31. Which of the following opioid is a μ-Opioid receptor partial agonist?
(A) Oxymorphone
(B) Buprenorphine.
(C) Nalbuphine
(D) Pentazocine
(E) Methadone

27. 關於鴉片類藥物的敘述，下列何者最不正確？ (A) Codeine 在肝臟中經 cytochrome P450 2D6 進行 O-demethylation 後會產生 morphine (B) Tramadol 屬於 weak opioid 類藥物，口服生物利用率（oral bioavailability）差，對 neuropathic pain 和 fibromyalgia 效用不佳 (C) Tramadol 造成嚴重呼吸抑制的風險極低，但嚴重腎功能障礙或嚴重藥物過量時仍可能發 生 (D) Oxycodone 的口服生物利用率比 morphine 高，且比較沒有 active metabolite 的疑慮 (E) 肝腎功能障礙對於 methadone 的代謝清除率（clearance）並沒有明顯的影響

28. 關於治療 opioid use disorder 藥物的敘述何者有誤? (A) Naltrexone 是 mu-opioid agonist，可以用來治療 opioid use disorder (B) Naltrexone 也可以用來治療 alcohol use disorder (C)使用 Naltrexone 常見的副作用為頭痛、噁心、頭暈、疲勞、鎮定、與焦慮 (D) Buprenorphine有partial agonist作用，對於中樞神經與呼吸抑制作用有天花板效應(ceiling effect) (E) Buprenorphine 採用舌下劑型、黏膜劑型為主，來治療 opioid use disorder，主要是因為口服吸收差以及肝臟的首度效應(first-pass effect)

29. 在考科藍文獻回顧(Cochrane review)治療下背痛實證方面，以下敘述何者有誤? (A) Paracetamol 對於急性下背痛與安慰劑相比，並沒有得到更好的結果 (B) 長期使用 opioids 對於慢性下背痛是安全並且有效的 (C) Radiofrequency denervation 目前沒有高品質的證據顯示對於慢性下背痛病人有好的治療效果 (D) 針灸相對沒治療或是其他中醫治療，對於下背痛的疼痛改善是比較有效的 (E) 合併整脊療法是稍微能夠改善急性或亞急性下背疼痛

30. 關於周邊神經手術的敘述何者有誤？ (A)周邊神經切除術基本考量就是去除製造疼痛的神經與切除不正常的神經傷害(如 neuroma) (B)部分內分泌與風濕疾病是與增加周邊神經纏套(entrapment)風險相關，例如糖尿病 (C) 周邊神經纏套(entrapment)除了來自組織壓迫外，可能與神經缺血也有關係 (D) 診斷 sympathetically maintained pain 有一定診斷標準，例如皮膚顏色改變等等 (E) sympathetically maintained pain 可能與 A、C 神經傷害感受器有關

32. Which of the folllowing pharmacokinetics and pharmacodynamics is seldom associated with aging? (A) slowed elimination of the drug and active and toxic metabolites (B) increased bioavailability of drugs, that are highly protein-bound. (C) increased drug elimination time (D) increased sensitivity to both the desired and undesired effects of opioids (E) all of the above pharmacokinetics and pharmacodynamics are associated with aging

33. Which opioid owns the highest conversion factor to morphine minigram equivalents? (A) codeine (B) hydromorphone (C) oxycodone (D) morphine (E) fentanyl transdermal patch (in ug/hr)

34. Which of the following consideration for the use of adjuvants in the older persons is correct? (A) amitriptyline has more anticholinergic adverse effects than second-generation tricyclic antidepressants (nortriptyline or desipramine) (B) Serotonin and norepinephrine reuptake inhibitors (SNRIs) have fewer of these undesired effects from tricyclic antidepressants but a greater risk of drug interactions and elevation of liver enzymes (C) Antiepileptic drugs are first-line agents to treat neuropathic pain in older persons with labeled indications (D) carbamazepine may be useful for neuropathic pain, but less ideal in older adults due to drug interactions, renal, liver, and hematologic toxicity (E) all of the above are correct descriptions for adjuvants use in older persons

35. Which of the following description for the analgesic pharmacology in infants and children is wrong? (A) Neonates and young children have increased maturation of hepatic enzymes involved in the metabolism of analgesics such as opioids and amide local anesthetics (B) Neonates and young infants have decreased plasma concentrations of albumin and α1 acid glycoprotein, leading to decreased protein binding and greater concentrations of unbound, pharmacologically active drug (C) Neonates also have reduced glomerular filtration rates in the first few weeks of life resulting in slower elimination of many drugs (D) Young infants have significantly less of pseudocholinesterase compared to the adult population, leading to prolonged clearance of the ester-type local anesthetics (E) all of the above are correct descriptions

36. 下列何項診斷為最常見的遺傳性神經病變(hereditary neuropathy) ? (A) Fabry’s disease (B) Inherited erythromelalgia (C) Charcot-Marie-Tooth disease (CMT) (D) Familial amyloid polyneuropahty (E) Guillain-Barre Syndrome (GBS)

37. 下列有關 complex regional pain syndrome (CRPS)的 interventional therapies 敘述何者正確? (A) Sympathetic block 目前被認為是 CRPS 第一線的標準介入性治療 (B) 由於 CRPS 皆有 sympthetically maintained pain (SMP), 因此 systemic infusion of sympatholytic agent (例如 phentolamine)具有很好的療效 (C) 目前實證醫學證據顯示針對下肢的 CRPS, spinal cord stimulation 比 dorsal root ganglion stimulation 的療效更佳 (D) 相較於 conservative treatment, spinal cord stimulation 於 CRPS 的療效目前已有 prospective randomized controlled trial 證實 (E) 以上皆正確