NAGELHOUT - OPIOIDS AND NON-
NARCOTICS EXAM QUESTIONS
(GRADED A)
Name the 4 endogenous opioid groups - ANSWER-1. Enkephlans
2. B-Endorphins
3. Dynorphins
4. Endomorphins
Name two types of Enkephalins - ANSWER-Leu-enkephalin
Met-enkephalin
Name two types of Dynorphins - ANSWER-Dynorphin
a - Neoendorphin
Name two types of endomorphin - ANSWER-endomorphin 1
endomorphin 2
What is the precursor molecule to enkephalins - ANSWER-Proenkephalin A
What is the precursor molecule to B-Endorphin - ANSWER-Pro-opiomelanocortin
What is the precursor molecule to Dynorphins - ANSWER-Prodynorphin
What is the precursor to Endomporhin - ANSWER-UNKNOWN
Where are the majority of endogenous opioids found - ANSWER-Majority found in the
nervous system (brain and spinal cord) with 2nd highest concentration in GI tract (GUT)
What is the analgesic action of opioid drugs - ANSWER-inhibition of pain releasing
chemicals in the pain pathway (PRESYNAPTIC INHIBITION)
when you give morphine.....How are opioid receptors stimulated? - ANSWER-
endorphins are released and attach to opioid receptor and stimulate opioid receptor
What happens when opioid receptors are stimulated - ANSWER-presynaptic receptors
that sit on pain nerves and help control or diminish release of pain producing chemicals
What side effects are reduced when using a multi modal therapy for pain relief -
ANSWER-Constipation, pruritis, & PONV (avoids sedation and resp depression from
excessive dosing)
, What is the multi modal therapy for pain relief - ANSWER-decrease the dose of any
single agent, thus improving antinociception (anti-pain drugs) and reducing side effects.
KEY: OPIOID SPARING
what is included in multi-modal therapy for pain relief - ANSWER-COMBO OF:
COX 2 specific inhibitors
local anesthetics (beads at incision area)
opioids
nSAIDS,
a2 agonists (Precedex)
What are the classifications of opioid receptors - ANSWER-MOP Mu opioid receptor
DOP Delta opioid receptor
KOP Kappa opioid receptor
What receptor does vast majority of the work - ANSWER-MU receptor
What receptor causes dysphoria, restlessness - ANSWER-Kappa
What receptor has an anti-shivering affect - ANSWER-Kappa (Demerol)
What do Kappa and Delta receptors do - ANSWER-usually augment / just give greater
intensity of something
What is the drug classified as Diphenylheptanes - ANSWER-methadone (prototype)
What are the 3 agents most likely to stimulate release of histamine - ANSWER-
Morphine , Codeine, & Demerol
If allergic to one drug in classification can you take another drug in different
classification - ANSWER-The three major chemicals classes are structurally different.
Therefore cross allergic reactions are less likely to occur between the major chemical
classes. If a true allergic reaction occurs with a drug from one chemical class, select
from a different chemical class
What are the major metabolites of Morphine - ANSWER-3 glucocoronide & morphine 6
glucoronide
How is morphine metabolized - ANSWER-In the liver , has active metabolites that are
eliminated (peed out) in the kidneys... HOWEVER, if someone with renal failure - these
metabolites can last in body longer and get an exaggerated effect (build up and
metabolites are still active)
NARCOTICS EXAM QUESTIONS
(GRADED A)
Name the 4 endogenous opioid groups - ANSWER-1. Enkephlans
2. B-Endorphins
3. Dynorphins
4. Endomorphins
Name two types of Enkephalins - ANSWER-Leu-enkephalin
Met-enkephalin
Name two types of Dynorphins - ANSWER-Dynorphin
a - Neoendorphin
Name two types of endomorphin - ANSWER-endomorphin 1
endomorphin 2
What is the precursor molecule to enkephalins - ANSWER-Proenkephalin A
What is the precursor molecule to B-Endorphin - ANSWER-Pro-opiomelanocortin
What is the precursor molecule to Dynorphins - ANSWER-Prodynorphin
What is the precursor to Endomporhin - ANSWER-UNKNOWN
Where are the majority of endogenous opioids found - ANSWER-Majority found in the
nervous system (brain and spinal cord) with 2nd highest concentration in GI tract (GUT)
What is the analgesic action of opioid drugs - ANSWER-inhibition of pain releasing
chemicals in the pain pathway (PRESYNAPTIC INHIBITION)
when you give morphine.....How are opioid receptors stimulated? - ANSWER-
endorphins are released and attach to opioid receptor and stimulate opioid receptor
What happens when opioid receptors are stimulated - ANSWER-presynaptic receptors
that sit on pain nerves and help control or diminish release of pain producing chemicals
What side effects are reduced when using a multi modal therapy for pain relief -
ANSWER-Constipation, pruritis, & PONV (avoids sedation and resp depression from
excessive dosing)
, What is the multi modal therapy for pain relief - ANSWER-decrease the dose of any
single agent, thus improving antinociception (anti-pain drugs) and reducing side effects.
KEY: OPIOID SPARING
what is included in multi-modal therapy for pain relief - ANSWER-COMBO OF:
COX 2 specific inhibitors
local anesthetics (beads at incision area)
opioids
nSAIDS,
a2 agonists (Precedex)
What are the classifications of opioid receptors - ANSWER-MOP Mu opioid receptor
DOP Delta opioid receptor
KOP Kappa opioid receptor
What receptor does vast majority of the work - ANSWER-MU receptor
What receptor causes dysphoria, restlessness - ANSWER-Kappa
What receptor has an anti-shivering affect - ANSWER-Kappa (Demerol)
What do Kappa and Delta receptors do - ANSWER-usually augment / just give greater
intensity of something
What is the drug classified as Diphenylheptanes - ANSWER-methadone (prototype)
What are the 3 agents most likely to stimulate release of histamine - ANSWER-
Morphine , Codeine, & Demerol
If allergic to one drug in classification can you take another drug in different
classification - ANSWER-The three major chemicals classes are structurally different.
Therefore cross allergic reactions are less likely to occur between the major chemical
classes. If a true allergic reaction occurs with a drug from one chemical class, select
from a different chemical class
What are the major metabolites of Morphine - ANSWER-3 glucocoronide & morphine 6
glucoronide
How is morphine metabolized - ANSWER-In the liver , has active metabolites that are
eliminated (peed out) in the kidneys... HOWEVER, if someone with renal failure - these
metabolites can last in body longer and get an exaggerated effect (build up and
metabolites are still active)
