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Retired NBME 21 Answers

nbme21/Block 4/Question#41 (reveal difficulty score)
A 66-year-old man with stage IV colon cancer ...
Loperamide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +11  upvote downvote
submitted by โˆ—hungrybox(1277)
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Loperamide: Agonist at u-opioid receptors. Slows gut motility (remember, constipation is a common side effect for all opioids).

quiz yourself:

Q: Would a junkie want to use Loperamide?

A: No, it has poor CNS penetration (which is why it has a low addictive potential).

Q: Would a junkie rather have morphine or buprenorphine?

A: Morphine. Both are u-opioid agonists, but morphine is a full agonist while buprenorphine is only a partial agonist.

Q: What about morphine vs. codeine?

A: Trick question, both are partial agonists.

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cienfuegos  Thanks for passing off the knowledge. Regarding the last part, aren't morphine and codeine full agonists? +5
champagnesupernova3  Yes they are +3



 +1  upvote downvote
submitted by โˆ—peridot(115)
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SPOILER ALERT!!

Do not read ahead if you have not taken NBME 22!!!


I'm smh at this question because in NBME 22, they describe a scenario in which loperamide caused CNS effects - particularly ventilatory depression and we were supposed to know that it was loperamide. I guess this question specified "little to no" rather than "none at all" but come ON, I'm annoyed that we have to separate such nitpicky detail when one question emphasizes its lack of CNS effects, then they turn around and test us on an exception of this exact same content. /end rant

This was not very informative at all, I just wanted to consolidate a similar question that I knew I had just seen but it turned into me just being angry I'm sorry.

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 -7  upvote downvote
submitted by โˆ—divya(75)
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loperamide is basically diphenoxylate + atropine. atropine is added to reduce abuse potential by diphenoxylate.

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divya  ugh sorry. this is wrong. idk why i always thought loperamide is diphhenoxylate +3



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