A. an unpleasant sensory and emotional experience
B. associated with actual tissue damage
C. associated with potential tissue damage
D. All of the above.
Nociception or pain perception is __________.
A. the sensory detection of noxious stimuli
B. transduction of noxious stimuli
C. neuronal transmission of noxious stimuli
D. All of the above.
Which of the following are noxious stimuli that affect “high-threshold” primary afferent sensory neurons or nociceptors?
A. Intense mechanical stimuli.
B. Intense thermal stimuli.
C. Chemical activators.
D. All of the above.
Which of the following are chemical activators of nociceptors?
A. Ischemia- and inflammation-associated protons.
B. Cellular injury-associated extracellular ATP.
C. Tissue damage- and inflammation-associated kinins.
D. All of the above.
Which of the following statements associated with bradykinin is correct?
A. Bradykinins directly excite primary afferent fibers.
B. Activation of Gs -protein-coupled bradykinin B2 receptors promotes prostaglandin PGE2 synthesis.
C. PGE2 increases the sensitivity of primary afferent sensory neurons to chemical activators.
D. All of the above.
Which of the following statements is correct with reference to the activation of peripheral sensory neurons?
A. Activation of peripheral sensory terminals by noxious stimuli leads to intracellular sodium and calcium ion influx and neuronal depolarization.
B. Membrane depolarization leads to action potential generation if the activation threshold of voltage-sensitive sodium channels is reached.
C. Four types of voltage-sensitive sodium channels are expressed in primary afferent sensory fibers and two of these only respond to high-threshold peripheral stimuli.
D. All of the above.
Which of the following statements is correct with reference to neuronal transmission in the trigeminal nucleus?
A. Incoming action potentials activate pre-synaptic voltage-sensitive calcium channels.
B. Calcium ion influx into the primary sensory neuron terminal leads to synaptic release of glutamate.
C. Glutamate receptor activation leads to action potential generation in secondary relay neurons.
D. All of the above.
Which of the following statement is correct with respect to secondary or tertiary afferent neurons?
A. Secondary afferent neurons travel in the lateral aspects of the spinal cord and project to the thalamus where they synapse with tertiary afferent neurons.
B. Tertiary afferent neurons project to the somatosensory cortex, which is responsible for the localization of pain.
C. Tertiary afferent neurons project to the limbic system, which is responsible for the emotional aspects of pain.
D. All of the above.
Pain arising rapidly after tissue injury, which is perceived as sharp, bright, well-localized, but not particularly persistent, i.e., first pain, is most likely due to the activation of __________.
A. A-delta fibers
B. C fibers
C. B fibers
D. A-gamma fibers
Pain arising slowly after injury, which is perceived as burning, aching, dull, poorly localized, and persistent, i.e., second pain, is most likely due to the activation of __________.
A. A-delta fibers
B. C fibers
C. B fibers
D. A-gamma fibers
Which of the following endogenous ligands are major inhibitory neurotransmitters?
A. Opioid peptides.
B. Norepinephrine and serotonin (-5HT).
C. Endogenous cannabinoid.
D. All of the above.
The term perception (attention and cognition), when applied to pain refers to the __________.
A. awareness of a noxious sensation
B. interpretation and appreciation of negative emotions
C. attribution of meaning to the experience
D. All of the above.
Which of the following pharmacological considerations is correct with respect to analgesics?
A. Analgesics are specific inhibitors of pain pathways.
B. Analgesics activate receptors in primary afferent sensory neurons and the central nervous system.
C. The optimal analgesic regimen should include an agent that suppresses pain and reduces inflammation, i.e., a disease-modifying analgesic.
D. All of the above.
All of the following statements are correct with respect to APAP except which one?
A. APAP has clinically significant analgesic, anti-inflammatory, and antipyretic activity.
B. The antipyretic activity of APAP appears to be related to one of its metabolites, which inhibits cyclooxygenase activity in the CNS.
C. The likely mechanism of APAP’s analgesic effect is also related to a metabolite, which appears to indirectly increase cannabinoid receptor activity.
D. APAP is metabolized primarily by hepatic conjugation, but a small amount is metabolized by a CYP450 isoenzyme into a potentially toxic metabolite.
Cyclooxygenase inhibitors block the synthesis of prostaglandin PGE2 , which is known to produce all of the following physiological effects except which one? PGE2 __________.
A. produces vasodilatation and increase vascular permeability
B. modulates the inflammatory response and body temperature
C. decreases the pain threshold, i.e., increases nociception
D. activates platelets
All of the following statements are correct with respect to ASA except which one?
A. A single dose of ASA can irreversibly inhibit platelet function.
B. High doses and chronic use of ASA can cause GI ulceration.
C. ASA decreases the risk of Reye’s syndrome in children and adolescents during viral syndromes.
D. Today, ASA (in low dose) is used primarily for cardio-protection and stroke prevention.
All of the following statements are correct with respect to COX-inhibitors except which one?
A. Ibuprofen and naproxen formulations have analgesic, anti-inflammatory, but no antipyretic activity.
B. The oral formulation of ketorolac is restricted to those patients who have received the drug parenterally during the perioperative period.
C. Oral formulations of NSAIDs, other than ibuprofen or naproxen, offer no apparent advantage over ibuprofen or naproxen.
D. Celecoxib, a selective COX-2 inhibitor, offers no advantage over NSAIDs in treating odontogenic pain.
Which of the following statements is correct with respect to NSAIDs? NSAIDs are __________.
A. rapidly absorbed from the stomach and upper small intestine
B. distributed throughout the body and cross the placenta
C. metabolized in the liver by first-order kinetics; however, after large dose, the enzymes become saturated, which leads to zero-order kinetics and increased half-lives
D. All of the above.
Which of the following statements is correct with respect to opioid-receptor agonists?
A. Opioid-receptor agonists produce analgesia by acting primarily at μ-receptors, which are found in the brain, brain stem, spinal cord, and primary afferent sensory neurons.
B. Presynaptic μ-receptor activation inhibits calcium influx into primary sensory neurons, which decreases neurotransmitter release.
C. Post-synaptic μ-receptor activation increases K+ conductance, which decreases post-synoptic response to excitatory neurotransmission.
D. All of the above.
All of the following statements are correct with respect to morphine or oxycodone except which one?
A. Morphine is a naturally occurring strong full μ-receptor agonist, which after oral administration has very high bioavailability.
B. Oxycodone is a semi-synthetic full μ-receptor agonist, which after oral administration has high bioavailability.
C. Oxycodone is metabolized by glucuronidation to noroxycodone and by the CYP450 isoenzyme 2D6 into oxymorphone.
D. Oxycodone is primarily responsible for its analgesic effect.
Which of the following statement are correct with respect to codeine?
A. Codeine is a naturally occurring weak full μ-receptor agonist and its analgesic action is largely dependent on its hepatic demethylation to morphine.
B. The metabolism of codeine is subject to genetic polymorphism, up to 10% of the patients are poor metabolizers and do not experience analgesia.
C. About 10% of patients rapidly convert codeine to morphine, which can lead to severe toxicity (including death), even with therapeutic doses.
D. All of the above.
All of the following statements are correct with respect to hydrocodone except which one?
A. Hydrocodone is a synthetic weak full μ-receptor agonist with good bioavailability after oral administration.
B. Hydrocodone is demethylated by the CYP450 isoenzyme 2D6 into hydromorphone.
C. Hydromorphone has a much weaker affinity for μ-receptors than hydrocodone.
D. Hydrocodone is a prodrug.
Which of the following statements are correct with respect to tramadol or tapentadol?
A. Tramadol is a weak-centrally acting μ-receptor agonist/norepinephrine and serotonin reuptake inhibitor.
B. Tapentadol is a weak-centrally acting μ-receptor agonist/norepinephrine reuptake inhibitor.
C. Tapentadol has low bioavailability after oral administration due to extensive hepatic first-pass metabolism.
D. All of the above.
Based on available evidence, which of the following statement is correct with respect to the treatment of mild odontogenic pain?
A. Ibuprofen, 200 mg, is somewhat more effective than naproxen sodium, 220 mg, and both are more effective than APAP, 650 mg.
B. Over-the-counter NSAIDs are the drugs of choice for the treatment of mild-to-moderate odontogenic pain.
C. Since APAP has no significant anti-inflammatory activity; it should only be considered an alternative analgesic, i.e., when NSAIDs are contraindicated.
D. All of the above.
Based on available evidence, which of the following statements is correct with respect to the treatment of moderate odontogenic pain?
A. Prescription strength ibuprofen, naproxen, and naproxen sodium are more effective than codeine with APAP, 60/650 mg.
B. Full doses of NSAIDs are the drugs of choice for the treatment of moderate-to-severe odontogenic pain.
C. Full doses of NSAIDs administered concurrently with APAP (325 to 650 mg) are more effective pain than full dose of a NSAID or APAP (650 mg) alone.
D. All of the above.
Based on available evidence, which of the following statements is correct with respect to the treatment of moderate odontogenic pain?
A. If moderate-to-severe odontogenic pain is not relieved with full doses of ibuprofen with “add-on” doses of APAP, a weak, full μ-receptor agonist such as fixed-dose hydrocodone w/ibuprofen, 5/200 mg, with “add-on” doses of ibuprofen (and APAP) should be considered.
B. When NSAIDs are contraindicated the therapeutic options include fixed-doses of hydrocodone w/APAP, 5/325 mg, up to a maximum of two tablets per dose and no “add-on” APAP.
C. When NSAIDs are contraindicated the therapeutic options include fixed doses of codeine w/ APAP, 30/325 mg, up to a maximum of two tablets per dose and no “add-on” APAP.
D. All of the above.
Based on available evidence, which of the following statements is correct with respect to the treatment of severe odontogenic pain?
A. For the treatment of severe odontogenic pain, a strong, full μ-receptor agonist such as fixed-dose oxycodone w/ibuprofen with “add-on” doses of ibuprofen (and APAP) should be considered.
B. Oxycodone w/ibuprofen, 5/400 mg, is more effective than oxycodone w/APAP, 5/650 mg.
C. Fixed-dose oxycodone w/APAP, 5/325 mg, up to a maximum of two tablet per dose and no “add-on” APAP is an alternative, i.e., when NSAID is contraindicated.
D. All of the above.
Based on available evidence, which of the following statements is correct with respect to the use of tramadol or tapentadol in the treatment of odontogenic pain?
A. Tramadol w/APAP, 75/650 mg, is as effective for the management of postsurgical dental pain as hydrocodone w/APAP, 10/650 mg.
B. Ibuprofen, 200 mg, is more effective than tramadol w/APAP, 112/650 mg.
C. Ibuprofen, 400 mg, is more effective for the management of postsurgical dental pain than tapentadol, 200 mg.
D. All of the above.
Based on available evidence, which of the following statements is correct with respect to the preemptive effect of NSAIDs?
A. It has shown that NSAIDs have a preemptive effect and reduce postoperative analgesic requirements.
B. It also appears that there may be a window-period, and timely administration NSAID, i.e., within an hour of a procedure, will provide a similar benefit.
C. Deep anesthesia during RCT of teeth with irreversible pulpitis has been attributed to ibuprofen administered 1 hour before the administration of local anesthesia.
D. All of the above.
Which of the following segments are correct with respect to the use of adjuvant drugs in pain management?
A. Caffeine in doses greater than 100 mg. enhances the analgesic effect of NSAIDs and APAP.
B. Hydroxyzine (an antihistamine) in dose of 25 to 50 mg. enhances the analgesic effect of opioids and significantly reduces the incidence of opioid-induced nausea and vomiting.
C. Corticosteroids can enhance analgesia in patients with pain of inflammatory origin.
D. All of the above.
Which of the following statements is correct with respect to the placebo effect of analgesics?
A. The placebo response of analgesics cannot be blocked pharmacologically by naloxone (an opioid receptor antagonist).
B. The clinician’s attitude toward an analgesic affects the patient’s expectations and associated neurobiological changes can result in enhanced analgesia. and lead to a reduction in drug intake with maintenance of clinical effect.
C. The placebo effect can lead to a reduction in drug intake with maintenance of clinical effect.
D. All of the above.
Which of the following statements is correct with respect to APAP?
A. According to a Food and Drug Administration (FDA) Drug Safety Communication “acetaminophen-containing prescription products are safe and effective when used as directed”.
B. During the past decade, APAP has been identified as the leading cause of acute liver failure (ALF) in the United States and up to 50% of acetaminophen-related cases of ALF are due to unintentional overdose.
C. The FDA and the pharmaceutical industry have taken action to protect consumers from the risk of severe liver damage by formally withdrawing from the market all prescription combination drug products with more than 325 mg of APAP.
D. All of the above.
All of the following statements with respect to NSAID-related prescribing precautions are correct except which one?
A. Intolerance to NSAIDs is most likely to occur in individuals with a history of asthma, nasal polyps, and chronic urticaria.
B. Therapeutic doses of NSAIDs may cause nausea and vomiting; and have been associated with abdominal pain, diarrhea, and dyspepsia.
C. NSAIDs impair platelet adhesion to tissue components and platelet aggregation primarily through the inhibition of thromboxane A2.
D. The antiplatelet effect of NSAIDs is transient and in combination with anticoagulants they are not likely to increase the International Normalized Ration (INR).
Which of the following statements with respect to NSAID-related prescribing precautions is correct?
A. Hepatotoxicity has been reported in association with NSAIDs, but they appear to be idiosyncratic and often dose related.
B. Decreased synthesis of renal prostaglandins can result in decrease renal blood flow, fluid retention and increase blood pressure, and renal failure.
C. In general, NSAIDs should be used with caution in patients with a history of hypertension, ischemic heart disease, stroke, or congestive heart failure.
D. All of the above.
All of the following statements with respect to NSAID-related prescribing precautions are correct except which one?
A. NSAIDs at the time of conception may increase the risk of miscarriage.
B. NSAIDs should not be prescribed during the third trimester of pregnancy.
C. In breastfeeding women, ibuprofen and naproxen are contraindicated.
D. The primary concern when children are administered NSAIDs is dosage errors resulting in overdose.
Which of the following statements related to opioid overdose is correct?
A. Nearly half of all opioid overdose deaths are related to prescription opioid analgesics.
B. The hallmark of opioid overdose is the presence (1) pinpoint pupils, (2) unconsciousness, and (3) respiratory depression, i.e. the “opioid overdose triad.”
C. Respiratory depression is related to mu-receptor activation in the brain stem, which decreases the sensitivity of respiratory chemoreceptors to carbon dioxide.
D. All of the above.
Which of the following statements with respect to opioid-receptor agonist-related prescribing precautions is correct?
A. Patients who take opioids for acute pain rarely experience euphoria and even more rarely do they develop psychological dependence or addiction.
B. Clinically significant physical dependence is more likely to develop after several weeks of treatment with relatively large doses of an opioid.
C. In patients with physical dependence abrupt cessation of treatment results in withdrawal syndrome.
D. All of the above.
Which of the following statements with respect to opioid-receptor agonist-related prescribing precautions is correct?
A. Allergic reactions to opioid analgesics are rare.
B. Opioid analgesics may induce histamine release, which does not appear to have an immunological basis.
C. Histamine release may produce pruritis, dilation of cutaneous blood vessels around “blush areas”, and peripheral vasodilation-induced orthostatic hypotension.
D. All of the above.
Which of the following statements with respect to opioid-receptor agonist-related prescribing precautions is correct?
A. Nausea and vomiting are common adverse effect associated with the initiation of opioid analgesic therapy.
B. With chronic use of opioid analgesics, constipation is the most common adverse gastrointestinal effect.
C. Opioid-induced constipation is dose related and patients do not develop tolerance to this effect.
D. All of the above.
Which of the following statements with respect to opioid-receptor agonist-related prescribing precautions is correct?
A. In general, the use of opioids in the pregnant or nursing patient is discouraged because of their general CNS depressant effects on the fetus and infant.
B. In pregnant patients, the short-term use of codeine with acetaminophen is appropriate for the management of moderate-to-severe odontogenic pain.
C. If a pregnant or nursing patient is a rapid metabolizer of codeine, she may produce more morphine than those with normal metabolism; this, in 2 to 3 days, can lead to morphine overdose in the fetus or neonate.
D. All of the above.
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