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					159. Accidental poisonings are common with both aspirin and ibuprofen, two OTC drugs available in tasty
    chewable tablets. In cases of overdose, aspirin is more likely than ibuprofen to cause
     A. Autonomic instability
     B. Hepatic necrosis
     C. Metabolic acidosis
     D. Thrombocytopenia
     E. Ventricular arrhythmias

160. Compared with diazepam (Valium®), midazolam(Versed®)
     A. Is more lipid soluble
     B. Has a longer elimination half-life
     C. Has a larger volume of distribution
     D. Has greater clearance
     E. Undergoes slower hepatic metabolism

161. Compared with midazolam, diazepam has which of the following characteristics?
      A. Greater solubility in water
      B. Shorter beta half-life
      C. More potent ventilatory depressant effect
      D. Lower risk for thrombophlebitis
      E. A pharmacologically active metabolite

162. Once an opioid treatment is selected, titration upwards should continue until:
     A. A ceiling is reached.
     B. Addiction occurs
     C. Tolerance occurs
     D. A balance between analgesia and side effects is reached.
     E. Respiratory depression occurs

163. Patients usually develop tolerance to all opioid effects EXCEPT:
      A. Sedation
      B. Pruritus
      C. Constipation
      D. Pain relief
      E. Respiratory depression

164. Cocaine, produced from the leaves of Erythroxylon species,
      A. Produces bradycardia and vasodilation
      B. Is directly related chemically to opioid analgesics
      C. Is metabolized by the microsomal metabolizing system
      D. Blocks nerve conduction effectively
      E. Blocks norepinephrine receptors directly

165. Acetaminophen is a proven analgesic and anti-pyretic through action at:
      A. Hypothalamus
      B. Dorsal horn of the spinal cord
      C. Modulation of neurotransmitter activity at the locus ceruleus
      D. By cholinergic enhancement of the GABA-B receptor complex
      E. By Cox-2 inhibition

166. Meprobamate is the active metabolite of which skeletal muscle relaxant?
        A. Carisoprodol (soma®)
        B. Cyclobenzaprine (Flexeril®)
        C. Methocarbamol (Robaxin®)
        D. Valdecoxib (Bextra®)
        E. Baclofen®

167. When an inactive substance or condition induces a therapeutic change, the procedure (result) is called
      A. Non pharmaceutical reaction
      B. Modulated conditioning
      C. Placebo effect
      D. Reaction formation
      E. Fantasy reaction

168.     A drug that is used in the treatment of parkinsonism and will also attenuate reversible extrapyramidal
       side effects of neuroleptic is
        A. Amantadine (Symmetrel®)
        B. Levodopa (Dopar®)
        C. Pergolide (Permax®)
        D. Selegiline (Eldepryl®)
        E. Trihexyphenidyl (Artane®)

169. Which of the following agents does not act on prostaglandins peripherally, and as such does not block local
     inflammation?
      A. Acetaminophen®
      B. Ibuprofen®
      C. Naproxen®
      D. Celebrex®
      E. Aspirin®

170. The phenothiazines have a variety of actions at different receptor types. However, they do NOT appear to
    interact with receptors for
     A. Dopamine
     B. Histamine
     C. Nicotine
     D. Norepinephrine
     E. Muscarine

171.     Which one of the following drugs mimics the activity of metenkephalin in the dorsal horn of the spinal
       cord?
        A. Deprenyl (selegiline)
        B. Trihexyphenidyl
        C. Baclofen
        D. Morphine
        E. Phenobarbital

172. Inhibitors of serotonin (5-HT) uptake such as paroxetine (Paxil®) interact significantly with which of the
    following drugs?
     A. Chlorpromazine
     B. Tranylcypromine
     C. Halothane
     D. Benztropine
     E. Digoxin
173. Absorption is most dependent upon which of the following?
      A. Gastric pH >7
      B. Liver metabolism
      C. Gastric & intestinal motility
      D. Presence of some liquid in stomach when medications are taken
      E. Amount and volume of drug administered

174. Tolerance is:
     A. A need to increase drug dosage to obtain the same effect.
     B. A rapid immunity to opioids, secondary to cross-reactive antibodies.
     C. The concept of understanding that a drug is necessary, except in the community.
     D. A patient‟s ability to take the drug.
     E. The physician‟s willingness and acceptance to prescribe the drug.

175. Which of the following opioids is vagolytic?
     A. Morphine
     B. Meperidine
     C. Sufentanil
     D. Nalbuphine
     E. Alfentanil

176.       Compared to morphine, butorphanol would be expected to display which one of the following
       pharmacologic characteristics?
        A. Kappa receptor antagonist activity
        B. Analgesic ceiling effect
        C. No respiratory depression
        D. Histamine release
        E. Mu receptor agonist activity

177.     Among the following neuroleptics, the most likely neuroleptic associated with skeletal muscle rigidity,
       tremor at rest, flat facies, uncontrollable restlessness, and spastic torticollis is
        A. Clozapine
        B. Haloperidol
        C. Olanzapine
        D. Sertindole
        E. Ziprasidone

178. Which one of the following statements about pentazocine (Talwin®) is FALSE?
     A. Analgesia is at least equivalent to that of codeine
     B. Causes sedation
     C. Classified as a mixed agonist-antagonist
     D. Full agonist at mu receptors
     E. May interfere with the analgesic effects of morphine

179. Demerol (meperidine) should not be used for chronic pain because:
     A. It is addictive
     B. It is ineffective
     C. The metabolite causes seizures
     D. The medication is expensive
     E. It accumulates in hepatic failure
180. Which one of the following effects is unlikely to occur during treatment with amitriptyline?
     A. Alpha adrenoceptor blockade
     B. Elevation of the seizure threshold
     C. Mydriasis
     D. Sedation
     E. Urinary retention

181. N-acetyl benzoquinoneimine is the hepatotoxic metabolite of which drug?
      A. Sulindac
      B. Acetaminophen
      C. Isoniazid
      D. Indomethacin
      E. Procainamide

182. Which controlled substance produces a toxic metabolite which may cause seizures with accumulation with
    repeated dosing?
     A. Pentazocine
     B. Propoxyphene
     C. Morphine
     D. Ketamine
     E. Meperidine

183. The following drug is not associated with enhancement of the activity of g-aminobutyric acid (GABA)
     A. Chlordiazepoxide
     B. Phenobarbital
     C. Diazepam
     D. Valproic acid
     E. Chlorpromazine

184.     Methadone metabolism may be significantly altered by the co-administration of all of the following
       EXCEPT:
        A. Ciprofloxin
        B. Phenytoin
        C. Oxycodone
        D. Biaxin
        E. Rifampin

185. True comments regarding COX II specific inhibitors include immunity from:
      A. Potential Nephrotoxicity
      B. Platelet Inhibition
      C. Gastrointestinal Erosion
      D. None of the Above
      E. All of the above

186. Which of the following is NOT true about benzodiazepines when used long term in chronic pain?
     A. Decrease REM and slow wave sleep
     B. Decrease serotonin levels
     C. May produce a dangerous withdrawal syndrome if suddenly discontinued
     D. Have a primary analgesic effect
     E. May have a much higher rate of cognitive dysfunction than opioids
187. Which one of the following drugs is most likely to increase plasma levels of alprazolam, theophylline, and
     warfarin:
      A. Desipramine (Pamelor®)
      B. Fluvoxamine (Luvox®)
      C. Imipramine (Tofranil®)
      D. Nefazodone (Serazone®)
      E. Venlafaxine (Effexor®)

188. A patient injured in an auto accident received 80 mg of meperidine. He subsequently developed a severe
     reaction characterized by tachycardia, hypertension, hyperpyrexia, and seizures. When a questioned, the
     uninjured spouse revealed that the patient had been taking a drug for a psychiatric condition. Which of the
     following drugs is most likely to be responsible for this untoward interaction with meperidine?
      A. Alprazolam (Xanax®)
      B. Amitriptyline (Elavil®)
      C. Lithium
      D. Mirtazapine (Norbil®)
      E. Phenelzine (Nardil®)

189. Fentanyl patches have been used to provide analgesia. The most dangerous adverse effect of this mode of
     administration is
      A. Cutaneous reactions
      B. Diarrhea
      C. Hypertension
      D. Relaxation of skeletal muscle
      E. Respiratory depression

190. All of the following are true regarding the use of opioids in patients with altered hepatic function except:
     A. Smaller clearance of the opioid
     B. Volume of distribution is increased
     C. Prolonged elimination half-time
     D. Relatively normal initial distribution
     E. Accumulation of drug will occur

191. Drug interactions involving antidepressants do NOT include
      A. Additive impairment of driving ability in patients taking trazodone when ethanol is ingested
      B. Behavioral excitation and hypertension in patients taking MAO inhibitors with meperidine
      C. Elevated plasma levels of lithium if fluoxetine is administered
      D. Increased antihypertensive effects of methyldopa when tricyclics are administered
      E. Prolongation of tricyclic drug half-life in patients with cimetidine

192.      Which one of the following is characteristic of cytochrome P-450?
       A. Located in the lipophilic environment of mitochondrial membranes
       B. Catalyzes O-, S-, and N-methylation reactions
       C. Catalyzes aromatic and aliphatic hydroxylations
       D. Catalyzes conjugation reactions
       E. Activity is not inducible by drugs

193. A 17-year old who ingests “mushrooms” would present with symptoms best described as:
     A. Anticholinergic
     B. Adrenergic
     C. Cholinergic
     D. Alpha adrenergic
        E. Dopaminergic

194. Which of the following is the most accurate definition of tolerance:
     A. The medication stops working after a few months
     B. Stopping the medication causes withdrawal symptoms
     C. A given dose is less effective, increasing the dose restores the effect
     D. Side effects of a given dose are less severe over time
     E. A medication is less effective, changing to a different medication restores the effect

195. Identify evidence-based recommendations of meperidine use in chronic pain.
     A. Given no more frequently than every four hours for 6 months
     B. Used in standard doses in the elderly indefinitely if response is positive
     C. Used in individuals with impaired renal function as meperidine is shown to have only hepatotoxicity
     D. Always used in conjunction with non-steroidal anti-inflammatory agents.
     E. Reserved for very brief therapy in otherwise healthy patients who cannot tolerate other opioids

196.      Concerning the proposed mechanisms of action of antidepressant drugs, which one of the following
       statements is accurate?
        A. Bupropion (Wellbutrin®) can effective inhibitor of NorEpinephrine and 5-HT transporters
        B. Chronic treatment with an antidepressant often leads to the up-regulation of adrenoceptor
        C. Elevation in amine metabolites in cerebrospinal fluid is characteristic of most depressed patient prior to drug
            therapy
        D. MAO inhibitors used as antidepressants selectively decrease the metabolism of norepinephrine
        E. The acute effect of most tricyclics is to block the neuronal reuptake of both norepinephrine and serotonin in
            the CNS

197. A meperidine (Demerol) dose equivalent to morphine 10 mg every 3 to 4 hours by injection is:
     A. 100 mg every 3 hours
     B. 75 mg every 3 hours
     C. 50 mg every 3hours
     D. 100 mg every 4 hours
     E. 75 mg every 4 hours

198.     The most frequent type of drug interaction that occurs in patients using drugs of the sedative hypnotic
       class is
        A. Additive CNS depression
        B. Antagonism of sedative or hypnotic actions
        C. Competition for plasma protein binding
        D. Induction of liver drug-metabolizing enzymes
        E. Inhibition of liver drug-metabolizing enzymes

199.      A 40-year-old patient with liver dysfunction is scheduled for an interventional surgical procedure.
       Lorazepam ( Ativan®) can be used for sedation in this patient without concern for excessive CNS
       depression because the drug is
        A. A selective anxiolytic like buspirone
        B. Actively secreted in the renal proximal tubule
        C. Conjugated extrahepatically
        D. Eliminated via the lungs
        E. Reversible by administration of naloxone
200. Which one of the following drugs has been used in the management of alcohol withdrawal states and in
    maintenance treatment of patients with tonic-clonic or partial seizure states? Its chronic use may lead to an
    increased metabolism of warfarin and phenytoin.
     A. Chlordiazepoxide
     B. Meprobamate
     C. Phenobarbital
     D. Triazolam
     E. Zolpidem

201. Which of the following statements is most correct?
     A. Maximum efficacy of a drug is directly correlated with its potency
     B. The therapeutic index if the LD50 (or TD50) divided by the ED50
     C. A partial agonist has no effect on its receptors unless another drug is present
     D. Graded dose-response data provide information about the standard deviation of sensitivity to the drug in the
         population studied
     E. Quantal dose-response curves provide information about the efficacy of a drug

202. Which one of the following statements best describes the mechanism of action of benzodiazepines?
     A. Benzodiazepines activate GABA B receptors in the spinal cord
     B. Their inhibition of GABA transaminase leads to increased levels of GABA
     C. Benzodiazepines block glutamate receptors in hierarchical neuronal pathways in the brain
     D. They increase the frequency of opening of chloride ion channels that are coupled to GABA A receptors
     E. They are direct-acting GABA receptor agonists in the CNS

203. A 23-year-old male presents with a history of smoking “crack cocaine.” He is disoriented, confused, and in
    a dissociative state. Physical examination reveals rotary nystagmus. Pending the results of his urine drug
    screen, you would be suspicious that his drug had been adulterated with:
     A. Methamphetamine.
     B. LSD
     C. Lidocaine
     D. Phencyclidine
     E. Ketamine.

204. Haloperidol may best be characterized by which of the following statements?
     A. It is classified as a phenothiazine
     B. It is a selective D2 receptor agonist
     C. Its mechanism of action is completely different from that of chlorpromazine
     D. It is more potent as an antipsychotic drug than is chlorpromazine
     E. It produces a lower incidence of extrapyramidal reactions than does chlorpromazine

205. Which of the following is highly selective inhibitor of cyclooxygenase II?
     A. Aspirin
     B. Acetaminophen
     C. Ibuprofen
     D. Celecoxib (Celebrex®)
     E. Piroxicam (Feldene®)

206. In severe tricyclic antidepressant overdose, it would NOT be of value to
     A. Administer lidocaine (to control cardiac arrhythmias)
     B. Institute hemodialysis (to hasten drug elimination)
     C. Administer bicarbonate and potassium chloride (to correct acidosis and hypokalemia)
     D. Provide intravenous diazepam (to control seizures)
      E. Maintain the rhythm of the heart by electrical pacing

207. Although it does not act at any histamine receptor, epinephrine reverses many effects of histamine.
    Epinephrine is a
     A. Competitive inhibitor of histamine
     B. Noncompetitive antagonist of histamine
     C. Physiologic antagonist of histamine
     D. Chemical antagonist of histamine
     E. Metabolic inhibitor of histamine

208. The mechanism of action of most benzodiazepines is by :
     A. Activation of GABA receptors
     B. Antagonism of glycine receptors in the spinal cord
     C. Blockade of the action of glutamic acid
     D. Increased GABA-mediated chloride ion conductance
     E. Inhibition of GABA aminotransferase

209. Gabapentin (Neurontin®) exerts its analgesic affect by:
     A. Inhibition of reuptake Serotonin and Norepinephrine
     B. Central modulation of the dorsal lateral funiculus at the dorsal horn intermediary.
     C. GABA-A affinity and activation.
     D. The analgesic effect is unknown.
     E. NMDA modulation.

210. If one patient is taking amitriptyline (Elavil®) and another patient is taking chlorpromazine (Thorazine®),
     they are both likely to experience the following:
      A. Excessive salivation
      B. Extrapyramidal dysfunction
      C. Gynecomastia
      D. Increased gastrointestinal motility
      E. Postural hypotension

211. Which of the following is unlikely to be associated with oral drug administration of an enteric-coated
    dosage form?
     A. Irritation to the gastric mucosa with nausea and vomiting
     B. Destruction of the drug by gastric acid or digestive enzymes
     C. Unpleasant taste of the drug
     D. Formation of nonabsorbable drug-food complexes
     E. Variability in absorption caused by fluctuations in gastric emptying time

212. Fluoxetine (Prozac®) is classified as:
     A. As an MAO inhibitor (MAOI)
     B. As a tricyclic nonselective amine reuptake inhibitor
     C. As a heterocyclic nonselective amine reuptake inhibitor
     D. As a selective serotonin reuptake inhibitor
     E. As an alpha2-adrenergic receptor inhibitor

213. Drug interactions common to cyclobenzaprine (Flexeril®) include all of the following except :
     A. MAOI agents
     B. Barbiturates
     C. Tertiary tricyclic antidepressants
     D. Zolpidem (Ambien®)
      E. Alcohol

214. The states of a patient in which repetitions of the same dose of a drug has progressively less effect or in
     which the dose needs to be increased to obtain the same degree of pharmacological effect as was caused by
     the original dose is defined as:
      A. Physical dependence
      B. Synergistic effect
      C. Additive effects
      D. Disuse supersensitivity
      E. Tolerance

215. A Phase II clinical trial typically involves :
     A. Measurement of the pharmacokinetics of the new drug in normal volunteers
     B. Double-blind evaluation of the new drug in thousands of patients with target disease
     C. Post-marketing surveillance of drug toxicities
     D. Evaluation of the new drug in 50 to several hundred patients with the target disease
     E. Collection of data regarding late-appearing toxicities fro patients previously studies in phase I trials

216. Which of the following statements is accurate with administration of psychostimulants in opioid induced
    sedation?
    A. They are safe in patients with a history of paranoid disorders
    B. They are safe in patients with a history of hypertension
    C. They should be given morning and noon so as not to disturb sleep
    D. They are safe in patients with a history of delirium
    E. They should be administered only at bedtime

217. Most drug receptors are
     A. Small molecules with a molecular weight between 100 and 1000
     B. Lipids arranged in a bilayer configuration
     C. Proteins located on cell membrane or in the nucleus
     D. DNA molecules
     E. RNA molecules

218. Which of the following statements applies to a drug exhibiting a saturated elimination process?
     A. Upon multiple dosing, steady-state plasma concentrations will be reached in approximately 4 to 5 biologic
         half-lives
     B. The fraction of drug eliminated per unit time is constant
     C. The biologic half-life (t1/2) is affected by dose
     D. First-order kinetics are operable
     E. The rate of drug elimination is dependent on plasma drug concentration

219. Which of the following is an action of a non-competitive antagonist?
     A. Alters the mechanism of action of an agonist
     B. Alters the potency of an agonist
     C. Shifts the dose-response curve of an agonist to the right
     D. Decreases the maximum response to an agonist
     E. Binds to the same site on the receptor as the agonis

220. Adverse effects of opioids that can be used to advantage include:
     A. Dysphoria
     B. Respiratory depression
     C. Decreased GI motility
       D. Pupil constriction
       E. Sexual dysfunction

221. Which of the following factors will determine the number of drug-receptor complexes formed?
     A. Efficacy of the drug
     B. Receptor affinity for the drug
     C. Therapeutic index of the drug
     D. Half-life of the drug
     E. Rate of renal secretion

222. A weak acid drug (A), with a pKa = 6, is given orally. Assuming that the pH of the stomach equals 3 and
    the pH of the blood equals 7, which of the following statements is true?
    A. At equilibrium, there is roughly 1000 times more dissociated drug than undissociated drug in the stomach
    B. At equilibrium, the ratio of dissociated to undissociated drug in the blood is approximately 10
    C. At equilibrium, 10 times more undissociated drug than dissociated drug is in the blood
    D. Drug concentrations on the blood side of the stomach barrier will never reach the concentration of drug in the
        stomach
    E. The drug will be more rapidly excreted if the urine is         made acidic

223. Which of the statements about tolerance is most true in a patient taking repeated daily doses of lysergic
    acid diethylamide (LSD)?
     A. No tolerance develops
     B. Tolerance develops in 3 to 4 days
     C. Tolerance develops in 2 to 3 weeks.
     D. Tolerance develops in 2 to 3 months.
     E. Tolerance develops in 6 months.

224. The pharmacologic effects of acetylsalicylic acid (Aspirin®) include
    A. Reduction in elevated body temperature
    B. Promotion of platelet aggregation
    C. Alleviation of pain by stimulation of prostaglandin synthesis
    D. Efficacy equal to that of acetaminophen as an anti-inflammatory agent
    E. Less gastric irritation than other salicylates



   Directions: Each question below contains four suggested responses of which one
   or more is correct. Select


   A if             1, 2 and 3 are correct
   B if             1 and 3 are correct
   C if             2 and 4 are correct
   D if             4 is correct
   E     if         All (1, 2, 3 and 4) are correct



225. The elimination of Gabapentin is primarily by:
     1. Hepatic degradation
        2. Hepatitc degradation and hydrolysis.
        3. Plasma protein transferase degradation.
        4. Renal excretion as unchanged drug.

226.     Which best describes the mechanism of interaction of nonsteroidal anti-inflammatory drugs (NSAIDs)
       with lithium salts?
        1. They increase lithium intestinal absorption
        2. They increase lithium plasma protein binding
        3. They increase lithium sensitivity at its site of action
        4. They increase lithium renal reabsorption

227. Opioid peptides are derived from larger prohormones that include
     1. Proenkephalin A
     2. Proopiomelanocortin
     3. Proenkephalin B
     4. Alpha neoendorphin

228. Tramadol might be considered a medication to use with caution in those taking:
     1. Monoamine oxidase inhibitors.
     2. Serotonin reuptake inhibitors.
     3. Concomitant use of tricyclic anti-depressants.
     4. Benzodiazepines.

229. Ziconotide
     1. Is a N-type voltage sensitive calcium channel antagonist.
     2. Has been reported to be beneficial in spinal cord injury.
     3. Has side effects including nystagmus, ataxia, hallucinations etc.
     4. Is a L-type voltage sensitive calcium channel antagonist.

230. Discontinuation of tramadol can result in
     1. Seizures
     2. Tardive dyskinesia
     3. Ventricular tachycardia
     4. Cholinergic activity

231. The action of Tramadol is considered:
     1. A centrally acting synthetic opioid analgesic.
     2. Associated with mu-opioid receptor activity.
     3. Inhibition of reuptake of norepinephrine and serotonin.
     4. Tramadol induced analgesia is totally reversed by naloxone.

232. Tricyclic toxicities are best described by which of the following?
      1. Diarrhea and urinary frequency
      2. Adverse effect on cardiac rhythm
      3. No effect on other mental disorders other than relief of Major Depression
      4. Delirium may result from central cholinergic blockade

233. Pharmacokinetic properties and toxicity of NSAIDs appear to be related to:
      1. Plasma half life
      2. Protein binding
      3. Dose of the drug
      4. Hepatic function
234. Anti Inflammatory medications exert their action at the tissue level by blocking:
     1. Phospholipase A2
     2. Arachidonic Acid Liberation at the Lipid Membrane
     3. Functional Leukotrienes
     4. Lipoxygenase

235. Non-selective NSAID agents inhibit both:
     1. Cyclooxygenase-I Constitutive Pathway
     2. Leukotrienes Pathway
     3. Cyclooxygenase-II Inducible Pathway
     4. Arachidonic Acid Lipid Membrane Cascade

236. Cautions when using the lidocaine 5% transdermal patch delivery system includes:
     1. Contraindications or hypersensitivity to amide local anesthetics
     2. Hepatic disease
     3. Allergy or sensitivity to PABA derivatives
     4. The elderly or infirmed

237. Non-steroidal anti-Inflammatory medicines should be used with caution with the following cotherapeutic
     agents:
      1. Coumadin
      2. Methotrexate
      3. Lithium Carbonate
      4. H2 Antagonists

238. Symptoms of salicylate toxicity include:
     1. Tinnitus
     2. Acid-Base disturbances.
     3. Dehydration
     4. Mydriasis

239.      Traditional NSAIDs (e.g. Ibuprofen) are now known to effect their pharmacodynamic activity via
       inhibition of:
        1. Cyclooxygenase 1
        2. Prostaglandin synthetase
        3. Thromboxane synthetase
        4. Cyclooxygenase 2

240. Newer COX-2 selective NSAIDs were believed to be preferred agents based on which of the following
     criteria:
      1. Diminished renal toxicity
      2. Diminished hepatic toxicity
      3. Diminished platelet effects
      4. Diminished gastrointestinal toxicity

241. COX II selectivity of NSAIDs:
     1. Is associated with prostaglandin inhibition that is associated with pain and hyperalgesia
     2. Preserves normal function of the GI mucosa
     3. Is characterized by the ability to decrease sensitization in the central nervous system by inhibition of
        prostanoid formation, and action of substance P at the NMDA receptor
     4. Related to sexual dysfunction in males over age 60
242. Those that drink alcohol on a regular basis are recognized to have increased risk when mixed with
    controlled substances, particularly sedatives, opioids and benzodiazepines. Which is true of those that
    consume alcohol, and placed at risk in this population?
     1. 120 million Americans use alcohol regularly.
     2. 20% of the American population consider themselves alcohol users.
     3. 16.1 million are heavy, or regular drinkers.
     4. 1% of Americans have participated in a binge drinking episode one month prior to the survey.

243. Which of the following statements about biotransformation are true ?
      1. Biotransformation often produces metabolites with less affinity for receptors than the parent drug
      2. Biotransformation often produces metabolites with a higher renal clearance than the parent drug
      3. Biotransformation often entails multiple enzyme-catalyzed reactions
      4. Biotransformation reactions often occur in the liver

244. Which of the following adverse effects if associated with the use of Neuroleptic agents ?
     1. Acute dystonia
     2. Gynecomastia
     3. Sedation
     4. Loss of libido

245. Which of the following measures would reduce the risk of maternal secretion of drug into the breast milk?
      1. Reducing the drugs lipid solubility
      2. Increasing the drug‟s molecular weight
      3. Increasing drug polarity
      4. Reducing protein binding
246. Which one of the following results may occur from repeated administration of a drug?
      1. Increased metabolism of the drug
      2. Increased metabolism of other drugs
      3. Induction of cytochrome P-450 or glucuronyl transferase
      4. Increased metabolism of endogenous compounds

247. Which of the following statements about biotransformation reactions are true?
      1. They may introduce an active center for further conjugations
      2. They almost always yield water-soluble metabolites
      3. They are often important in activating pro-drugs
      4. They are all inducible upon repeated drug administration

248. What are the Methadone interactions?
     1. Cimetidine will increase methadone levels
     2. Butalbital will decrease methadone levels
     3. Ciprofloxin will increase methadone levels
     4. Phenytoin will decrease methadone levels

249. Opioids exert their action by:
     1. Inhibiting the release of substance P
     2. Activating G proteins
     3. Inhibiting adenylate cyclase
     4. Activating dopaminergic neurons

250. The class of compounds considered prostanoids include:
     1. Prostacyclins
      2. Thromboxanes
      3. Prostaglandins
      4. Leukotrienes

251. Which of the following have been identified as algogenic substances?
     1. Serotonin
     2. Leukotrienes
     3. Acetylcholine
     4. Histamine

252. G-protein coupled receptor activation produces pharmacologic effects by modulation of which of the
    following?
     1. Cyclic AMP
     2. Ionic channels
     3. Phospholipases
     4. Protein kinases

253. Enkephalins are found in the
     1. Lungs
     2. CNS
     3. Bladder
     4. Adrenal medulla

254. Which of the following drugs induces the activity of CYP 3A4?
     1. Carbamazepine
     2. Phenobarbital
     3. Phenytoin
     4. Fluoxetine

255. The following statements are true regarding Fentanyl as a good agent for transdermal use,
     1. Low molecular weight
     2. Adequate lipid solubility
     3. High analgesic potency
     4. Low abuse potential

256. Drugs able to diminish the dose of opioids analgesics required to relieve pain include the following:
     1. Amphetamines
     2. Tricyclic antidepressants
     3. Non-steroidal anti-inflammatory agents
     4. Acetaminophen (Tylenol)

257. Highly tolerant opioid users, maintained on their drug in a research setting, will:
     1. Continue to feel a “rush” when their drug of choice is administered intravenously.
     2. Continue to use their drug of choice for reasons other than fear of experiencing withdrawal.
     3. Continue to experience pleasurable effects from food, sex, tobacco and other non-opiate drugs.
     4. Will not use any other drug for medical or recreational purposes

258. Analgesia of six hours or longer in duration can be obtained with all the following drugs:
     1. Levo Dromoran
     2. MS Contin
     3. Methadone
     4. Oxycodone
259. True statements concerning patient controlled analgesia include the following:
     1. Better patient satisfaction with pain control.
     2. Shorter hospital stays.
     3. Less total analgesic use.
     4. A greater potential for subsequent opiate dependence

260. Which of the following include subjective reports of marijuana effects?
     1. Increased sexual desire
     2. Increased appetite
     3. Enhanced tactile sensitivity
     4. Increased motivation

261. Choose all side effects of clonidine (Catapres):
     1. Drowsiness
     2. Hypotension
     3. Dizziness
     4. Dry mouth

262. Analgesic agents capable of producing tolerance, dependence and withdrawal include:
     1. Codeine
     2. Propoxyphene (Darvon)
     3. Buprenorphine
     4. Pentazocine (Talwin)

263. Which of the following are true about lorazepam:
     1. Has a serum half-life of approximately 12 hours
     2. Exhibits linear kinetics
     3. Is almost completely converted to benzoylecgonine
     4. Is frequently used an anti-anxiety agent

264. Dexmedetomidine and midazolam share the following pharmacologic properties:
      1. Provide a continuum of sedation
      2. Preserve respiratory function without potentiating opioid-induced respiratory depression
      3. Clearance is decreased in hepatic disease
      4. Selective alpha-2 adrenergic agonist activity

265.      Drug clearance from the plasma at a constant amount per unit time and the time for the plasma
       concentration of a drug to decrease by one-half, best represent which of the following drug properties?
        1. Pharmacodynamic profile
        2. Bioequivalence
        3. Drug potency
        4. Metabolism and excretion

266. Dose-response curves of drugs describe
     1. Activity
     2. Potency
     3. Affinity
     4. Slope

267. Characteristics that describe methadone for cancer pain include:
     1. High potency
     2. Long half-life
     3. Low cost
     4. Low lipid solubility

268. Which of the following correctly describe an agonist drug?
      1. Produces an effect by inducing conformation change
      2. May displace an endogenous ligand from the receptor
      3. Receptor interaction mediated by weak molecular forces
      4. Binds by covalent forces to the receptor

269. Which of the following are correct regarding drugs bound to plasma proteins?
     1. Have large volumes of distribution
     2. Are typically biologically active
     3. Displaced by other drugs
     4. Filtered by the glomerulus

270. Phase II reactions
     1. Are oxidative processes
     2. Increase water solubility
     3. Are typically microsomal
     4. Occur in the kidney

271. Serious drug interactions may occur with MAO inhibitors and which of the following drugs?
     1. Fluoxetine
     2. Amitriptyline
     3. Sumatriptan
     4. Meperidine

272. Which of the following factors must be true for two drugs to be considered bioequivalent?
     1. Identical Area Under the Curve data for both drugs
     2. Drugs given by the same route of administration
     3. Time to peak plasma concentrations the same
     4. Equal peak plasma concentrations

273. Most commonly observed side effects in adults who use Gabapentin include:
     1. Somnolence
     2. Peripheral edema.
     3. Dizziness.
     4. Amnesia.

274. Which of the following are true statements concerning NSAIDs:
     1. Do not produce pharmacological dependence
     2. May be opioid sparing
     3. Are extensively protein bound
     4. Do not maintain an analgesic ceiling

275. Which of the following classes of pharmacologic agents is(are) useful for nausea?
     1. Butyrophenones (Haloperidol and droperidol)
     2. Benzodiazepines (midazolam)
     3. Antiserotonergic agents (ondansetron)
     4. Opioids (fentanyl)
276. A COX 2 selective agent may be preferred in the following:
     1. History of GI bleed or complicated ulcer
     2. Anticoagulant use
     3. Oral corticosteroid use
     4. Age < 60

277. Hepatic toxicity and NSAID is related to:
     1. Class of NSAID
     2. Pharmacokinetics of drug
     3. Dose of drug
     4. Cholestatic activity

278. Which of the following effects is associated with benzodiazepines?
      1. Paradoxical excitement
      2. Ataxia
      3. Sedation
      4. Amnesia

279. Which of the following may cause constipation in the cancer patient?
     1. Chronic opioid use for pain.
     2. Iron supplementation for anemia.
     3. Antacids containing Ca and Al.
     4. Drugs with anticholinergic effects.

280. Regarding the metabolism of opioids:
     1. Some opioids are metabolized by glucuronidation
     2. Some opioids are metabolized by the P450 enzyme system
     3. M6G is an analgesic metabolite of morphine
     4. M3G is an analgesic metabolite of morphine

281. The following are the true statements explaining the mechanisms of increased opioid requirements.
      1. Tolerance
      2. Tachyphylaxis
      3. Physical dependence
      4. Psychological dependence

282. The transdermal route of fentanyl administration has been used in cancer patients because it offers the
     following advantages:
      1. Convenience of dosing.
      2. Rapid absorption through the skin allows quick titration.
      3. Highly potent opioid for analgesic efficacy.
      4. Low cost.

283. True statements about NMDA receptors are as follows:
     1. A number of heterogenous chemicals are antagonists of the N-methyl-D-aspartate (NMDA) receptor subtype
        of the major excitatory neurotransmitter, glutamic acid, in the brain.
     2. NMDA antagonists include phencyclidine, dizocilpine, and nitrous oxide.
     3. Most of the known NMDA antagonists are drugs of abuse.
     4. NMDA antagonists in low doses induce a psychotomimetic state, which resembles schizophrenia.

284.      When a person taking a medication or abusing a drug develops tolerance, which of the following
       statements are valid?
      1.   The same dosage of the drug has reduced effect
      2.   Tolerance develops uniformly to all effects of the drug
      3.   Physical dependence tends to develop in parallel with tolerance
      4.   Withdrawal symptoms are less likely after tolerance has developed

285. Which of the following sedative medications have analgesic properties:
      1. Midazolam®
      2. Ketamine®
      3. Propofol®
      4. Dexmedetomidine®

286. Adrenergic receptors are involved in which of the following functions?
      1. Depression
      2. Anxiety
      3. Arousal
      4. Learning

287. Withdrawal convulsions are likely to occur in patients who have used chronically which of the following
    drugs?
     1. Secobarbital
     2. Desipramine
     3. Lorazepam
     4. Phencyclidine

288. The following statements regarding partial agonists are true
     1. The slope of the dose-response curve is less steep than that of a full agonist
     2. The dose-response curve has no limit
     3. Concomitant administration of a partial and a full agonist can antagonize the effect of the full agonist
     4. The agent can act as an agonist at one receptor and an antagonist at another simultaneously

289. When using intrathecal opioids, speed of onset of analgesia is:
      1. Inversely related to lipid solubility
      2. Indirectly related to lipid solubility
      3. Unrelated to lipid solubility
      4. Directly related to lipid solubility

290. Delirium is an acute confusional state that results from diffuse organic brain dysfunction. In the cancer
    patient, the causes include:
     1. Opioid toxicity
     2. Dehydration
     3. Hypoxia
     4. Brain metastases

291. 30 mg of Morphine Sulphate orally is equivalent to:
     1. 10mg MSO4 IV
     2. 20mg of oral oxycodone
     3. 1.5mg hydromorphone IV
     4. 20mg methadone

292. Examples of the phenanthrene class of opioid include all except:
     1. Morphine
     2. Fentanyl
3. Codeine
4. Meperidine
413. For the following statements, first decide if each is true or false and then select the correct pattern from the
     choices given.1)Codeine is metabolized to morphine.2)Methadone has no significant drug
     interactions.3)Hydrocodone is metabolized to hydromorphone.
      A. 1 is True, 2 is True, 3 is True
      B. 1 is False, 2 is True, 3 is True
      C. 1 is True, 2 is False, 3 is True
      D. 1 is False, 2 is True, 3 is False
      E. 1 is False, 2 is False, 3 is False

414. Which of the following is associated with crack (the free-base form of cocaine)?
     A. Flashbacks (recurrences of effects) may occur months after the last use of the drug
     B. It may cause seizures and cardiac arrhythmias
     C. It acts by blocking adrenergic receptors
     D. It is the salt form of cocaine
     E. It is primarily administered intranasally
415. Choose the correct statement about a duped practitioner.
     A. Never assumes the best about his patients and is gullible
     B. Never leaves script pads lying around
     C. Does not believe in hydrophilic medicine “fell” into the toilet or the sink
     D. Believes when patients only want specific medications (i.e. OxyContin or Percocet)
     E. Never co-dependent - always tells patients “No” when they ask for narcotics

416. For the following statements, first decide if each is true or false and then select the correct pattern from
    the choices given.1)Narcotic agonist/antagonist drugs are useful agents for pain management in many
    situations.2)The metabolism of opioid medication is predictable within ethnic subsets or behavioral subsets
    of the general population.3)CYP2D6 extensive metabolizers (normals) comprise a majority of the patients
    tested for the genotype.
     A. 1 is True, 2 is True, 3 is True
     B. 1 is False, 2 is True, 3 is True
     C. 1 is True, 2 is False, 3 is True
     D. 1 is False, 2 is True, 3 is False
     E. 1 is False, 2 is False, 3 is False

417. Regarding the use of opioids, which of the following statements is true?
     A. Opioid medications have predictable side effects at certain doses.
     B. Blood level of the drug needed for perceived therapeutic effect is consistent through the day.
     C. If a pain signal is too weak to be perceived, it has no biophysiologic effect.
     D. Complete pain relief is the goal of the use of opioid medication.
     E. Treating pain aggressively early may decrease the risk of sensitization.

418. The Drug Abuse Warning Network (DAWN) is a network that:
     A. Treats addicted patients
     B. Is a self help and support group
     C. Collects information on hospital emergency department admissions for drug-related episodes
     D. Is an arm of the Drug Enforcement Agency
     E. Monitors physicians‟ prescription habits

419. Regarding low back pain in a primary care practice:
     A. Less than 10% of new low back pain patients followed up with a doctor at 12 months.
     B. Less than 10% of new low back pain patients still had low back pain at 12 months
     C. Less than 10% of new low back patients still had difficulties with ADLs at 12 months
     D. Less than 10% of new low back pain patients still had pain complaints at 3 months
      E. Less than 10% of new low back pain patients followed up with a doctor at 3 months
420. Multiple functions of a medical record include all EXCEPT:
      A. Support “medical necessity”
      B. Reduce medical errors & professional liability exposure
      C. Reduce audit exposure
      D. Facilitate claims review
      E. Facilitate upcoding

421. Which one of the following statements about cocaine is false?
     A. Blocks sodium channels in axonal membranes
     B. Blood pressure increase is due to its ability to release norepinephrine from sympathetic nerve terminals
     C. Cardiac arrhythmias may occur at high doses
     D. Derived from a botanical source
     E. Topical application can provide local anesthesia and restrict bleeding

422.     A 25-year-old male receiving hydrocodone and diazepam presents with disorientation. He states that he
       had nausea, vomiting, abdominal pain and diarrhea since he took “too many pain pills”. During this time
       he becomes extremely lethargic, with slow respirations. No other history is available. Your immediate
       action, in addition to O2 administration is to administer:
        A. Naloxone
        B. Diphenoxylate
        C. N-acetyl-L-cysteine
        D. Prochlorperazine
        E. Flumazenil

423. The thalamus:
     A. Is a collection of cell bodies that process incoming sensory signals.
     B. Can tell the difference between different receptors.
     C. Connects to various areas of the cortex.
     D. Is made up of wide dynamic response neurons.



424. Which of the following is true about the federal Controlled Substances Act:
     A. It prohibits self-prescribing.
     B. It permits DEA Diversion Investigators to inspect patient records without patient consent, upon written
         request.
     C. It allows most practitioners to prescribe C-I substances for IRB-approved research
     D. It permits a “Do Not Fill Until” instruction on a prescription order.
     E. It prohibits prescribing methadone without a special registration as a methadone clinic.

425. Pharmacologic options for pain:
     A. opioids work for peripheral, nerve, spinal cord, or brain pathologies
     B. local anesthetics work at the brain level
     C. AEDs work at the nerve root and the brain
     D. Anti-inflammatories work at the periphery only.

426. While on a maintenance dose of methadone 80 mg per day, a patient “shoots up” the heroin equivalent of
    10 mg. The most likely effect will be:
     A. Euphoria and sedation
     B. Sedation only.
     C. Neither euphoria nor sedation
     D. Lacrimation, piloerection, and abdominal cramps
      E. Respiratory distress, chest pain, and tachycardia

427. Following a very large overdose of a benzodiazepine, a patient is admitted to hospital. Which one of the
     following is not likely to be of therapeutic value in the management of this patient?
      A. Administration of naloxone
      B. Gastric lavage if an endotracheal tube is in place
      C. Intravenous flumazenil
      D. Protection of the airway
      E. Ventilatory support

428. What are the correct statements about drug abuse in patients receiving opioids?
      A. Illicit drug use and abuse of prescription controlled substances is non-existent in patients receiving long-acting
          opioids in appropriate doses.
      B. Short-acting opioids show significantly higher use of illicit drugs and abuse of controlled prescription drugs.
      C. Illicit drug use and controlled substance abuse in chronic non-cancer patients is similar whether they are on
          short-acting or long-acting opioids.
      D. Patients on long-acting opioids are highly compliant and functional and therefore not necessary to monitor
          them.
      E. Patients on short-acting opioids significantly abuse drugs. Thus, they should be monitored every month with
          urine drug testing.

429. A 29-year-old male uses secobarbital to satisfy his addiction to barbiturates. During the past week, he is
     imprisoned and is not able to obtain the drug. He is brought to the prison medical ward because of the onset
     of severe anxiety, increased sensitivity to light, dizziness, and generalized tremors. On physical examination,
     he is hyperreflexic. Which of the following agents should he be given to diminish his withdrawal symptoms?
      A. Buspirone
      B. Chloral hydrate
      C. Chlorpromazine
      D. Diazepam
      E. Trazodone

430. Convulsions caused by drug poisoning are most commonly associated with
      A. Phenobarbital
      B. Diazepam
      C. Strychnine
      D. Chlorpromazine
      E. Phenytoin

431. When stimulating a receptor:
     A. Increased stimulation causes increased amplitude of the action potential
     B. Increased stimulation causes increased firing of the action potential
     C. Increased stimulation causes increased voltage of the action potential
     D. Increased stimulation causes increased recruitment of other receptors

432. Which of the following statements are true?
     A. Opioid calculators are very useful and reliable.
     B. If a patient complains of breakthrough pain, you should double the dose of long acting opioid every day until
         pain relief.
     C. Nerve pain might respond better to anticonvulsants than opioids
     D. Bone pain might respond better to anticonvulsants than opioids
     E. Opioid hyperalgia may be due to M6G accumulation
433. A former heroin addict is maintained on methadone, but succumbs to temptation and buys an opioid on
    the street. He takes it and rapidly goes into withdrawal. Which opioid did he take?
     A. Meperidine
     B. Heroin
     C. Pentazocine
     D. Codeine
     E. Propoxyphene

434. Alkalinization of the urine with sodium bicarbonate is useful in the treatment of poisoning with
     A. Aspirin (acetylsalicylic acid)
     B. Amphetamine
     C. Morphine
     D. Phencyclidine
     E. Cocaine

435. A patient is admitted to the emergency room 2 hours after taking an overdose of phenobarbital. The
    plasma level of the drug at time of admission is 100 mg/L, and the apparent volume of distribution, half-life,
    and clearance of phenobarbital are 35 L, 4 days, and 6.1 L/d, respectively. The ingested dose was
    approximately
     A. 1 g
     B. 3.5 g
     C. 6.1 g
     D. 40 g
     E. 70 g

436. Phencyclidine may best be characterized by which of the following statements?
     A. It has opioid activity
     B. Its mechanism of action is related to its anticholinergic properties
     C. It can cause significant hallucinogenic activity
     D. It causes significant withdrawal symptoms
     E. Treatment of overdose is with an opiate

437. A 44-year-old patient suffering from alcoholism enters a residential treatment program that emphasizes
    group therapy but uses pharmacologic agents adjunctively. The patient is given a drug the decreases the
    craving for alcohol, possibly by interference with the neuroregulatory functions of opioid peptides. Since
    the drug will not cause adverse effects if the patient consumes alcoholic beverages, it can be identified as
     A. Bupropion
     B. Disulfiram
     C. Nalbuphine
     D. Naltrexone
     E. Sertraline

438. A heroin addict comes to the emergency room in an anxious and agitated state. He complains of chills,
    muscle aches, and diarrhea; he has also been vomiting. His symptoms include hyperventilation and
    hyperthermia. He claims to have had an intravenous “fix” approximately 12 hours ago. The attending
    physician notes that pupil size is greater than normal. What is the most likely cause of these signs and
    symptoms?
     A. The patient has overdosed with an opioid
     B. These are early signs of the toxicity of MPTP, a contaminant in “street heroin”
     C. The signs and symptoms are those of the abstinence syndrome
     D. In addition to opioids, the patient has been taking barbiturates
     E. The patient has hepatitis B
439. What are some of the signs of abuse of controlled substances by your office workers and co-workers?
     A. No extra time is spent near a drug supply
     B. Extreme reliability in keep appointments and meeting deadlines
     C. Never volunteer for overtime
     D. Only at work when scheduled
     E. Absenteeism, frequent disappearances or long unexplained absences, making improbable excuses and taking
         frequent or long trips to the bathroom or to the stockroom where drugs are kept

440. According to NIDA household surveys and the National Comorbidity Survey, the prevalence of substance
    abuse among U. S. adults is about:
     A. 1%
     B. 3%
     C. 7%
     D. 17%
     E. 33%

        441. The most commonly used illicit drug is:
        A. Marijuana
        B. LSD
        C. Ecstasy
        D. Methamphetamine
        E. OxyContin®

442. All of the following are signs of controlled substance in work place, EXCEPT:
     A. Progressive deterioration in personal appearance and hygiene
     B. Uncharacteristic deterioration of handwriting and charting
     C. Wearing long sleeves when inappropriate
     D. Personality change - mood swings, anxiety, depression, lack of impulse control, suicidal thoughts or gestures
     E. Increased personal and professional activities

443.     A 51-year-old alcoholic presents to the emergency room with horizontal nystagmus, ataxic gait, and
       confusion. Which of the following is the most likely diagnosis?
        A. Wernicke syndrome
        B. Niacin deficiency
        C. Korsakoff syndrome
        D. Kliiver-Bucy syndrome
        E. Delirium tremens

444. In performing urine drug testing, a physician must know all of the following EXCEPT:
     A. The characteristics of testing procedures, since many drugs are not routinely detected by all UDTs.
     B. Although no aberrant behavior is pathognomonic of abuse or addiction, such behavior should never be
         ignored.
     C. Reliance on aberrant behavior to trigger a UDT will miss more than 50% of those individuals using
         unprescribed or illicit drugs.
     D. Always prescribe “on-demand” for the patient until you are comfortable with the situation.
     E. A history of drug abuse does not preclude treatment with a controlled substance, when indicated, but does
         require a treatment plan with firmly defined boundaries.

445. A patient who had called for an early refill of opioid medication is rather agitated and jittery when seen in
     the office. She states she had not run out of her opioid medication but simply thought she needed a higher
     dose. All of the following symptoms would suggest opiate withdrawal EXCEPT :
        A. Diarrhea
        B. Piloerection
        C. Pinpoint pupils
        D. Sweating
        E. Rhinorrhea

446. Which of the following characteristics of buprenorphine best account for its effectiveness in the treatment
    of opioid dependence and detoxification?
     A. Sublingual formulation with naloxone
     B. High opioid mu-1 receptor affinity and slow receptor dissociation
     C. Partial kappa receptor agonist activity
     D. Low oral bioavailability necessitating parenteral administration
     E. High intrinsic activity at the opioid mu receptor
447. Cocaine intoxication has become a common problem in hospital emergency rooms. Which one of the
    following drugs is not likely to be of any value in the management of cocaine overdose?
     A. Dantrolene
     B. Diazepam
     C. Lidocaine
     D. Naltrexone
     E. Nitroprusside

448.     Compared to a short-acting, immediate release opioid, a long-acting, sustained release opioid differs in
       which one of the following characteristics?
        A. Higher level of opioid receptor affinity and intrinsic activity
        B. Greater degree of tachyphylaxis
        C. Faster development of tolerance
        D. Protracted withdrawal syndrome following abrupt discontinuation
        E. No ceiling effect for analgesia

449. A substance abuser who decides to abstain checks in to a county detoxification facility and undergoes a 5
    day detoxification program. Assuming the abuser gets no further treatment or aftercare, his or her chance
    at remaining sober is about:
     A. < 5%
     B. 10%
     C. 25%
     D. 50%
     E. 90%

450. Recreational use of drugs sometimes leads to dependence. Which of the following is LEAST likely to cause
    physical dependence?
     A. Amphetamine
     B. Cocaine
     C. Heroin
     D. Mescaline
     E. Secobarbital

451. True statements about addiction during pregnancy is:
      A. The prevalence of substance abuse during pregnancy is significant
      B. Women addicted to drugs always have regular menstrual cycles
      C. Women addicted to drugs are unable to conceive
      D. A pregnant woman generally finds out that she is pregnant within a few weeks
      E. Less than 2% of pregnant women use illegal substances during pregnancy
452. Identify the statement describing the withdrawal when chronic opioid use is discontinued?
      A. Is of no clinical significance
      B. Can be prevented by administering of a benzodiazepine
      C. Can be prevented by administering of an amphetamine
      D. Is best managed by slowly tapering the opioid dose by no more than 10% every few days.
      E. Can be alleviated by immediately starting on an opioid agonist-antagonist

453. The US work loss related to pain:
     A. Half the workforce report having pain in the last two weeks.
     B. 10% of the work force was absent from work one or more days per week
     C. Abdominal pain was the most common complaint.
     D. Half of the workforce lost productive time due to pain
     E. An average of 8 hours of work per week is lost because of pain

454. According to the Federal Controlled Substances Act of 1970, a Schedule III drug could be considered to
    possess which one of the following characteristics:
     A. Lack of accepted safety and indication for medical use
     B. Limited, if any, physical or psychological dependence
     C. High potential for abuse
     D. No withdrawal syndrome noted with abrupt discontinuation of use
     E. Analgesic, anabolic, sedative, and/or hypnotic effects

455. Your friend’s daughter whom you have known for several years makes an appointment with you. During
    the visit, she tells you that she is a heroin addict and requests a prescription for Hydrocodone. Your
    options in this situation are as follows:
     A. Immediately call her father and give hydrocodone.
     B. Immediately tell father and give her Methadone.
     C. Start rapid detoxification in your office.
     D. Provide her with a prescription for Methadone maintenance
     E. Do not tell the father and do not give Hydrocodone.

456.     All of the following are accurate statements with managing opioid-dependent pregnant patients
       experiencing withdrawal symptoms when the drug is discontinued, EXCEPT:
        A. Methadone frequently is used to treat acute withdrawal from opioids
        B. Current federal regulations restrict the use of methadone for the treatment of opioid addiction to specially
           registered clinics
        C. Methadone may be used by a physician in a private practice for temporary maintenance or detoxification when
           an addicted patient is admitted to the hospital for an illness other than opioid addiction
        D. Methadone may never be used by a private practitioner in an outpatient setting when administered daily.
        E. Methadone may be used by a private practitioner in an outpatient setting when administered daily for a
           maximum of three days

457. Which one of the following is the most frequently abused opiate in the United States?
     A. Morphine
     B. Toradol
     C. Hydrocodone
     D. Oxycodone
     E. Fentanyl lollypops

458. A substance abuser enters and completes a 6 months long term treatment program. His or her chance at
    remaining sober is about:
      A. 5%
      B. 10%
      C. 30%
      D. 60%
      E. 90%

459. An infant born at 35 weeks’ gestation to a mother with no prenatal care is noted to be jittery and irritable,
    and is having difficulty feeding. Child had coarse tremors on examination. The nurses report a high-pitched
    cry and note several episodes of diarrhea and emesis. It is suspected that the infant is withdrawing from
     A. Alcohol
     B. Marijuana
     C. Heroin
     D. Cocaine
     E. Tobacco

460. After an all-night party, a 38-year-old man is brought to the emergency room at 5 AM by friends. In the
     early morning hours the patient had become very happy, excited, and talkative. An hour later he had
     become dizzy and quite pale and then vomited. Subsequently, his friends noticed that his lips and fingers
     were twitching and that he seemed to be hallucinating. In the hospital, the physical examination reveals a
     well-dressed, apparently affluent young man who is very agitated and incoherent. His blood pressure is
     180/110 mm Hg, with a heart rate of 100/min and a respiratory rate of 20;/min. Other signs and symptoms
     include pale and dry mucous membranes, mydriasis, hyperthermia, and increased deep tendon reflexes.
     The most reasonable preliminary diagnosis in this case is that the patient is intoxicated by
      A. Cocaine
      B. Ethanol
      C. Flunitrazepam
      D. Hashish
      E. Heroin

461. Which of the following statements about the CSA is true?
     A. If a practitioner needs only a small number of dosage units of a controlled substance for office use , a
        prescription order may be issued to permit a pharmacy to dispense them.
     B. The Act prohibits treating a known addict with an opioid/opiate product for persistent (as opposed to acute)
        pain.
     C. The defines the term “narcotic” as those controlled substances which are opioids or opiates, whether natural,
        synthetic, or semi-synthetic.
     D. Cocaine is classified by the Act as a C-I substance.
     E. The Act permits DEA Diversion Investigators to inspect your controlled substances records (inventories,
        storage facility, order forms, etc.) at any time during your normal practice hours.




   Directions: Each question below contains four suggested responses of which one
   or more is correct. Select


   A if            1, 2 and 3 are correct
   B if            1 and 3 are correct
   C if            2 and 4 are correct
   D if            4 is correct
   E      if       All (1, 2, 3 and 4) are correct


462. Choose the correct statement of U.S. opiate abuse patterns:
      1. Change from morphine to heroin in 50s-60s. Dramatic increase in numbers 60s-70s.
      2. Reduction in opiate abuse during 80s and early 90s (?cocaine effect?)
      3. Prescription opiate abuse increases in late 1990s (?or increased awareness?)
      4. Heroin resurgence begins late 1880‟s.

463. What are the true statements about early history of Opium?
     1. Arabia - (600-900 A. D.) used medicinally. When the Koran forbade alcohol, Opium and Hashish became
        the primary social drugs.
     2. Galen - 100 A. D. - „great cure-all‟
     3. Greece - mixed with wine 100 B. C.
     4. Eber‟s Papyrus, 1500 B. C. - pain relief

464. An intervention on a chemically dependent individual should include all of the following:
      1. A clear message
      2. Caring for the patient
      3. Planning
      4. Presence of persons important to the patient

465. Urine screening of patients should be able to detect each of the following:
     1. Cocaine
     2. Morphine
     3. Alcohol
     4. Barbiturates

466.      Studies show that methadone maintenance in the mother, compared to untreated opioid abusers is
       associated with
        1. Shorter gestation and increased birth weight
        2. Longer gestation and increased birth weight
        3. Shorter gestation and decreased birth weight
        4. Longer gestation and decreased birth weight

467. What are the true statements describing history of spread of opium?
     1. Arabic traders spread use and cultivation to China by 900 A. D.
     2. 1644 China outlawed tobacco, opium smoking became endemic
     3. 1700 British East India company smuggled opium from India to China for tea (China refused legitimate
        trade).
     4. 1839 - Because of “rampant addiction” Chinese emperor destroyed 45,000 pounds of British opium in
        Canton, beginning the Opium war.

468. The duration of severity of withdrawal symptoms in sedative-anxiolytic abusers depend on:
      1. Duration of drug use
      2. Amount of drug used
      3. Rate of elimination of drug and metabolites
      4. Method of drug administration

469. Chose the correct statements about use of opium in Europe and America:
     1. Paracelsus 1500 called laudanum (opium, cloves, and alcohol) the “stone of immortality”.
     2. Thomas Sydenham brought to England about 1700.
     3. 1831 Sertuener given Nobel Prize for isolating individual opiates.
     4. 1853 - hypodermic syringe invented. The American Civil War and Prussian Wars of 1860-1870 led to
        widespread morphine injection.

470. A 34-year-old recently married man seeks help from a methadone clinic. Chose all of the true statements
     meeting criteria for acceptance into the program:
      1. He has AIDS
      2. He has no legal charges pending
      3. He has used heroin for 2 years
      4. He has been married to a heroin addict

471. Medications that should be avoided with grapefruit include:
      1. those with a low oral bioavailablity
      2. those metabolized by CYP3A4
      3. those with an intestinal transport by p-glycoprotein
      4. those metabolized by CYP2D6

472. Mechanisms of drug interactions include:
     1. Drug-drug interactions
     2. Drug allergies
     3. Drug-food interactions
     4. Drug doses

473. Examples of pro-drugs include:
     1. Gabapentin
     2. Morphine
     3. Baclofen
     4. Codeine

474. If a patient is a “slow metabolizer”, possible responses to medications might include:
     1. Increased toxicity
     2. Decreased effect
     3. Increased effect
     4. Decreased excretion

475. If a patient who is on tramadol is given a CYP2D6 inhibitor,
      1. the analgesia of tramadol will decrease
      2. the analgesia of tramadol will increased
      3. the excretion of tramadol will decrease
      4. the excretion of tramadol will increase

476. Drugs can be altered by:
     1. Absorbsion
     2. Distribution
     3. Metabolism
     4. Excretion

477. What is the level of care - necessary to achieve and maintain abstinence from opioids?
     1. Medically managed inpatient treatment
     2. Intensive outpatient program
     3. Residential treatment program
      4. Medically managed phone consultations

478. What precautions must a physician take in interpretation of urine drug testing?
     1. Consult with laboratory regarding ANY unexpected results.
     2. Never use results to strengthen physician-patient relationship and support positive behavior change.
     3. Schedule an appointment to discuss abnormal/unexpected results with the patient; discuss in a positive,
         supportive fashion to enhance readiness to change/motivational enhancement therapy (MET) opportunities.
    4. It is not necessary to document results and interpretation

479. Urine Drug Testing (UDT) may be useful in which of the following situations?
     1. To determine if a patient is taking the controlled substances prescribed
     2. To determine the patient‟s state of hydration in an effort to regulate the dosage of medication
     3. To determine if the patient is taking medications and substances which are not prescribed by the physician
        administering the test
     4. To determine the half-life of the drugs prescribed

480. What are the correct statements of urine drug testing?
     1. Thin-layer chromatography (TLC) is a relatively old technique, testing the migration of a drug on a plate or
        film, which is compared to a known control
     2. Gas chromatography (CGMS) is most sensitive and specific test, most reliable, and labor intensive/costly
     3. Enzyme immunoassay is easy to perform/highly sensitive, more sensitive than TLC, and less expensive than
        GC/MS
     4. Rapid drug screens are not similar to other enzyme immunoassay testsand may be more expensive

481. Choose the correct statements about cocaine testing.
     1. A patient‟s urine may test positive for the cocaine metabolite benzoylecgonine after a procedure with cocaine
        as a topical anesthetic for up to 3 to 4 weeks.
     2.    Cocaine, a topical anesthetic, is clinically used in certain trauma, dental, ophthalmoscopic, and
        otolaryngologic procedures.
     3. There is structural similarity between other topical anesthetics that end in “caine” (eg, Novocaine, lidocaine)
        and cocaine or benzoylecgonine.
     4. A positive UDT result for the cocaine metabolite, in the absence of a medical explanation, should be
        interpreted as due to deliberate use.

482. All of the following statements are correct about detoxification EXCEPT:
      1. In one year post completion outcome data all patients still had some pain - most had much less
      2. In one year post completion outcome data 70% had achieve continuous sobriety
      3. In one year post completion outcome data pain was not ever worse without narcotics than it was while taking
          narcotics
      4. In one year post completion outcome data only 20% had continued sobriety

483. Controlled substance abuse in work place may be identified by the following signs?
      1. Work performance alternating between periods of high and low productivity and mistakes made due to
         inattention, poor judgment and bad decisions.
      2. Confusion, memory loss, and difficulty concentrating or recalling details and instructions. Ordinary tasks
         require greater effort and consume more time
      3. Interpersonal relations with colleagues, staff and patients suffer.
      4. Promptly admits errors or accepts blame for errors or oversights

484. Drug testing may be performed by any of the following
     1. Hair samples
     2. Saliva testing
      3. Serum drug testing
      4. Urine drug screening

485. What are the reasons for drug testing in patients in your practice?
     1. To assess if the patient is taking the medications prescribed
     2. To assess if the patient is taking substances/drugs NOT prescribed
     3. To assess if the patient is taking licit and illicit drugs
     4. To assess if the prescribed drugs caused diabetes

486. What are Federation of State Medical Boards Guidelines for the Treatment of Pain?
     1. Use of controlled substances, including opiates may be essential in the treatment of pain
     2. Effective pain management is a part of quality medical practice
     3.   Patients with a history of substance abuse may require monitoring, consultation, referral and extra
        documentation
     4. MD‟s should not fear disciplinary action for legitimate medical purposes

487. What are the correct statements about controlled substance abuse?
      1. Almost half a ton of prescription narcotics reached six counties in Eastern Kentucky from 1998-2001,
         equating to .75 pound for every adult in those counties.
      2. On a per capita basis, Eastern Kentucky drugstores, hospitals, and legal outlets receive more prescription
         painkillers than anywhere else in the United States.
      3. Nationally, emergency room visits for hydrocodone overdoses increased 500 percent from 1990-2000
      4. OxyContin sells on the street for about $10/pill; Lortab sell for $2/pill and Lorcet for $1/pill

488. Choose the correct statement about state board rules physicians do not know:
      1. Cannot Rx Schedule II or III for family members
      2. Can provide samples of unscheduled drugs for family, but MUST document in a medical record
      3. Cannot Rx to anyone (including friends) if you have not documented their H&P and have a current chart on
         file.
      4. Can Rx for yourself

489. What are the correct statements about urine drug testing (UDT)?
     1. A UDT would be positive if the patient took the drug (true positive) and negative if the drug was not taken
        (true negative).
     2. Sensitivity of a test is the ability to identify a particular drug.
     3. False-positive or False-negative results can occur, so it is imperative to interpret the UDT results carefully.
     4. Specificity is the ability to detect a class of drugs.

490. Studies have shown:
     1. Daily pain is present in one third of the population over 65 years old
     2. Moderate to severe non-cancer pain is present in 9% of the US population.
     3. One-thirds of chronic pain patients have been living with pain for more than 5 years.
     4. Only 15% of primary care physicians enjoy taking care of pain patients.

491. The CSA requires the following of practitioners who dispense ONLY manufacturer’s samples of controlled
     substances to patients.
      1. An initial, and then biennial, inventories.
      2. A secure locked box for storage of controlled substances.
      3. As separate dispensing log, in addition to any records kept in the patients‟ charts.
      4. Complete records of all controlled substances received, dispensed, or otherwise disposed of.
492. “Joe the Doper” is one of your patients. You are prescribing oxycodone for a legitimate medical purpose,
    and his pain is well controlled. Joe had a routine urine drug test as part of a federal job interview and the
    screen reported opiates as “none detected”Joe “found religion” during his last incarceration in jail for
    cutting the heads off parking meters and swears that he has been taking the meds and not selling them on
    the street. Correct options at this time include:
     1. Increase his dose of oxycodone and recheck his urine
     2. Make a note in the chart that you really believe him and continue the oxycodone
     3. Change his pain medication to a fentanyl patch
     4. Order GC/MS specifically for oxycodone

493. As a pain physician, you are evaluating a new patient who recently moved to your area. Consistent with
     your usual office policy, all new patients get a urine drug test. The patient’s urine is positive for morphine,
     however his medication list shows no listing for any controlled substances.Which of the following are
     possible sources for this finding?
      1. Morphine use
      2. Heroin use
      3. Poppy seeds
      4. Codeine

494. If urine tampering is suspected, the following should be included in urine drug testing (UDT)
     1. Temperature
     2. Creatinine
     3. PH
     4. Color

495. What are the true statements about marijuana urine drug testing (UDT)?
     1. UDTs provide reasonable reliability
     2. Marinol tests positive
     3. Protonix may test false-positive
     4. Marijuana may be positive 2 years after use.

496. The “Whizzinator” is which of the following:
     1. An electromechanical device for stirring alcoholic drinks
     2. A urologic testing device to measure the force of urine flow
     3. A suction device for maintaining an erection
     4. A commercially available device to thwart urine drug testing

497. The CSA requires the following of practitioners who administer controlled substances via any modality to
     patients directly, before or during procedures in the office or surgical suite, from physician-owned stock or
     supplies:
      1. An initial, and then biennial, inventories
      2. A secure locked box for storage of controlled substances
      3. As separate dispensing log, in addition to any records kept in the patients‟ charts.
      4. Complete records of all controlled substances received, dispensed, or otherwise disposed of.

498. A newly immigrated patient from Viet Nam with tuberculosis, neuropathy, and acid reflux disease is being
     prescribed methadone for pain following spine surgery to stabilize a fracture. The metabolism of
     methadone has been documented to be affected by:
      1. Isoniazid
      2. Carbamazepine
      3. Cimetidine
      4. Ethnicity
499. When a state has different rules than the CSA:
     1. Federal constitutional supremacy principles dictate that the CSA overrules all state regulations relating to
        controlled substances.
     2. The issue is decided on a case-by-case basis, by the courts.
     3. State rules govern, as the states traditionally regulate medicine and pharmacy.
     4. Whichever rule is more restrictive must be followed, as both have full legal force and effect.

500. What are the correct statements about UDT of cocaine?
     1. Tests for cocaine react principally with cocaine and its primary metabolite, benzoylecgonine.
     2. Tests for cocaine are non-specific in predicting cocaine use.
     3. Tests for cocaine have low cross-reactivity with other substances
     4. Cold medicines may test false-positive for cocaine

501. Significant drug-food interactions include:
     1. Coffee and tea are more rapidly metabolized in the presence of ciprofloxin.
     2. Phenobarbital is useful to treat folate deficiency neuropathy.
     3. Smokers have a greater perceived effect of propoxyphene than non- smokers.
     4. NSAIDS cause greater renal damage in patients with high dietary fat intake.

502. Incipient liver failure due to acetaminophen toxicity will most affect the metabolism of:
     1. Lidocaine
     2. Methadone
     3. Codeine
     4. Meperidine

503. When changing a patient’s controlled substance medications, a physician may desire a patient to bring in
     all unused supplies of discontinued controlled substances. Which of the following is true?
      1. The physician may refuse to prescribe additional controlled substances until the patient destroys (in a verified
          manner) or surrenders all unused meds.
      2. Because they are the legal property of the patient, the physician can do nothing about the patient‟s previously
          prescribed and dispensed medications.
      3. The physician may observe the patient destroy the medications by flushing them down the toilet, unless such
          disposal is prohibited by state law.
      4. The physician may take possession of unused medications, inventory them, and send them to the DEA.

504. Choose the correct statements about codeine and morphine
      1. Prescribed morphine cannot account for the presence of codeine.
      2. Codeine metabolizes to morphine.
      3. Codeine alone is possible due to a small proportion of patients who lack the cytochrome P450 2D6 enzyme
         necessary to convert codeine to morphine.
      4. Morphine metabolizes to codeine

505. The following MAY legally be prescribed by a physician without a special registration or permission from
    DEA:
     1. methadone
     2. buprenorphine
     3. injectible C-II morphine
     4. heroin

506. What are the pitfalls of opioid urine drug testing?
     1. Tests for opiates are very responsive for morphine and codeine.
     2. Urine drug tests do not distinguish between morphine and codeine.
     3. UDT‟s show a low sensitivity for semisynthetic/synthetic opioids such as oxycodone.
     4. A negative response excludes oxycodone and methadone use.

507. What are the correct statements of amphetamine in urine drug testing?
     1. Tests for amphetamine/methamphetamine are highly cross-reactive.
     2. Very predictive for amphetamine/methamphetamine use.
     3. UDT will detect other sympathomimetic amines such as ephedrine and pseudoephedrine
     4. Further testing is NOT required.

508. What is the explanation of a routine urine drug test in a patient receiving codeine with acetaminophen 240
    mg/day testing positive for codeine and negative for morphine?
     1. The laboratory made a mistake
     2. The morphine was metabolized faster than the codeine and was therefore excreted earlier
     3. The morphine was “neutralized” by the specific carrier agent in the Codeine with acetaminophen
     4. The patient is one of a small number who lack cytochrome P450 2D6 and cannot convert codeine to
        morphine

509. You are treating a pregnant heroin addict who wants to be sure that her baby is not harmed. Your best
    management would be:
     1. Maintain the patient on high-dose methadone
     2. Withdraw the patient from opioids using clonidine
     3. Withdraw the patient from heroin using methadone
     4. Maintain the patient on low-dose methadone

510. The following statements are true:
     1. All opiates are opioids
     2. All opioids are opiates
     3. All opioids are narcotics
     4. All narcotics are opioids

511. Which of the following are likely to be shown by patients with alcoholic hallucinosis?
     1. Hallucinatory voices commenting unfavorably
     2. Underlying schizophrenic illness
     3. Consciousness not impaired
     4. No evidence of delusional thinking

512. Which of the following statements about LSD flashbacks are correct?
     1. Often triggered by marijuana use
     2. Usually cease within a few months of stopping hallucinogen
     3. Often pleasant to the hallucinogen user
     4. Subject may intentionally induce

513. In adults with no prior history of seizure disorder, seizures may be caused by:
      1. Phencyclidine intoxication
      2. Cocaine intoxication
      3. Amphetamine intoxication
      4. Meperidine intoxication

514. Which of the following symptoms are characteristic of phencyclidine intoxication?
     1. Elevated blood pressure
     2. Pinpoint pupils
     3. Vertical nystagmus
     4. Hematuria

515. During cocaine withdrawal, which of the following symptoms can be anticipated?
      1. Cardiac arrhythmias
      2. Desire for sleep, often with insomnia
      3. Delirium
      4. Depression

516. Which of the following statements about alcohol-induced blackouts are correct?
     1. Remote memory deficit
     2. Immediate memory deficit
     3. Does not occur in non-alcoholics
     4. Short-term memory deficit

517. After chronic amphetamine use, abrupt withdrawal is likely to cause which of the following symptoms?
      1. Seizures
      2. Delirium
      3. Formication
      4. Sleep disturbance

518. In the management of detoxified substance-abusing patients in a therapeutic community, poor prognosis is
     more likely with:
      1. Coexisting severe psychopathology
      2. Dropout before three months
      3. Continued alcohol use
      4. Adjunctive use of antidepressants

519. Which of the following statements about diazepam-dependent patients are correct?
      1. Withdrawal symptoms become disabling within 24 hours of stopping
      2. Low alcohol intake may precipitate overdose
      3. Most likely to be black male
      4. May show no disability until stopping diazepam use

     520. Which of the following are true regarding nociceptive pain?
     1. Alpha 2 antagonists are useful for management.
     2. Automatic firing of damaged nerves is a component.
     3. Deafferentation can produce a firing of first order neurons.
     4. Prostaglandin inhibition may be useful for management.

521. Sequelae of an acute cocaine overdose include
     1. Myocardial ischemia and high output cardiac failure
     2. Seizure activity
     3. Tremulousness and hyperthermia
     4. Blockade of inhibition of epinephrine

522. Symptoms of opioid toxicity include which of the following?
     1. Leg muscle twitching
     2. Pulmonary edema
     3. Seizures
     4. Hypothermia
523. What are the characteristics of a drug dependent (addict) practitioner?
     1. Starts by taking controlled drug samples
     2. Never asks staff to pick up medications in their names
     3. Calls in scripts in names of family members or fictitious patients and picks them up himself
     4. Never uses another doctor‟s DEA number

524. Methadone blood levels are:
     1. increased by cimetidine
     2. decreased by butabutal
     3. increased by Ciprofloxin
     4. decreased by grapefruit juice

525. In amphetamine delusional disorder, the patient is likely to show:
     1. Paranoid delusions
     2. Craving for food
     3. Tactile hallucinations
     4. Excessive REM sleep

526. Which of the following statements about alcohol withdrawal delirium are correct except ?
      1. May be precipitated by surgery
      2. Withdrawal seizures are most common 24 hours after withdrawal
      3. Delirium tremens has peak incidence four days after withdrawal
      4. Does not occur while still drinking

527. Which of the following statements about daily, heavy marijuana users are correct?
     1. Decrease in tachycardia caused by marijuana
     2. Detectable in urine 2-3 weeks after stopping
     3. Reduced mood elevation effect
     4. Reduced need to continue marijuana use

528. Which of the following statements about the treatment of chronic alcoholics are correct?
     1. It is essential to face them with the physical consequences of their drinking during the first interview
     2. It is necessary to discuss frankly the patient‟s drinking patterns when initially interviewed
     3. Family history of alcoholism is irrelevant in the individual treatment prognosis
     4. The alcoholic‟s denial often makes the patient unavailable for treatment

529.      The following statements are true with relation to routine drug screens and their detectability. The
       following drugs may not be detected in routine urine drug screens:
        1. Methadone
        2. Fentanyl
        3. Oxycodone
        4. Morphine

530. Appropriate therapy for alcohol withdrawal includes the administration of the following medications:
     1. Diazepam
     2. Clonidine
     3. Lorazepam
     4. Buprenorphine

531. The characteristics of marijuana include:
     1. It may lower intraocular pressure
     2. A sign of acute intoxication is reddening of conjunctiva
     3. It has antiemetic properties
     4. Heavy chronic use can lower serum testosterone levels in men

532. Strategies to reduce aberrant drug behaviors include:
     1. Random urine drug screens
     2. Narcotic contracts
     3. No early refills
     4. Opioid rotation

533. Chronic alcoholism is associated with:
     1. Retrobulbar optic neuropathy
     2. Caudate calcification
     3. Cerebellar anterior lobe degeneration
     4. Acoustic neuroma

534. Which of the following statements are correct in the treatment of pregnant opioid addicts?
      1. High-dose methadone maintenance leads to low-risk neonatal withdrawal
      2. Opioid withdrawal may lead to miscarriage or fetal death
      3. Women using opioids tend to have easy, uncomplicated deliveries
      4. Many opioid dependence women seek treatment when they become pregnant

535. Which of the following statements about the treatment of chronic alcoholism with disulfiram are correct?
     1. Alcohol dehydrogenase is inhibited
     2. Aldehyde accumulation causes vasodilation and hypotension
     3. Indicated in alcohol-induced dementia
     4. Treatment benefit is not dose-related

536. When a patient has been taking heavy doses of barbiturates for an extended period, early symptoms of
    withdrawal are likely to include:
     1. Weakness
     2. Insomnia
     3. Anxiety
     4. Tremulousness

537. Which of the following statements about the symptoms of barbiturate withdrawal are correct?
     1. Develops more quickly with secobarbital then phenobarbital abusers
     2. Cardiovascular collapse may be fatal
     3. Abdominal discomfort, nausea, and vomiting
     4. Seizures generally precede delirium

538. Which of the following statements are correct about heroin abuse?
     1. The peak incidence is age 25 to 35
     2. It affects men three times as often as women
     3. The majority of heroin abusers are involved in maintenance programs
     4. Most heroin abusers eventually stop on their own

539. Symptoms of heroin withdrawal include all of the following :
      1. Twitching movements in the legs
      2. Dilated pupils
      3. Increased blood pressure
      4. Diarrhea
540. In treatment opioid overdose, which of the following is effective?
     1. Methadone
     2. L-alpha-acetylmethadol (LAAM)
     3. Buprenorphine
     4. Naloxone

541. Symptoms of withdrawal from opioids include the following symptoms and signs:
     1. Sweating
     2. Restlessness
     3. Irritability
     4. Hot/cold flashes

542.     A patient presents to you with injury of ankle strain. The ankle is swollen and extremely painful.
       However, there was no fracture. The patient is also on opioid maintenance treatment with methadone of
       120 mg daily. True statements with regards to his pain management including the following:
        1. Opioid maintenance patients develop full tolerance to the analgesic effects of the maintenance dose of
           methadone.
        2. During opioid maintenance treatment, a cross-tolerance develops to all opioid agonist drugs.
        3. The usual maintenance dose of opioid maintenance does not provide any analgesia, and adequate analgesia
           will require higher doses of opioid agonists given more frequently than in the non-tolerant patient.
        4. The usual maintenance dose provides significant analgesia, thus, no opioid agonists are required to provide
           analgesia for the acute pain.

543. What were the physician opioids of choice in the 1990s?
     1. Oxycodone 20%
     2. Hydrocodone 70%
     3. Dilaudid 20%
     4. Fentanyl class 10%

544. What are the correct statements about a deficient (dated practitioner)?
     1. Too busy to keep up with CME
     2. Only aware of a few treatments or medications
     3. Prescribes for friends or family without a patient record
     4. Well aware of controlled drug categories

545. Regarding cancer pain:
     1. There are 1 million cancer patients world-wide
     2. 10% of cancer patients in active treatment report pain
     3. Half of advanced cancer patients complain of pain
     4. More than one-third of oncology outpatients complain of pain that interferes with ADLs

546. Which of the following is a true statement:
     1. Tramadol‟s first metabolite has less activity than the parent compound
     2. Heroin is metabolized to morphine
     3. Morphine‟s metabolites increase in liver failure.
     4. Hydrocodone is metabolized to hydromorphone.

547. What were the physician drugs of abuse in 2001?
     1. Opioids 30%
     2. Alcohol 20% to 30%
     3. Benzodiazepines 20%
     4. Marijuana 2%
548.   A significant minority of persons with substance abuse disorder have and atypical course and will
    eventually either stop using or be able to return to controlled use. Which of the following factors are
    associated with being able to stop or control use?
     1. Stable premorbid personality
     2. Developing medical complications of substance abuse
     3. Age greater than 40
     4. Arrest and incarceration
549. A 29-year old patient whom you had been treating for postlaminectomy syndrome with only time release
    morphine, 120 mg per day, had a urine drug screen positive for cocaine and benzodiazepines. When this
    was discussed with the patient, he admitted getting medications from a number of physicians and to
    injecting cocaine intravenously, but refused evaluation by an addictionologist and was dismissed from your
    practice. 3 days later an emergency room physician calls because the patient has been admitted following
    his first ever grand mal seizure. Which of the following are likely causes of the seizure?
     1. Cocaine overdose
     2. Opiate withdrawal
     3. Benzodiazepine withdrawal
     4. Cocaine withdrawal

550. Which of the following medications can be used therapeutically in the rehabilitation of opioid dependent
     patients?
      1. Methadone
      2. Naltrexone
      3. Clonidine
      4. Levo-alpha-acetylmethadol

551. In obtaining a history during the evaluation of a new patient, which of the following would be considered
     risk factors for possible substance abuse?
      1. History of substance abuse in a brother and father.
      2. History of psychiatric problems in the mother
      3. History of bipolar illness in the patient
      4. Age over 40 years old

552. Definitions of addiction include the following:
     1. A primary, chronic neurobiologic disease with genetic, psychosocial and environmental factors effecting its
        course and presentation
     2. Characterized by either impaired control of drug use or other symptoms
     3. Addiction involves loss of control, craving, compulsive use, and continued use despite consequences
     4. DSM-IV definition defines addiction to involve impaired control of drug use

553. What were the physician opioids of choice in 2002?
     1. Hydrocodone 40%
     2. Oxycodone 25%
     3. Ultram 70%
     4. Dilaudid 25%

554. Epidemiologic risks for work-related low back pain include:
      1. Prior WC claim
      2. Perceived over-education
      3. Cumulative compressive back forces
      4. Peak hand forces
555. Which of the following would indicate alcohol dependence?
      1. Persistent drinking, even though worsens gastric ulcers
      2. Job efficiency impaired due to repeated hangovers
      3. Several unsuccessful attempts to cut down on drinking
      4. Family history of alcoholism

556. All of the following are symptoms of alcohol withdrawal :
     1. Coarse tremor of hands or tongue
     2. Generalized tonic-clonic seizures
     3. Tachycardia, sweating, dilated pupils
     4. Abducent nerve paresis or paralysis

557. Cocaine abuse is likely to produce symptoms similar to which of the following?
     1. Major depression
     2. Obsessive compulsive disorder
     3. Generalized anxiety disorder
     4. Paranoid schizophrenia

558.     A 16-year-old boy is brought for emergency evaluation after taking some of his mother’s medication in
       order to get “high.” He is flushed and his pupils are dilated and only poorly reactive. He complains of dry
       mouth. He is restless, confused at times, and may be having visual hallucinations. Which of the following
       medications is he likely to have taken?
        1. Phenelzine
        2. Disulfiram
        3. Alprazolam
        4. Benztropine

559.     An otherwise healthy 45 year old patient taking 100 mg of morphine per day for pain associated with
       rheumatoid arthritis has decided to stop his pain medication 3 days prior to seeing you in the office. Which
       of the following symptoms indicate severe withdrawal that probably requires treatment:
        1. Fever
        2. Headache
        3. Hypertension
        4. Rhinorrhea

560. Which of the following agents is associated with withdrawal anxiety
      1. Opioids
      2. Lorazepam
      3. Dexamethasone
      4. Haloperidol

561. True statement about physical examination findings in pregnant women with drug abuse are as follows:
      1. Posterior cervical lymphadenopathy is an early sign of HIV infection.
      2. Finding a new murmur on examination of the heart may indicate endocarditis
      3. A cough productive of black sputum indicates crack smoking
      4. Poor dentition may indicate ongoing drug use, with little concern for dental hygiene
562. True statements about neonatal withdrawal syndrome from methadone are as follows:
      1. Neonatal withdrawal syndromes are characterized by hyperactivity, irritability, hypertonia, difficulty sucking
         or excessive sucking, and high pitched cries.
      2. Neonates with intrauterine drug exposure should be followed in the hospital for 3 to 4 days after the delivery
         to monitor for signs of an abstinence syndrome.
      3. Timing of withdrawal onset depends on the time of the last drug exposure, and metabolism and excretion of
         the drug.
      4. If more than 7 days have elapsed between the last maternal use and delivery, the incidence of neonatal
         withdrawal is high.

563. Opioid neonatal withdrawal syndrome is characterized by the following:
     1. It occurs in 60% to 80% of infants with intrauterine exposure to heroin or methadone
     2. Neonatal opioid withdrawal syndrome is treated with a substitute opioid, such as tincture of opium, paregoric,
        or methadone
     3. Neonatal opioid withdrawal syndrome is treated with a CNS depressant such as phenobarbital
     4. Neonatal opioid withdrawal syndrome occurs in less than 20% of infants with intrauterine exposure to heroin
        or methadone

564. True statements of treatment for acute withdrawal from sedative-hypnotics in pregnant women including
    the following:
     1. This is accomplished in an outpatient setting, which allows family to interact and provide support
     2. This should be accomplished in an inpatient setting, which allows for medical supervision in collaboration
         with an obstetrician
     3. Treatment is different for withdrawal for each sedative-hypnotic, such as barbiturates, benzodiazepines, and
         alcohol
     4. Uncontrolled withdrawal symptoms may be life-threatening to both mother and fetus

565. The choice of opioid medications is influenced by:
     1. Frequency of pain
     2. Response to prior opioids
     3. Daily activity
     4. Cost and insurance plan

566. DSM-IV definition of substance abuse includes at least one of the following in 12 months:
     1. Maladaptive pattern leading to distress or impairment
     2. Recurrent failure to fill role
     3. Recurrent physically hazardous behavior
     4. Recurrent legal problems

567. The following are true statements regarding morphine:
     1. Morphine is primarily renally metabolized
     2. Morphine is primarily renally excreted
     3. Morphine is metabolized by CYP2D6
     4. Morphine is metabolized by glucuronidation
568. DSM-IV definition of substance dependence includes some of the following items as part of at least 3 in 12
    months.
     1. Larger amounts/longer periods
     2. Patient spends large amount of time using/obtaining controlled substances
     3. Activities given up: social/work/recreation
     4. Continued use despite problems
569. If a patient has inadequate relief from an opioid, options include:
     1. increase the dose
     2. increase the frequency
     3. add a breakthrough medication
     4. change medications

570. When choosing an opioid, factors to be considered include:
      1.   patient compliance
      2.   dosing schedule of concurrent medications
      3.   drug interactions
      4.   opioid side effects

571. Findings of illicit drug use based on insurance in interventional pain management setting was:
      1. Third party - 17%
      2. Medicare with/without third party - 10%
      3. Medicare/Medicaid - 24%
      4. Medicaid - 39%

572. The following statements are true regarding the paleospinothalamic tract:
      1. The paleospinothalamic tract is poor in opioid receptors.
      2. The paleospinothalamic tract connects the thalamus to the cortex.
      3. The paleospinothalamic tract passes impulses from the 2nd order neurons to the C-fibers.
      4. The paleospinothalamic tract connects the thalamus and the reticular activating system.

573. What is the definition of addiction as per the Controlled Substances Act?
     1. The term “addict” means any individual who habitually uses any narcotic drug so as to endanger the public
        morals, health, safety, or welfare
     2. “Addict” is a patient who is taking as per prescription very high opioids in cancer pain
     3. Any individual who is so far addicted to the use of narcotic drugs as to have lost the power of self-control
        with reference to his addiction.
     4. “Addict” is a patient taking controlled prescription drugs

574. Goals of pharmacotherapy in opioid addiction include the following:
      1. Prevention or reduction of withdrawal symptoms
      2. Prevention or reduction of drug craving
      3. Restoration to or toward normalcy of any physiologic function disrupted by chronic drug use.
      4. To provide addictive drugs to prevent relapse

				
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