31. Which of the following drug is categorized as Agonist-Antagonist and should "Not" be used in opioid tolerant patients.
(A) Morphine
(B) Tramadol
(C) Nalbuphine
(D) Hydromorphone
(E) Methadone

1.Which of the following drug is categorized as Agonist-Antagonist and should "Not" be used in opioid tolerant patients. (A) Morphine (B) Tramadol (C) Nalbuphine (D) Hydromorphone (E) Methadone

41. Which of the following drug is categorized as Agonist-Antagonist and should "Not" be used in opioid tolerant patients. (A) Morphine (B) Tramadol (C) Nalbuphine (D) Hydromorphone (E) Methadone

32. Which of following description about opioid receptors is "Incorrect" ? (A) Opioid receptors belong to the superfamily of G protein–coupled receptors (GPCR) (B) Opioid receptors are coupled to Gs protein to trigger downstream signaling. (C) Overall opioid receptor activation leads to inhibit neuronal activity (D) In spinal cord level, opioid receptors are located mostly in the superficial dorsal horn (E) Endogenous opiates maybe released by immune cells and work on both central and peripheral opioid receptors.

33. Which of following description about non-steroidal anti-inflammatory drugs (NSAIDs) pharmacology is "Correct"? (A) NSAIDs work by inhibiting the inflammation associated enzyme cyclooxygenase and lipoxygenase (B) Perioperative use of NSAIDs will not increase the risk of surgical site bleeding (C) NSAIDs will not have drug-drug interaction with anticoagulant (such as warfarin) (D) Cyclooxygenase-2 (Cox-2) is the inducible isoform of cyclooxygenase but is constitutively expressed in certain tissues such as brain and kidney (E) Compared with non-selective NSAIDs, long term use of Cox-2 inhibitors will significantly reduce the risk of serious cardiovascular events, renal failure or congestive heart failure.

34. Which of following description about using anticonvulsants (used as Analgesic Drugs is "Correct"? (A) Most commonly used anticonvulsants as analgesics appear to work through potentiation of voltage-gated sodium and calcium channels (B) Sodium channel subtype 1.4 &1.5 are highly expressed in neuronal cell and could be the drug target for anticonvulsant medication (C) Gabapentinoid (Gabapentin & Pregabalin) works on GABA receptor (D) Topiramate works only on voltage-gated sodium channel (E) Lamotrigine and Phenytoin work on voltage-gated sodium channels

35.Which of following description about "antidepressant analgesic" is "Correct"? (A) In terms of treatment efficacy (smaller number needed to treat NNT), pregabalin is much better than tricyclic antidepressant and listed as first line therapy for neuropathic pain (B) In terms of treatment efficacy (smaller number needed to treat NNT), SSRI is better than SNRI for common neuropathic pain such as postherpetic neuralgia or painful diabetic polyneuropathy (C) Venlafaxine is effective for treatment of neuropathic pain associated with beast cancer. (D) For painful diabetic neuropathy, comparison of amitriptyline and pregabalin showed no difference in pain relief but fewer adverse effects with pregabalin. (E) All of above

36. Regarding the peripheral mechanisms of cutaneous nociception, which of the following statement is least likely: (A) Following a cutaneous injury, primary hyperalgesia develops at the site of injury, which is called sensitization. This sensitization is due to the local release of inflammatory mediators such as interleukins (IL-10) and prostaglandin E1. (B) Secondary hyperalgesia was induced in the surrounding uninjured skin, which is due to sensitization of neurons in the central nervous system. (C)hen nerves are severed, spontaneous activity and ectopic mechanical, thermal, and chemical sensitivity develop in the injured nociceptors. (D) The properties of nearby, uninjured nociceptors are also changed. (E) In both injured and uninjured nociceptors, responsiveness to adrenergic agents can develop, which may account for involvement of the sympathetic nervous system in certain forms of neuropathic pain.

37. Regarding the molecular biology of sensory transduction, which of the following statement is least likely: (A) Chemotransducers are metabotropic receptors, which is the slowest form of chemical transduction. (B) Thermotransducers include TRPA1–TRPV2, TRPV3 and TRPV4, TRPA1, TRPM3, TRPM8, TRPC5, K2P, which can respond to a wide range of temperatures. (C) The underlying mechanisms of mechanotransducers vary as a function of stimulus (stretch versus pressure) and the tissue stimulated. (D)Piezo1 and 2 channels are also refered to mechanotransducers. (E) Polymodalities existed across these transducers (many transducers are activated by several stimulus, e.g., thermo- and mechanotransducers also have chemosensitities).

38. Regarding the biological effects of exogenous nerve growth factor (NGF) on pain-signaling systems in normal animals in animals with nerve injury, which of the following statement is most likely occurred in DRG: (A) Decreases in substance P, increases in CGRP and trkA. (B) Decreases in substance P, brain-derived neurotrophic factor (BDNF). (C) Decreases in substance P, increase in BDNF (D) Decreases in substance P, CGRP and trkA. (E) Decreases in substance P, TRPV1, sodium channels.

39. Regarding the neuron–glial interactions within the spinal cord after peripheral nerve injury (PNI), which of the following statement is least likely: (A) Up-regulated P2X4R expression is induced in microglia within the spinal cord by PNI. (B) In this P2X4R+ state, microglia release BDNF, which inhibits neurons in the spinal nociceptive processing network. (C) Minocycline and propentofylline is glial-specific inhibitors. (D) MAPKs, p38, is the intracellular mediator of P2X4R–BDNF signaling in microglia-mediated post–nerve injury pain states. (E) BDNF from microglia is a critical signaling molecule mediating the central pathophysiological effects of PNI.

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