1. The answer is C. Opioid receptors are glycoproteins. |1 and receptor activation produces analgesia, while that of | 2 leads to the observed side effects such as respiratory depression, nausea, vomiting, euphoria, decreased gastrointestinal motility, urinary retention, tolerance, dependence, histamine release, miosis, and/or anorexia.

2. The answer is D. Phase I reaction produces more water-soluble and less active metabolite. Phase II reaction yields a large molecular weight compound which is usually inactive and is more easily excreted.

3. The answer is B. Despite significant first-pass metabolism, oral administration is made effective by proper scheduling and dosing adjustments.

4. The answer is C. The medication is delivered through passive diffusion. Iontophoresis uses electric charge for drug delivery.

5. The answer is B. Intrathecal opioids can spread rostrally producing delayed respiratory depression at a time when patient is least monitored. This is a real concern in the case of hydrophilic opioid like morphine.

Chapter 8: Opioids: Basic Concepts in Clinical Practice

1. The following is NOT a therapeutic indication for opioids:

A. Constipation

B. Diarrhea

C. Pain

D. Cough

2. Patients on long-term therapy with opioids do NOT develop tolerance to

A. Pain

B. Nausea and vomiting

C. Constipation

D. Respiratory depression

3. A 65-year-old woman undergoes knee arthroscopy, and in recovery she complaints of severe postoperative pain despite have been given substantial dose of intravenous morphine. Review of her past medical records reveals that she has been taking dihydrocodeine for the past year for arthritis. She is likely suffering from

A. Addiction

B. Pseudo addiction

C. Cross-tolerance

D. Physical dependence

4. Opioid rotation is indicated when

A. There is decreasing analgesic efficiency

B. There are persistent side effects

C. Patient requests it

D. All of the above

5. Which of the following opioids can potentially cause convulsions secondary to a metabolite?

A. Fentanyl

B. Diacetylmorphine

C. Meperidine

D. Sufentanil


1. The answer is A. Opioids can be used for symptomatic relief of diarrhea. Opioids also have antitussive properties.

3. The answer is C. She has developed tolerance to morphine secondary to the long-term use of dihydrocodeine.

4. The answer is D. It also may be indicated when the patient cannot take oral medication.

5. The answer is C. Normeperidine is a metabolic byproduct of meperidine. Normeperidine has less analgesic potency than meperidine, but has the pharmacological property of decreasing seizure threshold and inducing central nervous system hyperexcitability and seizures.

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