ABPN Basic Flashcards

By the use of the descending pain pathway, the dorsal horn facilitates the transmission of signals from peripheral nerves to the thalamus in response to noxious stimuli.

Answer: False

The statement is false. The descending pain pathway primarily functions to *modulate* or *inhibit* pain signals, rather than facilitating their transmission. It originates in the brainstem and projects to the dorsal horn of the spinal cord, where it can release neurotransmitters to reduce the intensity of incoming pain signals from peripheral nerves. The *ascending* pain pathway is responsible for transmitting pain signals to the thalamus and higher brain centers.

Which of the following statements of the many forms of chronic pain is NOT TRUE?

Answer: Only morphologic changes are observed in cases of chronic back pain.

The statement that 'Only morphologic changes are observed in cases of chronic back pain' is NOT TRUE. Chronic back pain, like other chronic pain conditions, involves complex neuroplastic changes in the central nervous system, including sensitization of neurons, altered pain processing, and functional changes in brain regions involved in pain perception and modulation. These changes extend far beyond mere morphological alterations and contribute significantly to the persistent pain experience.

Which of the following descriptions of Neurontin, or gabapentin is NOT TRUE?

Answer: All of the above.

The question asks which statement about gabapentin is NOT TRUE, and the correct answer is 'All of the above.' This implies that statements A, B, C, and D are all considered FALSE. However, renal adjustment is required for gabapentin (A is TRUE), the titration schedule provided is common (B is TRUE), dizziness and somnolence are common adverse effects (C is TRUE), and the onset of action and trial duration are generally accurate (D is TRUE). Given that A, B, C, and D are generally true, the premise that 'All of the above' are NOT TRUE (i.e., all are false) is incorrect, indicating a potential flaw in the question's design or answer choices.

Which of the following statements regarding Lyrica, or pregabalin is NOT TRUE?

Answer: Starting dose - 500mg/day; Titration-Within 1 week

The statement 'Starting dose - 500mg/day; Titration-Within 1 week' for Lyrica (pregabalin) is NOT TRUE. The typical starting dose for pregabalin is significantly lower, often 75mg twice daily or 50mg three times daily (totaling 100-150mg/day), not 500mg/day. While titration can be relatively quick, starting at such a high dose and titrating within one week is not standard practice and would likely lead to severe side effects.

Applying a 5% patch, which can be cut to fit the administration site, once a day is part of the proper lidocaine patch administration protocol.

Answer: False

The statement that a 5% lidocaine patch can be cut to fit the administration site is false. Lidocaine patches, particularly those with a drug matrix design (like Lidoderm), are generally not recommended to be cut. Cutting the patch can compromise the integrity of the drug delivery system, potentially altering the release rate, exposing the drug to air, or leading to inconsistent dosing. Patients are typically instructed to apply the patch whole to the affected area.

Which of the following is NOT TRUE about tramadol?

Answer: Titrate up as tolerated

The statement 'Titrate up as tolerated' for tramadol is considered NOT TRUE in a strict sense. While dose titration is common for tramadol to manage efficacy and side effects, its unique pharmacological profile, including its serotonergic effects and potential to lower the seizure threshold, necessitates careful and often more structured titration protocols. Simply titrating 'as tolerated' might not adequately account for these specific risks, requiring more cautious and guided dose adjustments to prevent adverse events like seizures or serotonin syndrome.

Constipation is the pharmacologic side effect of opioid receptors (mu, kappa, and delta) based on the action of the delta receptor.

Answer: False

The statement is false. While constipation is a very common pharmacologic side effect of opioids, it is primarily mediated by the activation of *mu* opioid receptors in the gastrointestinal tract, not the delta receptors. Mu receptor activation reduces gut motility, increases fluid absorption, and decreases intestinal secretions, all contributing to opioid-induced constipation.

Which of the tools listed below is used to evaluate how severe the symptoms of alcohol withdrawal are?

Answer: CIWA-Ar

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) is a widely recognized and validated tool specifically used to assess the severity of alcohol withdrawal symptoms. It consists of 10 items that quantify symptoms such as nausea, tremor, anxiety, agitation, and hallucinations, providing a score that guides treatment decisions and monitors the patient's progress during alcohol detoxification. Other scales like COWS are for opioid withdrawal.

Which of the following claims regarding alcohol's PK and PD is NOT TRUE?

Answer: Alcohol dehydrogenase's downregulation causes acute toxicity.

Alcohol dehydrogenase (ADH) is an enzyme that metabolizes alcohol. If ADH is downregulated, alcohol is metabolized slower, leading to higher and more prolonged levels of alcohol in the body. This would exacerbate the severity and duration of acute toxicity caused by alcohol, rather than directly causing the toxicity itself. Therefore, the claim that downregulation of ADH *causes* acute toxicity is not true.

Which of the following claims about Wernicke's Encephalopathy (WE) is NOT TRUE?

Answer: Although there are no set rules, it is preferable to use IV therapy with a continuous infusion of 2000 mg for more than 60 minutes.

The standard treatment for Wernicke's Encephalopathy involves high-dose intravenous thiamine, typically 500 mg three times daily for several days, or 100 mg daily. A continuous infusion of 2000 mg for more than 60 minutes is not a recognized or preferred regimen. Such a high single dose administered continuously is not supported by current clinical guidelines for WE treatment.

The CIWA-Ar score is used to determine how to treat sedative and hypnotic withdrawal, which is different from alcohol withdrawal.

Answer: False

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) scale is specifically designed and validated to assess the severity of alcohol withdrawal symptoms. While some symptoms may overlap, it is not intended or validated for managing withdrawal from other substances like sedative-hypnotics (e.g., benzodiazepines or barbiturates). Therefore, the statement is false.