout Exam Questions
With Correct Answers
What are the 3 naturally occurring phenanthrenes? - answer✔1) Morphine --> HISTAMINE
2) Codeine ---> HISTAMINE
3) Thebaine
What are the 5 semisynthetic phenanthrenes? - answer✔1) heroin
2) vicodin (Hydrocodone)
3) dialudid (hydromorphone)
4) oxycodone (oxycontin)
5) oxymorphone
What are the 7 synthetic phenanthrenes? - answer✔1) levorphanol
2) butorphanol
3) nalbuphine
4) pentazocine
5) naloxone
6) naltrexone
7) nalmefene
What are the two mixed opioids? (synthetic phenanthrenes) - answer✔1) nalbuphine - can
antagonize respiratory depression and pruritus, but maintain analgesia
2) butorphanol
MU antagonists, Kappa partial agonists, and Delta agonists
, ©THEBRIGHT EXAM SOLUTIONS
11/05/2024 12:06 PM
What are the 6 piperidines? (all are referred to as phenylpiperidines even though this isn't
technically correct) - answer✔1) meperidine --> HISTAMINE
2) loperamide
3) Fentanyl
4) Sufentanil
5) Alfentanil
6) Remifentanil
What is the only diphenylheptane? - answer✔methadone
Which are the 3 specific drugs that are MOST likely to stimulate histamine release? - answer✔1)
codeine
2) morphine
3) meperidine
-general rule = phenanthrines and demerol
Are there cross allergies between classes? - answer✔NO
-just AMONG classes
1) If someone is allergic to Vicodin can they have oxycodone?
2) If someone is allergic to morphine can they have dilaudid?
3) If someone is allergic to codeine can they have demerol?
4) If someone is allergic to fentanyl can they have morphine? - answer✔1) NO
2) NO
3) YES
4) YES
Why do opioids cause analgesia? - answer✔-suppress release of pain chemicals
-PRESYNAPTIC AGONISTS THAT CAUSE INHIBITION OF RELEASE OF SUBSTANCE P and other
neurotransmitters
, ©THEBRIGHT EXAM SOLUTIONS
11/05/2024 12:06 PM
What class includes the drugs of choice for asthmatics? - answer✔-phenylpiperidines EXCEPT
demerol
-ex: FENTANYL is safe
Opioid with equal potency to fentanyl - answer✔remifentanil
Opioid with weakest potency - answer✔codeine
Opioid with strongest potency - answer✔Sufentanil (MU agonist)
What are the 4 endogenous opioid peptides? - answer✔1) enkephalins
2) B-endorphins
3) Dynorphins
4) Endomorphins
What is the MAIN receptor that causes analgesia? - answer✔-MU
-if all do the action write MU because it is the MAIN one
What endogenous receptor causes dysphoria AND sedation? - answer✔-Kappa
-also think SHIVERING for kappa
What 4 factors put pts more at risk for effects of demerol toxic metabolite? - answer✔1) elderly
2) renal disease 3) liver disease 4) chronic use
Where is remifentanil metabolized? - answer✔-hydrolyzed in the plasma by non-specific
esterases (rapid metabolism due to addition of ester group)
Which opioid has a toxic metabolite? - answer✔-demerol --> metabolized to normeperidine
-can be CNS toxic
-seizures with high levels
How is morphine metabolized? - answer✔-demethylation = minor pathway
-conjugation/phase II to nontoxic metabolites morphine 3 & 6 glucoronide ***M6G is ACTIVE
metabolite*** --> no toxic levels in body unless too much accumulated such as with renal
failure = prolonged action/entry into CNS
Which opioid should not be given to children after T&A surgery? - answer✔-codeine
