Fundamentals of Pharmacology 8th Edition Bullock Test Bank

Fundamentals of Pharmacology 8th
Edition Bullock Test Bank

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Exam
Name___________________________________
Bullock 8e: Fundamentals of Pharmacology

Section 8
Section Name: Medicines Used To Relieve Pain and Produce
Anaesthesia
Chapters 39-43
Chapter 39 OPIOID ANALGESICS
Topics:
Pain
Opioid analgesics
Opioid antagonists
Learning objective:
1. Describe the classification, physiology and assessment of pain.
2. Describe the mechanisms of action, adverse effects and clinical considerations of the opioid analgesics.
3. Outline the uses and clinical considerations of the opioid receptor antagonists.
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
1) Somatic pain is defined as:

A) pain of sudden onset and short duration.
B) pain associated with the musculoskeletal system.
C) a reaction that avoids further tissue damage.
D) pain induced through remodelling of neural connections.
Answer: B
Topic: Pain
Learning objective: 1 Describe the classification, physiology and assessment of pain.
Difficulty: 1
2) What is the equivalent dose of pethidine when compared with 10 mg of morphine?

A) 25–50 mg of pethidine
B) 50–75 mg of pethidine
C) 75–100 mg of pethidine
D) 100–125 mg of pethidine
Answer: C
Topic: Opioid analgesics
Learning objective: 2 Describe the mechanisms of action, adverse effects and clinical considerations of the opioid analgesics.
Difficulty: 3
3) The opioid tramadol should be avoided in clients with:

A) epilepsy.
B) a heart condition.
C) asthma.
D) liver disease.
Answer: A
Copyright ©2017 Pearson Australia (a division of Pearson Australia Group Pty Ltd) – 9781488610028/Bullock/Fundamentals of Pharmacology/8e
Difficulty: 3
4) When administering tramadol, it should not be given with drugs that:

A) affect coagulation.
B) affect blood vessel vasculature.
C) are largely metabolised renally.
D) increase seizure tendencies.
Answer: D
Difficulty: 3
5) Which of the following is NOT a characteristic of oxycodone?

A) It has less of a hepatic first pass than morphine.
B) It has a shorter half-life than morphine.
C) It comes as a suppository formulation, which is useful for overnight analgesia.
D) It comes as a scored tablet formulation, which can be crushed and given with water to clients who have difficulties in
swallowing tablets whole.
Answer: B
Difficulty: 2
6) The opioid receptors most involved in mediating analgesia are:

A) delta and epsilon.
B) kappa and delta.
C) mu and epsilon.
D) mu and kappa.
Answer: D
Difficulty: 3
7) Which of the following narcotics has a prolonged duration of action?

A) Pethidine
B) Methadone
C) Codeine
D) Fentanyl
Answer: B
Difficulty: 3
8) Which of the following pain medicines produce a constipating effect?

A) Pethidine
B) Aspirin
C) Morphine
D) Paracetamol
Answer: C
Learning objective: 2 Describe the mechanisms of action, adverse effects and clinical consideration of the opioid analgesics.
Difficulty: 1
9) The reason that methadone is used to help wean people off heroin is that:
A) methadone has a long half-life, which contributes to weak withdrawal symptoms.
B) methadone is administered orally, reducing syringe use.
C) methadone binds to opioid receptors, leaving few receptors available for a heroin ‘high’.
D) all of the above.
Answer: D
Learning objective: 2 Describe the mechanisms of action, adverse effects and clinical consideration of the opioid analgesics.
Difficulty: 1
Chapter 40 ANTI-INFLAMMATORY, ANTIPYRETIC AND NON-OPIOID

ANALGESIC AGENTS
Topics:
The physiological roles of prostaglandins and their biosynthesis
Non-steroidal anti-inflammatory drugs (nsaids)
The classification of the nsaidS and miscellaneous analgesics
Paracetamol
Medicines used in the management of rheumatoid arthritis
Learning objective:
1. Outline the physiological roles of prostaglandins and their biosynthesis.
2. Describe the mechanisms of action, common adverse effects, and clinical considerations of the non-steroidal anti-
inflammatory drugs (NSAIDs).
3. Describe the classification of the NSAIDs and miscellaneous analgesic agents.
4. Describe the mechanism of action, common adverse effects, and clinical considerations of paracetamol.
5. Outline the types of medicines used in the management of rheumatoid arthritis.
1) Which enzyme is the target for inhibition by the NSAIDs?

A) Cyclo-oxygenase
B) Phospholipase A
C) Adenylate cyclase
D) 5-Lipoxygenase
Answer: A
Topic: The physiological roles of prostaglandins and their biosynthesis
Learning objective: 1 Outline the physiological roles of prostaglandins and their biosynthesis.
Difficulty: 2
2) The combined use of salicylates and corticosteroids may lead to ________ and should therefore be avoided.
A) tinnitus
B) renal failure
C) peptic ulceration
D) liver failure
Answer: C
Topic: Non-steroidal anti-inflammatory drugs (nsaids)
Learning objective: 2 Describe the mechanisms of action, common adverse effects, and clinical considerations of the non-steroidal
anti-inflammatory drugs (NSAIDs).
Difficulty: 2
3) Controlled-release preparations of ketoprofen should be taken ________ to improve the symptoms of arthritic pain.
A) immediately after meals
B) 15 minutes before physical activity
C) at bedtime
D) upon rising in the morning
Answer: C
Difficulty: 2
4) The propionic acid derivatives ibuprofen and naproxen are useful for children suffering from inflammatory disease because
they:
A) are not metabolised in the liver.
B) do not cause gastrointestinal problems.
C) are available as oral liquids so that the exact dose can be administered.
D) do not affect platelet aggregation.
Answer: C
Difficulty: 2
5) Aspirin needs to be stopped approximately ________ before planned surgery and some complex dental procedures because of
the possibility of increased bleeding.
A) two days
B) seven days
C) two weeks
D) seven weeks
Answer: B
Difficulty: easy
6) NSAIDs may not be suitable for use in individuals with renal impairment because they:
A) increase sodium excretion.
B) increase body temperature.
C) reduce the glomerular filtration rate.
D) reduce pepsin levels in the stomach.
Answer: C
Difficulty: 3
7) Extreme diligence should be exercised in administering the correct dose of paracetamol to children because overdose can lead
to:
A) gastrointestinal bleeding.
B) renal failure.
C) inhibition of the hypothalamic control on temperature.
D) liver damage.
Answer: D
Topic: Paracetamol
Learning objective: Describe the mechanisms of action, common adverse effects, and clinical considerations of paracetamol.
Difficulty: 1
8) Which micronutrient should be supplemented with methotrexate use?

A) Folate
B) Thiamin
C) Riboflavin
D) Pyridoxine
Answer: A
Topic: Medicines used in the management of rheumatoid arthritis
Learning objective: 5 Outline the types of medicines used in the management of rheumatoid arthritis.
Difficulty: 2
SHORT ANSWER QUESTIONS:
9). Describe the effects of prostaglandins on inflammation and pain.

Answer: They cause vasodilator and increased vascular permeability, augmenting the action of histamine and other pro-
inflammatory mediators; they act on peripheral pain pathways to enhance transmission.
Topic: The physiological roles of prostaglandins and their biosynthesis
Learning objective: 1 Outline the physiological roles of prostaglandins and their biosynthesis.
Difficulty: 3
10). Which individuals may be more susceptible to paracetamol overdose? Why?

Answer: Paracetamol can cause potentially fatal acute liver disease. Children under 4 years old have a very low therapeutic index
and are therefore more susceptible to overdose. Heavy alcohol drinkers may be more susceptible to overdose, as ethanol likely
increases the rate of conversion of paracetamol to its toxic metabolite.
Topic: Anti-inflammatory, antipyretic and non-opioid analgesic agents
Learning objective: 4 Describe the mechanism of action, common adverse effects, and clinical considerations of paracetamol.
Difficulty: 2
Chapter 41 MEDICINES USED TO TREAT MIGRAINE
Topics:
Migraine pathophysiology
Treatment of acute attacks of migraine
Migraine prophylaxis
Learning objective:
1. Describe the pathophysiology of migraine.
2. Explain the treatments used for acute attacks of migraine.
3. Explain the treatments used for preventing migraine attacks.
1) Analgesic agents that are effective in treating mild to moderate acute migraine headaches include:
A) ibuprofen and indomethacin.
B) aspirin and paracetamol.
C) piroxicam and sulindac.
D) propranolol and ketamine.
Answer: B
Topic: Treatment of acute attacks of migraine
Learning objective: 2 Explain the treatments used for acute attacks of migraine.
Difficulty: 2
2) Which substance enhances the absorption of ergotamine?

A) Apple juice
B) Sumatriptan
C) Dairy products
D) Caffeine
Answer: D
Difficulty: 2
3) How does metoclopramide assist in the treatment of an acute migraine?

A) It decreases the incidence of nausea and vomiting.
B) It increases the absorption of ergotamine.
C) It decreases the rate at which ergotamine is excreted.
D) It inhibits the isoenzyme of the cytochrome P450 system that metabolises ergotamine.
Answer: A
Difficulty: 2
4) In treating an acute migraine attack, sumatriptan should not be given with ergotamine because the combination may lead to:
A) excessive bronchoconstriction.
B) excessive vasoconstriction.
C) gastrointestinal bleeding.
D) excessive diuresis.
Answer: B
Difficulty: 2
5) First-line therapy for an acute migraine attack includes:

A) triptans.
B) paracetamol.
C) ergotamine.
D) tricyclic antidepressants.
Answer: B
Difficulty: 1
6) Preventive therapies for migraine should be used for a period of:

A) three to six days.
B) three to six weeks.
C) three to six months.
D) six to twelve months.
Answer: C
Topic: Migraine prophylaxis
Learning objective: 2 Explain the treatments used for preventing migraine attacks.
Difficulty: 2
7) Which of the following is true of ergotamine for migraine prophylaxis?

A) Caffeine enhances its absorption and onset of action.
B) No more than five doses should be taken in any one week.
C) Doses should be closely monitored due to the risk of rebound headaches and dependence.
D) All of the above.
Answer: D
Topic: Migraine prophylaxis
Learning objective: 2 Explain the treatments used for preventing migraine attacks.
Difficulty: easy
Chapter 42 GENERAL ANAESTHESIA

Topics:
Stages of anaesthesia
Mechanism of action of general anaesthetics
Types of general anaesthetics
Anaesthetic premedication
Learning objective:
1. List the stages of anaesthesia.
2. Outline the possible mechanisms of action of the general anaesthetics.
3. Identify the types of general anaesthetics, and describe their characteristics.
4. Outline the various premedications before general anaesthesia.
1) Which of the following is NOT a contraindication for the use of nitrous oxide as an inhalational anaesthetic?
A) Pneumothorax
B) Surgical procedures involving the middle ear
C) Tachycardia
D) Intestinal obstruction
Answer: C
Topic: Mechanism of action of general anaesthetics
Learning objective: 2 Outline the possible mechanisms of action of the general anaesthetics.
Difficulty: 3
2) The rate of absorption of inhaled anaesthetic into the bloodstream is dependent on the ________ of the gas.
A) rate of osmosis
B) partial pressure
C) volume
D) surfactant levels
Answer: B
Learning objective: 2 Outline the possible mechanisms of action of the general anaesthetics.
Difficulty: 3
3) Intrathecal administration of anaesthetic produces:

A) profound anaesthesia with a small dose.
B) a mild analgesic effect with a small dose.
C) analgesia via the nerve roots that communicate with the epidural space.
D) no analgesic effect; this route of administration is inappropriate to achieve analgesia.
Answer: A
Learning objective: Outline the possible mechanism of action of the general anaesthetics.
Difficulty: 2
Chapter 43 Local anesthesia

Topics:
Action potentials in peripheral nerves
Local anaesthetics
Learning objective:
1. Outline the phases of the action potential in peripheral nerves.
2. Describe the general characteristics of local anaesthetics, highlighting the characteristics of some common local
anaesthetics.
1) The mechanism of action of the local anaesthetics is to impede the movement of which ion through its membrane channels?
A) Calcium
B) Potassium
C) Sodium
D) GABA
Answer: C
Topic: Local anaesthetics
Learning objective: 1 1 Outline the phases of the action potential in peripheral nerves.
Difficulty: 3
2) Which of the following routes of administration has the highest rate of systemic absorption of local anaesthetic agents?
A) Epidural administration
B) Intercostal administration
C) Subcutaneous administration
D) Brachial plexus administration
Answer: B
Topic: Local anaesthesia
Learning objective: 2 2 Describe the general characteristics of local anaesthetics, highlighting the characteristics of some common
local anaesthetics.
Difficulty: 3
3) Which of the following local anaesthetics has a relatively long duration of action?
A) Procaine
B) Lignocaine
C) Bupivacaine
D) Mepivacaine
Answer: C
Topic: Local anaesthesia
Learning objective: 2 Describe the general characteristics of local anaesthetics, highlighting the characteristics of some common
local anaesthetics
Difficulty: 2

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Fundamentals of Pharmacology 8th

Edition Bullock Test Bank

Bullock 8e: Fundamentals of Pharmacology

1) Somatic pain is defined as:

2) What is the equivalent dose of pethidine when compared with 10 mg of morphine?

3) The opioid tramadol should be avoided in clients with:

4) When administering tramadol, it should not be given with drugs that:

5) Which of the following is NOT a characteristic of oxycodone?

6) The opioid receptors most involved in mediating analgesia are:

7) Which of the following narcotics has a prolonged duration of action?

8) Which of the following pain medicines produce a constipating effect?

Chapter 40 ANTI-INFLAMMATORY, ANTIPYRETIC AND NON-OPIOID

1) Which enzyme is the target for inhibition by the NSAIDs?

8) Which micronutrient should be supplemented with methotrexate use?

SHORT ANSWER QUESTIONS:

9). Describe the effects of prostaglandins on inflammation and pain.

10). Which individuals may be more susceptible to paracetamol overdose? Why?

Chapter 41 MEDICINES USED TO TREAT MIGRAINE

2) Which substance enhances the absorption of ergotamine?

3) How does metoclopramide assist in the treatment of an acute migraine?

5) First-line therapy for an acute migraine attack includes:

6) Preventive therapies for migraine should be used for a period of:

7) Which of the following is true of ergotamine for migraine prophylaxis?

Chapter 42 GENERAL ANAESTHESIA

3) Intrathecal administration of anaesthetic produces:

Chapter 43 Local anesthesia

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