Opioid analgesics

Question 1

All the following is true about endogenous opioid peptides EXCEPT:

A. Very potent analgesic
B. Widely distributed in CNS
C. They can’t cross BBB
D. Effective if given IV

Answer 1

D. Effective if given IV

not effective if given IV

endogenous opioid peptides (endorphin, dynorphin, enkephalins, orphanin “nociception”).

Question 2

Mention the opioid receptors and function of each one?

Answer 2

1. M (mu):
   -M1: supra-spinal analgesia.
   -M2:
   (a) spinal analgesia. (b) Euphoria. (C) Sedation.
   (D) Miosis. (E) Constipation (F) Respiratory depression.
2. K (Kappa):
   (a) Spinal analgesia. (b) Dysphoria.
   (C) Hallucination. D) sedation
3. δ (delta): Spinal, supra spinal analgesia.

Question 3

Mention the semi-synthetic opioid analgesics?

Answer 3

Heroin

Question 4

Mention the Natural opioid analgesics?

Answer 4

morphine, codeine

Question 5

All the following are partial agonists opioid analgesics EXCEPT?

A. Buprenorphine
B. Nalbuphine
C. Levorphanol
D. Butorphanol

Answer 5

C. Levorphanol
Opioid agonists : Morphine &congeners

Question 6

T OR F / Subcutaneous morphine is recommended during shock

Answer 6

F / not recommended, because repeated S.C administration may produce serious
toxicity as once the circulation is improved and hypotension is corrected

Question 7

If morphine given during labor it will cross the placental barrier and cause………………………………..

Answer 7

Neonatal asphyxia or neonatorum asphyxia

Question 8

Morphine is metabolized in the liver by conjugation with glucuronic acid forming……………………………………….

Answer 8

1- Morphine -3- glucuronide

Question 9

1- Morphine -3- glucuronide is neuroexcitatory compound that may induce…………………….and………………….

Answer 9

seizure& trunk rigidity

Question 10

Mention the mechanism of action of Morphine?

Answer 10

1. activate specific opioid receptors in brain and spinal cord
2. these receptors are linked to Gi protein
3. leading to inhibition of adenyl cyclase and decrease in CAMP
4. result in CNS depression

Question 11

Mention the analgesic of Morphine on CNS actions?

Answer 11

1. Inhibit ascending transmission of pain (nociceptive) impulse from spinal cord dorsal horn to brain.
2. Elevation of pain threshold which decrease pain perception.
3. Modify emotional reaction to pain.

Question 12

All the following are types of pain that the Morphine can relief EXCPT?

A. somatic pain & visceral pain
B. sharp intermittent pain
C. dull continuous pain
D. neurogenic, psychogenic pain
E. both B & D

Answer 12

E. both B & D

B. sharp intermittent pain
D. neurogenic, psychogenic pain

Question 13

Give reason why morphine not used for head injuries?

Answer 13

-Interfere with diagnosis of head injury as it produce miosis

• Respiratory depressant effect of morphine tend to increase intracranial pressure due to CO2 retention and VD of cerebral blood vessels

Question 14

The diagnostic feature in acute poisoning of morphine is …………………………………….

Answer 14

pin point pupil (PPP)

Question 15

Mention the hormonal effect of morphine?

Answer 15

1. inhibit the release of ACTH (corticotropin), FSH, LH
2. stimulate release of ADH

Question 16

Morphine inhibit the release of all the following hormones EXCPT?
A. ADH
B. LH
C. FSH
D. ACTH

Answer 16

A. ADH