Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:

  1. Read the article by Waxler et al.  entitled “Primer of postoperative pruritus for anesthesiologists” on page 168 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.

The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

The American Society of Anesthesiologists designates this continuing medical education program for a maximum of 1 hour of Category 1 credit toward the AMA’s Physician Recognition Award. Each physician should claim only those hours of credit actually spent in the activity.

Purpose:  The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.

Target Audience:  Physicians and other medical professionals whose medical specialty is the practice of anesthesia.

Learning Objectives:  After reading this article, participants should have a better understanding of pruritus, the conditions and drugs that can produce it, and its treatment.

Authors –Beverly Waxler, M.D., Zerin P. Dadabhoy, M.D., Ljuba Stojiljkovic, M.D., Ph.D., and Sara F. Rabito, M.D., F.A.H.A.

Grants or research support:  None

Consultantships or honoraria:  None The article authored by Drs. Waxler, Dadabhoy, Stojiljkovic, and Rabito was supported solely from institutional and/or departmental sources.

Question Writer –Peter L. Bailey, M.D. Dr. Bailey has no grants, research support, or consultant positions, nor does he receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.

Based on the article by Waxler et al.  entitled “Primer of postoperative pruritus for anesthesiologists” the July issue of Anesthesiology, choose the one correct answer for each question:

  1. Which of the following statements concerning the causes of pruritus is least  likely true?

    • Pruritus can be caused by certain systemic diseases.

    • Pruritus is usually of cutaneous origin.

    • Pruritus can be neurogenic in origin.

    • Pruritus can be psychogenic.

  2. Which of the following drugs is least  effective in treating opioid-induced pruritus?

    • Naloxone

    • Droperidol

    • Naltrexone

    • Prednisone

  3. Which of the following statements concerning the neurotransmission of pruritus is most  likely true?

    • Pain and pruritus have the same neurosensory pathways.

    • Pruritus is transmitted via  a type of C-nociceptor.

    • Pruritus is transmitted via  the ipsilateral spinothalamic tract.

    • Conduction velocity for the transmission of pruritus is very rapid.

  4. Which of the following statements concerning the pharmacology of pruritus is most  likely true?

    • Antihistamines relieve most types of pruritus.

    • Prostaglandins are the primary mediators of pruritus.

    • Serotonin receptor antagonists can reduce the pruritus triggered by spinal opioid administration.

    • The endogenous substances linked to pruritus are limited to the cytokines.

  5. Which of the following statements concerning diseases or conditions associated with pruritus is most  likely true?

    • Hemodialysis consistently relieves the pruritus associated with renal failure.

    • Antihistamines are effective in treating the pruritus associated with liver failure.

    • Pruritus is rarely a manifestation of hematological diseases.

    • Pruritus can precede the development of other symptoms of Hodgkin disease by years.

  6. Which of the following statements concerning pruritus following intrathecal or epidural opioid administration is most  likely true?

    • It is caused by direct opioid action in the ventral horn of the spinal column.

    • It is due to histamine release.

    • It can originate from multiple levels in the neuraxis.

    • It originates in the skin.