Chapter 30 - Drug Abuse Toxicology Flashcards Preview

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Flashcards in Chapter 30 - Drug Abuse Toxicology Deck (100):
0

An estimation of the amount of cocaine use in a community could best come from...

A. Hospital admissions

B. Police arrests

C. Concentration of metabolites in water supply

D. Interviews

C. Concentration of metabolites in water supply

1

In 2003, the leading 2 illicit drugs causing death reported to the Drug Abuse Warning Network (DAWN) were...

A. Heroin and cocaine

B. Methadone and fentanyl

C. Methamphetamine and hydrocodone

D. Cocaine and oxycodone

A. Heroin and cocaine

2

The ratio of cocaine to benzoylecgoninc in a postmortem brain specimen can best be an indicator of...

A. Rate of hepatic drug metabolism

B. Time of ingestion

C. Cause of death

D. Source of drug

B. Time of ingestion

3

The predominant cocaine analyte measured in human hair is...

A. Cocaine

B. Coacaethylene

C. Norcaine

D. Benzoylecgonine

A. Cocaine

4

All of the following are true regarding cocaine except...

A. Tolerance to its effects can develop

B. Myocardial fibrosis can occur in chronic users

C. There can be postmortem redistribution

D. There is a good correlation between postmortem levels and cause of death

D. There is a good correlation between postmortem levels and cause of death

5

All of the following plants produce chemicals that have a stimulant effect except...

A. Oleander

B. Khat

C. Ephedra

D. Absinthe

A. Oleander

6

All of the following are true regarding methamphetamine except...

A. It is N-demethylated to amphetamine

B. At low doses, it impairs psychomotor performance

C. The urine immunologic screening test is considered positive at 1,000 mg / L or greater

D. Selegiline can be converted in vivo to methamphetamine

B. At low doses, it impairs psychomotor performance

7

In the presence of ethanol, cocaine will be metabolized to...

A. Norcocaine

B. Methylecgonine

C. Benzoylecgonine

D. Cocaethylene

D. Cocaethylene

8

The major pyrolysis product of cocaine is...

A. Norcocaine

B. Methylecgonine

C. Anhydroecgonine methyl ester

D. Cocaethylene

C. Anhydroecgonine methyl ester

9

Cocaine is primarily metabolized by...

A. CYP450 2B6

B. Glucuronidation

C. Esterases

D. Acetylation

C. Esterases

10

The L isomer of methamphetamine is commercially available as...

A. Pseudoephedrine

B. Phenylephdrine

C. Vicks decongestant

D. Phenylpropanolamine

C. Vicks decongestant

11

A marker for smoked methamphetamine is...

A. Norephedrine

B. trans-phenylpropene

C. O-hydroxynorphedrine

D. P-hydroxymethamphetamine

B. trans-phenylpropene

12

The urinary excretion of methamphetamine can be decreased by...

A. Phenobarbital

B. Basic urine

C. Acidic urine

D. Ammonium chloride

B. Basic urine

13

Eighty percent of methylphenidate is excreted in the urine as...

A. Unchanged drug

B. Ethylphenidate

C. Ritalinic acid

D. Amphetamine

C. Ritalinic acid

14

Methylphenidate differs from cocaine and amphetamine in that...

A. It blocks the dopamine transporter

B. It blocks the norepinephrine

C. It has a low affinity for the 5HT transporter

D. It has a higher potential for abuse

C. It has a low affinity for the 5HT transporter

15

GHB has increasingly been used as an agent to...

A. Induce anesthesia

B. Treat status epilepticus

C. Facilitate sexual assault

D. Counteract cocaine-induced delirium

C. Facilitate sexual assault

16

All of the following are true regarding dextromethorphan except...

A. It has been associated with the serotonin syndrome

B. it is highly first passed

C. It is metabolized by CYP2D6

D. It is a racemic mixture

D. It is a racemic mixture

17

All of the following are considered benzodiazepines except...

A. Oxazepam

B. Eszopiclone

C. Chlordiazepoxide

D. Clorazepate

B. Eszopiclone

18

All of the following could be metabolized to oxazepam except..

A. Lorazepam

B. Temazepam

C. Diazepam

D. Prazepam

A. Lorazepam

19

All of the following are true regarding benzodiazepines except...

A. Withdrawal convulsions can occur

B. Overdose of benzodiazepines alone rarely cause death

C. Lorazepam and oxazepam do not undergo CYP450-mediated biotransformation

D. Ibuprofen can cause a false positive result on urine screen tests

D. Ibuprofen can cause a false positive result on urine screen tests

20

All of the following are true of normeperidine except...

A. It strongly binds to mu opioid receptors

B. More is formed after oral meperidine administration than through intravenous administration

C. It causes serotonin excess in the CNS

D. It is responsible for possible precipitation of the serotonin syndrome when merperidine is given concurrently with a MAO inhibitor

A. It strongly binds to mu opioid receptors

21

All of the following are metabolites of oxycodone except...

A. Codine

B. Oxymorphone

C. Noroxycodone

D. Oxycodone glucuronide

A. Codine

22

An opiate not metabolized by the P450 system is...

A. Buprenorphine

B. Fentanyl

C. Oxymorphone

D. Propoxyphene

C. Oxymorphone

23

Propoxyphene is a derivative of...

A. Meperidine

B. Methadone

C. Fentanyl

D. Morphine

B. Methadone

24

The cardiac toxicity of propoxyphene results from..

A. Dextropropoxyphene

B. Levopropoxyphene

C. EDDP

D. Norpropoxyphene

D. Norpropoxyphene

25

The mechanism of action of phencyclidine is...

A. Agonist at the glycine receptor

B. Noncompetitive antagonist at glutamate-NMDA receptor

C. Blockade of dopamine release

D. Stimulation of central acetylcholine release

B. Noncompetitive antagonist at glutamate-NMDA receptor

26

Blood levels of phencyclidine...

A. Strongly correlate with psychedelic effects

B. Are present only for minutes before being converted to an active metabolite

C. Could be present from phencyclidine use weeks before the level was drawn

D. Are approximately 10x higher than brain levels

C. Could be present from phencyclidine use weeks before the level was drawn

27

All of the following are true of phencyclidine except...

A. It is classified as a dissociative anesthetic

B. It can be snorted, smoked, injected or swallowed

C. Glucuronide metabolites are excreted in the urine

D. Alkalinization of the urine enhances its elimi ation

D. Alkalinization of the urine enhances its elimi ation

28

The reason that ketamine is used for induction of anesthesia in trauma victims is that ketamine causes...

A. Increased blood pressure

B. A blockade of the vomiting center

C. A shortening of the QT interval

D. A stimulation of respiration

A. Increased blood pressure

29

Postmortem tissue concentrates of GBH have little scientific meaning because...

A. They could be present from months before

B. There is a 10 - 100x postmortem redistribution

C. The conjugated metabolites are rapidly converted back to the parent

D. It forms in the blood as a postmortem artifact

D. It forms in the blood as a postmortem artifact

30

All of the following are true of fentanyl except...

A. Sufentanil is the principal metabolite

B. Routine urine drug screening for drugs with an opiate nucleus will not detect it

C. When fentanyl patches are used to relieve chronic pain, little drug appears in the systemic circulation for the first 2 hrs

D. Norfentanyl may appear in the urine of surgical patients for greater than 48 hrs

A. Sufentanil is the principal metabolite

31

All of the following are true of hydrocodone except...

A. An intravenous form is not commercially available

B. It is a metabolite of codine

C. It has a terminal half-life of around 4 hrs

D. It is a mu receptor partial agonist/antagonist

D. It is a mu receptor partial agonist/antagonist

32

All of the following are true of hydromorphone except...

A. It is more potent than morphine

B. It is a metabolite of morphine

C. It has a terminal half-life of 8 hrs

D. Hydromorhone-3-glucuronide is a metabolite

C. It has a terminal half-life of 8 hrs

33

All of the following statements are true except...

A. Bupreborphine is more expensive than methadone

B. L-LAAM was taken off the market because of QT prolongation

C. Heroin patients receiving methadone maintenance may have improved immune function

D. Both d and l isomers of methadone have equal potency at the mu receptor

D. Both d and l isomers of methadone have equal potency at the mu receptor

34

The main metabolite of methadone is...

A. L-LAAM

B. EDDP

C. N-desethyl methadone

D. O-desmethyl methadone

B. EDDP

35

All of the following are true regarding buprenorphine except...

A. It can interact with HIV medication

B. Death rates with buprenorphine maintenance are higher than with methadone

C. It is more potent than morphine

D. It is classified as a partial opioid agonist

B. Death rates with buprenorphine maintenance are higher than with methadone

36

The conversion of codine to morphine is mediated by...

A. CYP2A3

B. CYP3A6

C. CYP2D6

D. CYP1A2

C. CYP2D6

37

All of the following are possible metabolites of codine except...

A. Codine-6-glucutonide

B. Norcodone

C. Hydrocodone

D. 6-acetylmorphine

D. 6-acetylmorphine

38

The least common route of fentanyl administration is...

A. Intramuscular

B. Transdermal

C. Intravenous

D. Transmucosal

A. Intramuscular

39

For approximately how many hours following removal of a fentanyl patch is drug still released into the systemic circulation?

A. 1

B. 4

C. 12

D. 24

C. 12

40

A level of 6-acetylmorphine in urine above the cutoff means...

A. Heroin was definitely ingested

B. Heroin or morphine could have been ingested

C. Heroin or codine could have been ingested

D. Heroin or oxymorphone could have been ingested

A. Heroin was definitely ingested

41

The presence of codine in the urine of a heroin user most likely means...

A. It was metabolized from morphine

B. It was a contaminant of the heroin

C. It was deliberately co-injected with heroin

D. It results from morphine causing a false positive result on a codine assay

B. It was a contaminant of the heroin

42

Which of the following drugs when ingested would produce a positive morphine test result on a urine drug screen?

A. Codine

B. Fentanyl

C. Methadone

D. Meperidine

A. Codine

43

All of the following could be metabolized eventually to hydromorphone except...

A. Codine

B. Heroin

C. Morphine

D. Oxycodone

D. Oxycodone

44

Morphine glucuronides are eventual metabolites of all of the following except...

A. Morphine

B. Heroin

C. Hydrocodone

D. Codine

C. Hydrocodone

45

Codine can be metabolized to all of the following except...

A. Oxycodone

B. hydrocodone

C. Norcodone

D. Morphine

A. Oxycodone

46

Morphine can only be metabolized to which of the following...

A. Heroin

B. hydrocodone

C. Normorphine

D. Oxymorphine

C. Normorphine

47

Which of the following could be metabolized to morphine?

A. Buprenorphine

B. oxymorphone

C. Propoxyphene

D. None of the above

D. None of the above

48

The drug with the shortest half-life is...

A. Buprenorphine

B. Heroin

C. Propoxyphene

D. Methadone

B. Heroin

49

The opioid with the highest retail sales in 2006 was...

A. Codine

B. Fentanyl

C. Oxycodone

D. Hydrocodone

C. Oxycodone

50

A spice that can act as an hallucinogen is...

A. Paprika

B. Cumin

C. Coriander

D. Nutmeg

D. Nutmeg

51

All of the following are true of psilocybin except...

A. It is a derivative of tryptamine

B. Increases in pulse blood pressure occur before psychological effects

C. The symptoms produced resemble schizophrenia

D. Effects mediated through the 2AR-mGIuR2 receptor

B. Increases in pulse blood pressure occur before psychological effects

52

The mechanism of psychosis in LSD is related to its binding to which receptor...

A. D2

B. 5-HT3

C. 5-HT2

D. 5-HT5

C. 5-HT2

53

The mechanism of LSD is most closely related to...

A. PCP

B. ketamine

C. Mescaline

D. Methylphenidate

C. Mescaline

54

The purported fourth opiate receptor that is no longer recognized as such is...

A. Mu

B. Kappa

C. Sigma

D. Delta

C. Sigma

55

Mescaline is derived from a...

A. Lichen

B. Mushroom

C. Cactus

D. Moss

C. Cactus

56

MDMA is classified as a/an...

A. Dissociative anesthetic

B. Drug for ADHD

C. Hallucinogenic amphetamine

D. Anti-Parkinson drug

C. Hallucinogenic amphetamine

57

MDMA is an inhibitor of...

A. CYP2E1

B. CYP2D6

C. CYP1A2

D. Glucuronyl transferase

C. CYP1A2

58

The activity of MDMA is due to the CNS release of...

A. Dopamine

B. 5-HT

C. Norepinephrine

D. All of the above

B. 5-HT

59

Drugs that can increase the risk of serotonin syndrome in MDMA users include all of the following except...

A. Merperidine

B. Nadolol

C. Tramadol

D. Dextromethorphan

D. Dextromethorphan

60

A finding that could support tolerance in a deceased heroin user is...

A. Presence of morphine throughout the hair

B. Presence of morphine in liver

C. Presence of morphine in skeletal muscle

D. A morphine to morphine-3-glucuronide ratio of 6:1

B. Presence of morphine in liver

61

Which of the following drugs is least likely to be part of the toxicology results in a heroin-related death?

A. Fentanyl

B. Alcohol

C. Phencyclidine

D. Benzodiazepine

A. Fentanyl

62

A recently discovered mechanism for sudden death in methadone users is...

A. Cytokine storm

B. Inhibition of the hERG potassium channel

C. Pulmonary embolism

D. Lowering the seizure threshold

C. Pulmonary embolism

63

Levels of nonprotein-bound methadone would decrease in...

A. Liver disease

B. Presence of other drugs that strongly bind to alpha-1-acid glycoprotein

C. Presence of other drugs that bind strongly to albumin

D. Inflammatory disorders

B. Presence of other drugs that strongly bind to alpha-1-acid glycoprotein

64

All of the following are true of methadone except...

A. It is metabolized by CYP3A4 and CYP2B6

B. Its terminal half-life is very variable

C. The d isomer strongly binds to the opiate receptor

D. The d isomer can cause QT prolongation

D. The d isomer can cause QT prolongation

65

A postmortem free morphine concentration value refers to...

A. Morphine without its conjugation metabolites

B. Non-protein bound morphine and its metabolites

C. Morphine, morphine glucuronides and normorphine

D. Combined level of morphine, codine and 6-acetylmorphine

C. Morphine, morphine glucuronides and normorphine

66

All of the following are true regarding postmortem liver opiate levels except...

A. Formalin embalming does not interfere with extraction and measurement of free morphine

B. In a non-refrigerated cadaver, morphine glucuronides can be converted back to morphine

C. They can be useful in some exhumations

D. Liver 6-acetylmorphine levels are usually higher than brain levels

A. Formalin embalming does not interfere with extraction and measurement of free morphine

67

Poppy seed ingestion could cause a false positive urine test for all of the following except...

A. Morphine

B. 6-acetylmorphine

C. Codine

D. Morphine-6-glucuronide

D. Morphine-6-glucuronide

68

A substance found in poppy seeds but not in refined heroin is...

A. Papaverine

B. Noscapine

C. Thebaine

D. Lidocane

B. Noscapine

69

In order to prove heroin ingestion, 6-acetylmorphine must be present in the urine at a concentration of at least...

A. 10 ng/ml

B. 100 ng/ml

C. 500 ng/ml

D. 1000 ng/ml

A. 10 ng/ml

70

Endogenous opiate peptides include all of the following except...

A. Alfentanil

B. Dynorphin

C. Beta-endorphin

D. Endomorphin

A. Alfentanil

71

Opiate receptors are described as having...

A. 3 transmembrane domains

B. 5 transmembrane domains

C. 7 transmembrane domains

D. 10 transmembrane domains

C. 7 transmembrane domains

72

All of the following are common adulterants of heroin except...

A. Spironolactone

B. Quinine

C. Caffeine

D. Diphenylhydramine

A. Spironolactone

73

Common diluents of heroin include all of the following except...

A. Lactose

B. methamphetamine

C. Starch

D. Mannitol

B. methamphetamine

74

The morphine metabolite that is least pharmacologically active is...

A. Normorphine

B. hydromorphine

C. Morphine-6-glucuronide

D. Morphine-3-glucuronide

D. Morphine-3-glucuronide

75

A test used to detect abuse of anabolic steroids is...

A. Serum testosterone

B. Serum-free androgens

C. Urine T/E ratio

D. Urine for total steroids

C. Urine T/E ratio

76

All of the following are true regarding THC except...

A. It binds to two known cannaboid receptors in humans

B. Blood levels of the carboxylic acid metabolite in the living can reliably predict time of ingestion

C. Blood levels can peak very quickly

D. It has a high volume of distribution

B. Blood levels of the carboxylic acid metabolite in the living can reliably predict time of ingestion

77

Which of the following statements is most accurate regarding postmortem measurements of THC levels in blood?

A. They are extremely difficult to interpret with respect to time of use

B. THC levels are more accurate than 11-OH-THC

C. THC levels are more accurate than THC carboxylic acid lefels

D. Postmortem plasma levels are more accurate than whole blood

A. They are extremely difficult to interpret with respect to time of use

78

All of the following are true of dronabinol except...

A. It is a beta-blocker that binds to the CB1 receptor

B. It approved for chemotherapy-induced nausea

C. It is approved for appetite stimulation in AIDS

D. It causes a positive result in the urine screening test for marajuana

A. It is a beta-blocker that binds to the CB1 receptor

79

The urine metabolite of THC that is usually targeted for screening is...

A. 11-hydroxy-THC

B. 8-beta-hydroxy-THC

C. 8,11-dehydroxy-THC

D. 11-nor-9-carboxy-THC

D. 11-nor-9-carboxy-THC

80

All of the following are associated with chronic amphetamine use except...

A. Permanent neuronal damage

B. Glioblastoma

C. Vasculitis

D. Pulmonary hypertension

B. Glioblastoma

81

The most common illicit drug produced by clandestine labs in the US is...

A. Cocaine

B. Oxycodone

C. Methamphetamine

D. Fentanyl

C. Methamphetamine

82

All of the following are indicated in the setting of cocaine-induced acute coronary syndrome except...

A. Benzodiazepines

B. Nitroglycerin

C. Beta-adrenergic blockers

D. Asprin

C. Beta-adrenergic blockers

83

The preferred drug class for the treatment of cocaine-induced narrow complex reentrant supraventricular arrhythmias is...

A. Calcium channel blockers

B. Type 1A antiarrhythmics

C. Beta-adrenergic blocker

D. Type 1C antiarrhythmics

A. Calcium channel blockers

84

If a benzodiazepine fails to sedate an agitated patient using cocaine, the next drug of choice would be...

A. Haloperidol

B. Promazine

C. Methaqualone

D. Propofol

D. Propofol

85

Ethanol metabolites that are being evaluated as possible markers of previous ethanol use include all of the following except...

A. Fatty acid ethyl esters

B. pyruvate

C. Ethyl sulfate

D. Ethyl glucuronide

B. pyruvate

86

All of the following are true regarding the pharmacology of ethanol except...

A. A specific ethanol receptor has been recently identified

B. It enhances the inhibitory effects of GABA

C. It blocks the NMDA receptor

D. Withdrawal is related to NMDA receptor upregulation

A. A specific ethanol receptor has been recently identified

87

All of the following are true of the ethanol withdrawal syndrome except...

A. Delirium tremors are the most serious development

B. Seizures should be treated with benzodiazepines

C. Seizures can be prevented with phenytoin

D. Auditory hallucinations can occur

C. Seizures can be prevented with phenytoin

88

Disulfiram-type reactions have been reported with all of the following except...

A. Cefoperazone

B. Metronidazole

C. Chlorpropramide

D. Zaleplon

D. Zaleplon

89

Thiamine deficiency can cause all of the following except...

A. High-output congestive heart failure

B. Wernicke's encephalopathy

C. Pulmonary fibrosis

D. Korsakoff's psychosis

C. Pulmonary fibrosis

90

In 2007, the adhesive on toy beads that caused an epidemic of toxicity was chemically related to...

A. PCP

B. methamphetamine

C. GHB

D. Dextromethorphan

C. GHB

91

Recreational amyl nitrite inhalant is associated with...

A. Methemoglobinemia

B. Peripheral neuropathy

C. Hepatotoxicity

D. Renal toxicity

A. Methemoglobinemia

92

Salvia divinorum is classified as a...

A. Anticholinergic

B. Hallucinogen

C. Sympathomimetic

D. THC agonist

C. Sympathomimetic

93

GBH is a/an...

A. Endogenous neurotransmitter

B. Releaser of growth hormone

C. A drug of abuse

D. All of the above

D. All of the above

94

The pharmacologic effect of Kratom has been related to the presence of...

A. Safrole

B. Atropine

C. Salvinorin A

D. Mitragynine

D. Mitragynine

95

The neurobehavoral effects of PCP are most similar to the disease process of...

A. Mania

B. depression

C. Schizophrenia

D. OC disorder

C. Schizophrenia

96

The mechanism of action of ketamine at clinical concentrations involves...

A. Binding to the 5HT-2 receptor

B. Binding to the 5HT-3 receptor

C. Binding to the CB-1 receptor

D. Binding to the NMDA receptor

D. Binding to the NMDA receptor

97

The use of diazepam in the management of chloroquine and cocaine toxicity may involve competitive antagonisms at...

A. Peripheral benzodiazepine receptors

B. Central GABA A receptors

C. Central GABA B receptors

D. Central NMDA receptors

A. Peripheral benzodiazepine receptors

98

All of the following are true of the opiate receptor ORL 1 except...

A. Nociceptin is an endogenous ligand

B. It can bind opioid agonists and antagonists

C. It can be antagonized by naloxone

D. It has a brain distribution that is similar to other opioid receptor subtypes

C. It can be antagonized by naloxone

99

Methylnaltrexone is used to treat opioid-induced...

A. Respiratory depression

B. Nausea

C. Sedation

D. Constipation

D. Constipation