Pain Wang

The pro-seizure chemical laudanosine is a metabolite of which of the following drugs?
A) Succinylcholine
B) Mivacurium
C) Atracurium
D) Rocuronium

Non-depolarizing muscle relaxant mivacurium may increase histamine release. The concern(s) associated with this action is/are: (select all that apply)
A) Hypertension
B) Hypotension
C) Malignant hyperthermia
D) Seizure attack
E) Bronchospasm

High dose aspirin reduces the formation of prostaglandins by inhibiting
A) Lipoxygenase A4
B) Cyclooxygenase 2 (COX2)
C) Arachidonic acid
D)  Cyclooxygenase 1 (COX1)

Which of the following is a correct rank order regarding the relative risks of GI complications of these NSAIDs (“> ” means greater risk than)?
A) Aspirin > Indomethacin > Piroxicam > Naproxen
B) Piroxicam > Naproxen > Indomethacin > Aspirin
C) Indomethacin > Piroxicam > Naproxen > Aspirin
D) Aspirin > Piroxicam > Naproxen > Indomethacin
E) Piroxicam > Indomethacin > Naproxen > Aspirin

The therapeutic effect of sumatriptan on migraine headaches is mediated by two primary mechanisms. They are (Select all that apply):
A) Inhibition of vasodilating peptide release
B) Direct constriction of small arteries
C) Relaxation of the intracranial cerebral blood vessels
D) Increase in the production of prostaglandins

Which of the following are paired incorrectly?
A) Ketamine / inhibit NMDA receptors
B) Thiopental / activate GABA-B receptors
C) Opioid / activate µ receptors
D) Propofol / potentiate GABA-A receptors

Local anesthetic agent lidocaine blocks which of the following ion channels?
A) Chloride
B) Calcium
C) Sodium
D) Potassium
E) Magnesium

Which of the following is a mixed agonist-antagonist of opioid receptors?
A) Propoxyphene
B) Morphine
C) Buprenorphine
D) Oxycodone
E) Fentanyl

Which of the following is the wanted effect of a general anesthetic?
A) Increase in intracranial pressure
B) Unconsciousness and analgesia
C) Respiratory depression
D) Circulation depression
E) Maintenance of body temperature

Based on the definition of MAC, the MAC number of a general anesthetic is similar to which of the following measurements?   
A) IC50
B) EC50
C) TD50
D) None of the above

The blood:gas partition coefficients for nitrous oxide and isoflurane are 0.47 and 1.4, respectively.  The solubility of these two agent in blood is:
A) Isoflurance > Nitrous oxide
B) Nitrous oxide > Isoflurance
C) Equal
D) Hard to tell

Which of the following may not be a target of general anesthetics?
A) Nerve trunks of the extremities
B) Neurons
C) Ion channels or neurotransmitter receptors
D) Brain
E) Synapses in the CNS

Which of the following is correct regarding propofol?  
A) It can be easily dissolved into water
B) It has longer “hangover” effect than thiopental
C) It is an inhaled anesthetic
D) It has a high risk of respiratory depression
E) Fospropofol is its pro-drug
F) It cannot be used repeatedly

Which of the following is paired incorrectly:      
A) Ketamine / inhibit NMDA receptors
B) Propofol / potentiate GABA-B receptors
C) Thiopental / activate GABA-A receptors
D) Opioid / activate µ receptors

Which of the following is NOT a type of blockade of local anesthetics?
A) Nerve trunk
B) Epidural
C) Topical
D) Cerebral
E) Spinal block

Which of the following statement is true regarding triptans? (select all that apply)
A) good therapeutic agents for patients with high blood pressure
B) safe for patients at risk for stroke or heart attacks
C) good for patients with high blood pressure
D) good for patients at risk for stroke or heart attacks
E) ineffective for the symptoms of persistent pain

Which of the following is not a pain-relieving medication in the treatment of migraine?
A) Dexamethasone
B) Antidepressants
C) Opioids
D) Ergot alkaloids
E) Triptans
F) NSAIDs

Which of the following statements is true regarding sumatriptan? (select all that apply)              
A) It is a 5-HT antagonist
B) It is a 5-HT agonist
C) It is a 5-HT1 agonist
D) It is a 5-HT2 agonist

Which of the following is depolarizing muscle relaxant? 
A) Cisatracurium
B) Mivacurium
C) Pancuronium
D) Succinylcholine
E) Tubocurarine

Which of the following are amide local anesthetics? (select all that apply)    
A) Procaine
B) Procainamide
C) Tetracaine
D) Lidocaine
E) Bupivacaine

Which of the following local anesthetics has a high risk of cardiac toxicity?  
A) Lidocaine
B) Bupivacaine
C) Procaine
D) Procainamide
E) Tetracaine

Which of the following is a correct order of dose-dependent action of opioid?    
A) Analgesia / nausea / constipation / sedation / respiration depression / miosis
B) Sedation / analgesia / nausea / constipation / respiration depression / miosis
C) Analgesia / nausea / miosis / constipation / sedation / respiration depression
D) Analgesia / nausea / sedation / respiration depression / constipation / miosis

Which of the following chemical does not plays a role in nociceptive signal sensation/transmission?
A) Prostaglandin
B) CGRP
C) Histamine
D) Epinephrine
E) Substance P

High dose of aspirin reduces the formation of prostaglandins by inhibiting:   
A) Lipoxygenase A4 and COX2
B) Lipoxygenase A4
C) COX1 and Lipoxygenase A4
D) Cyclooxygenase 2 (COX2)
E) Cyclooxygenase 1 (COX1)

Activation of opioid µ receptors can inhibit pain sensation by increasing        
A) Outward potassium current
B) Inward sodium current
C) Inward calcium current
D) Outward sodium-calcium exchanger current
E) Inward chloride current

Activation of opioid µ receptors can inhibit pain sensation by decreasing      
A) Outward potassium current
B) Outward sodium-calcium exchanger current
C) Inward chloride current
D) Inward calcium current
E) Inward sodium current

Which one of the following statements regarding prostaglandins is/are true?
A) They are neurotransmitters in the brain
B) They sensitize nerve endings to pain stimuli
C) Their synthesis is enhanced by low dose of aspirin
D) They play an important role in reducing tissue inflammation

Which of the following agents has the least efficacy in treating acute tissue inflammation?  
A) Ibuprofen
B) Indomethacin
C) Aspirin
D) Acetaminophen

All of the following are the therapeutic effects of aspirin EXCEPT:
A) Reducing inflammation
B) Reducing nociception
C) Reducing bleeding tendency
D) Reducing fever

Which of the following drugs inhibits cyclooxygenases irreversibly?     
A) Aspirin (acetylsalicylic acid)
B) Celecoxib
C) Acetaminophen
D) Ibuprofen

Which of the following drugs shows reduced GI side effect, yet has elevated risks for myocardial infarction and stroke?
A) Celecoxib
B) Acetaminophen
C) Ibuprofen
D) Aspirin

Alcohol increases which of the following drug’s liver toxicity?
A) Celecoxib
B) Ibuprofen
C) Aspirin
D) Acetaminophen

NAPQI (N-acetyl-p-benxoquinone imine) is a toxic metabolite of:
A) ASAs
B) Acetaminophen
C) Celecoxib
D) All NSAIDs except ASA

Induction of CYP enzymes 1A2, 2E1 and 3A4 may increase which of following drug’s hepatotoxicity?
A) Aspirin
B) Celecoxib
C) Ibuprofen
D) Acetaminophen

Opioid receptors belong to: 
A) Receptor tyrosine kinase family
B) Ionotropic receptor family
C) Enzyme receptor family
D)  Nuclear receptor family
E) G-protein coupled receptor family

All of the following statements about opioid analgesics are true EXCEPT     
A) They reduce urine production
B) They do not cause respiratory depression even when overdosed
C) They have no significant direct effects on the heart
D) They increase intestinal peristalsis

Which drug is an opioid antagonist and used for treating opioid addiction?   
A) Codeine
B) Meperidine
C) Naloxone
D) Morphine

Non-selective NSAIDs inhibit which of the following enzymes? (Select all that apply) 
A) Cyclooxygenase 2 (COX2)
B) Cyclooxygenase 1 (COX1)
C) Nitric oxide synthase (NOS)
D) Phospholipase A2 (PLA2)

At anti-inflammatory dosage, aspirin inhibits which of the following enzyme(s)? (Select all that apply) 
A) Cyclooxygenase 2 (COX2)
B) Cyclooxygenase 1 (COX1)
C) Phospholipase A2 (PLA2)
D) Nitric oxide synthase (NOS)

At analgesic dosage, aspirin inhibits which of the following enzyme(s)? (Select all that apply)
A) Cyclooxygenase 2 (COX2)
B) Nitric oxide synthase (NOS)
C) Phospholipase A2 (PLA2)
D) Cyclooxygenase 1 (COX1)

At antipyretic dosage, aspirin inhibits which of the following enzyme(s)? (Select all that apply)
A) Cyclooxygenase 1 (COX1)
B) Phospholipase A2 (PLA2)
C) Cyclooxygenase 2 (COX2)
D) Nitric oxide synthase (NOS)

At low dosage (such as baby aspirin), aspirin inhibits which of the following enzyme(s)?
A) Cyclooxygenase 1 (COX1)
B) Cyclooxygenase 2 (COX2)
C) Nitric oxide synthase (NOS)
D) Phospholipase A2 (PLA2)

Flurbiprophen is:   
A) An opioid agonist
B) A selective COX1 inhibitor
C) A selective COX2 inhibitor
D) A non-selective COX inhibitor

Which of the following statement is true regarding celecoxib? (Select all that apply)   
A) It selectively inhibits COX2 activity
B) It reversibly inhibits COX2 activity
C) It selectively inhibits COX1 activity
D) It reversibly inhibits COX1 activity

Which of the following is a correct rank order regarding the relative risks of GI complications of these NSAIDs (“< ” means less risk than)? 
A) Piroxicam < Naproxen < Indomethacin < Aspirin
B) Aspirin < Indomethacin < Piroxicam < Naproxen
C) Aspirin < Naproxen < Indomethacin < Piroxicam
D) Indomethacin < Piroxicam < Naproxen < Aspirin
E) Aspirin < Piroxicam < Naproxen < Indomethacin

Drug interaction between NSAIDs and thiazide diuretics is mainly related to which of the following molecules?
A) Leukotriene A4
B) Prostaglandins
C) Arachidonic Acid
D) Thromboxane A2

Reduction in which of the following mediator will cause hyperkalemia by NSAIDs and ACEIs? 
A) PGE2 receptors
B) Aldosterone
C) Angiotensin II receptors
D) Thromboxane A2
E) Arachidonic acid

Which of the following opioid receptor subtypes is the most important one that mediates the analgesic effect of morphine?        
A) None
B) µ (mu)
C) k (kappa)
D) δ (delta)               

Which of the following is a mixed agonist-antagonist of opioid receptors?     
A) Morphine
B) Fentanyl
C) Oxycodone
D) Nalbuphine
E) Propoxyphene

Which of the following is a most potent opioid agonist?   
A) Propoxyphene
B) Fentanyl
C) Nalbuphine
D) Morphine
E) Oxycodone

Which of the following is the least potent opioid agonist? 
A) Oxycodone
B) Propoxyphene
C) Morphine
D) Nalbuphine
E) Fentanyl

Activation of which of the opioid receptors may produce dysphoric effect?  
A) µ (mu)
B) k (kappa)
C) None
D) δ (delta)    

Which of the following is/are opioid antagonist(s)? (select all that apply)     
A) Nalbuphine
B) Naltrexone
C) Naloxone
D) Fentanyl