NAGELHOUT PHARM 1 EXAM 3
QUESTIONS AND ANSWERS 100%
CORRECT
What is the least potent opiate? - ANSWER-Codeine.
Relative potency of 0.04 relative to morphine.
T or F. High dose opioids like sufentanil provide all of the requirement of general
anesthesia? - ANSWER-False.
Supplemental drugs may be need to achieve amnesia/unconsciousness, relaxation and
sympathetic control.
What is the most potent opioid? - ANSWER-Sufentanil
500-1000 as potent as morphine sulfate
Rank these drugs from least potent to most potent-
Meperidine, Fentanil, Codeine, Alfentanil, Sufentanil, Morphine, Remifentanil? -
ANSWER-1. Codeine 0.04
2. Meperidine 0.1
3. Morphine 1
4. Alfentanil 10
5. Fentanil 100
6. Remifentanil 100
7.Sufentanil 1,000
T or F. It's ok to give fentanyl to someone with morphine allergy. - ANSWER-True.
Fentanyl is a piperidine derivative. Morphine is phenantrene alkaloid. Cross allergy
occurs to drugs in the same classes
T or F. Morphine's metabolite has no significant analgesic activity? - ANSWER-False.
They have significant analgesic activity. Accumulation may occur with repetitive dosing
in renal patient.
Which class of opioids are best to give to asthmatics? - ANSWER-phenylpiperadines
(i.e fentanil)
(no histamine release)
Which opioid has a metabolite that is CNS toxic? - ANSWER-Meperidine.
metabolite (normeperidine) causes seizure. caution in patient with renal disease or the
elderly or when used repeatedly.
T or F. Someone allergic to morphine is also allergic to dilaudid? - ANSWER-True.
, They are both phenantrene alkaloids. cross allergy to same class.
We don't develop tolerance to which two narcotic effects? - ANSWER-Constipation and
Miosis
Cross allergy is common in opiotes in the same class, do we get cross tolerance among
all opiates? - ANSWER-Yes.
What receptors in the brain are involved in stimulating Nausea and Vomiting? -
ANSWER-Dopaminergic (D2),
Serotinergic (5-HT3),
Histamine (H1),
Muscarinic,
Opiate
What are the risk factors of PONV? - ANSWER-1. Female
2. History of PONV or motion sickness--most predictive of all.
3. Pain
4. High levels of anxiety
5. Long surgical procedure
6. Surgery (intra abdominal, major gynecologic, laparoscopic, breast, ENT, strabismus)
7. Use of volatile agent, N2O, opiates and high dose of Neostigmine.
What is the mechanism of action of Entereg or Alvimopan? - ANSWER-Works as a
narcotic antagonist. 100% water soluble.
Reverse the effect of the opioid in the GI system without crossing the gastric barrier.
Which opioid is metabolized by non esterase dependent enzymes? - ANSWER-
Remifentanil
This happens via hydrolysis of ester bonds in the blood plasma
What is the elimination half life of remifentanil? - ANSWER-5-10 minutes
T or F. Remifentanil has anti shivering property? - ANSWER-False.
Only Meperidine has anti shivering property.
Which stimuli requires the highest dose narcotics to achieve no response: skin incision,
skin closure, intubation? - ANSWER-Intubation
T or F. Opiates have anti-emetic properties. - ANSWER-True.
They inhibit vomiting center especially with repeated doses.
What receptors are responsible for the ventilatory depressing and analgesic effects of
opiods? - ANSWER-Mu
T or F. Naloxone is an antagonist at ALL opioid receptors? - ANSWER-True.
QUESTIONS AND ANSWERS 100%
CORRECT
What is the least potent opiate? - ANSWER-Codeine.
Relative potency of 0.04 relative to morphine.
T or F. High dose opioids like sufentanil provide all of the requirement of general
anesthesia? - ANSWER-False.
Supplemental drugs may be need to achieve amnesia/unconsciousness, relaxation and
sympathetic control.
What is the most potent opioid? - ANSWER-Sufentanil
500-1000 as potent as morphine sulfate
Rank these drugs from least potent to most potent-
Meperidine, Fentanil, Codeine, Alfentanil, Sufentanil, Morphine, Remifentanil? -
ANSWER-1. Codeine 0.04
2. Meperidine 0.1
3. Morphine 1
4. Alfentanil 10
5. Fentanil 100
6. Remifentanil 100
7.Sufentanil 1,000
T or F. It's ok to give fentanyl to someone with morphine allergy. - ANSWER-True.
Fentanyl is a piperidine derivative. Morphine is phenantrene alkaloid. Cross allergy
occurs to drugs in the same classes
T or F. Morphine's metabolite has no significant analgesic activity? - ANSWER-False.
They have significant analgesic activity. Accumulation may occur with repetitive dosing
in renal patient.
Which class of opioids are best to give to asthmatics? - ANSWER-phenylpiperadines
(i.e fentanil)
(no histamine release)
Which opioid has a metabolite that is CNS toxic? - ANSWER-Meperidine.
metabolite (normeperidine) causes seizure. caution in patient with renal disease or the
elderly or when used repeatedly.
T or F. Someone allergic to morphine is also allergic to dilaudid? - ANSWER-True.
, They are both phenantrene alkaloids. cross allergy to same class.
We don't develop tolerance to which two narcotic effects? - ANSWER-Constipation and
Miosis
Cross allergy is common in opiotes in the same class, do we get cross tolerance among
all opiates? - ANSWER-Yes.
What receptors in the brain are involved in stimulating Nausea and Vomiting? -
ANSWER-Dopaminergic (D2),
Serotinergic (5-HT3),
Histamine (H1),
Muscarinic,
Opiate
What are the risk factors of PONV? - ANSWER-1. Female
2. History of PONV or motion sickness--most predictive of all.
3. Pain
4. High levels of anxiety
5. Long surgical procedure
6. Surgery (intra abdominal, major gynecologic, laparoscopic, breast, ENT, strabismus)
7. Use of volatile agent, N2O, opiates and high dose of Neostigmine.
What is the mechanism of action of Entereg or Alvimopan? - ANSWER-Works as a
narcotic antagonist. 100% water soluble.
Reverse the effect of the opioid in the GI system without crossing the gastric barrier.
Which opioid is metabolized by non esterase dependent enzymes? - ANSWER-
Remifentanil
This happens via hydrolysis of ester bonds in the blood plasma
What is the elimination half life of remifentanil? - ANSWER-5-10 minutes
T or F. Remifentanil has anti shivering property? - ANSWER-False.
Only Meperidine has anti shivering property.
Which stimuli requires the highest dose narcotics to achieve no response: skin incision,
skin closure, intubation? - ANSWER-Intubation
T or F. Opiates have anti-emetic properties. - ANSWER-True.
They inhibit vomiting center especially with repeated doses.
What receptors are responsible for the ventilatory depressing and analgesic effects of
opiods? - ANSWER-Mu
T or F. Naloxone is an antagonist at ALL opioid receptors? - ANSWER-True.
