NR 565 ADVANCED PHARMACOLOGY
FUNDAMENTALS COMPREHENSIVE EXAM
2026 ENDOCRINE AND
NEUROPHARMACOLOGY CORE
CONCEPTS
◉ example opioid antagonist
Answer: naloxone
◉ When to refer a patient to a pain specialist?
Answer: required for patients who take 120 mme per day of
morphine milligram equivalents
◉ What is used to calculate pt's overdose risk?
Answer: total morphine milligram equivalent (MME) per day to help
assess the patient's overdose risk. If it is high (≥50 MME/day and
especially ≥90 MME/day)
Calculate total daily dose: 1. daily amount of each opioid that patient
takes 2. convert to MME, multiply dose for each opioid by conversion
factor 3. add them together
,◉ What is MME and when to use?
Answer: morphine milligram equivalent, represents the potency of
an opioid in comparison to morphine, used to identify opioid
prescription burden of a person
◉ What is the prescription drug monitoring program?
Answer: electronic databases enable providers to access information
regarding a patient's prescription history of controlled substances.
Nearly all states have implemented PDMPs, and some states require
providers to check the PDMP before prescribing controlled
substances.
◉ When should PDMP be used?
Answer: anytime a controlled substance is prescribed, refilled, or
filled
◉ Why is PDMP important?
Answer: identify those at risk for overdose
◉ Assess someone for possible drug diversion?
Answer: Urine test at least yearly
PDMP routinely
,◉ How does renal and hepatic function impact medication levels in
body?
Answer: Patients with renal or hepatic insufficiency can experience
greater peak effect and longer duration of action for medications,
thereby reducing the dose at which respiratory depression and
overdose may occur. Similarly, for patients ages 65 years and older,
reduced renal function and medication clearance due to age can
result in a smaller therapeutic window between safe dosages and
dosages associated with respiratory depression and overdose.
◉ How do elderly metabolize differently than younger people?
Answer: Older adults metabolize opioids slowly and therefore
require lower doses than younger adults.
◉ When should naloxone be prescribed?
Answer: with every opioid prescription
◉ What is the typical dose of naloxone and how is it administered?
Answer: 4 mg, nasal spray- one spray to one nostril
If no response, additional doses can be given every 2 to 3 minutes
until emergency services arrive
◉ In regards to dosage, why do we need to be cautious when giving
naloxone?
, Answer: Dosage must be titrated carefully bc if too much is given the
patient will swing from a state of intoxication to withdrawal
◉ What is the half-life of naloxone?
Answer: Short- naloxone must be administered every few hours
until opioid concentrations have dropped to nontoxic levels
◉ US Drug Enforcement Administration description of the scheduled
drugs
Answer: The DEA enacted the Controlled Substances Act (CSA) in
1970 to regulate drugs and other substances based on their
potential for abuse and dependency. Five schedules of controlled
substances were created that are updated annually. Classes of
scheduled substances include narcotics, depressants, stimulants,
hallucinogens, and anabolic steroids. The DEA issues eligible
providers with a registration number to write prescriptions for
controlled substances.
◉ Schedule I
Answer: high potential for abuse and no current accepted medical
use
◉ example of schedule I
FUNDAMENTALS COMPREHENSIVE EXAM
2026 ENDOCRINE AND
NEUROPHARMACOLOGY CORE
CONCEPTS
◉ example opioid antagonist
Answer: naloxone
◉ When to refer a patient to a pain specialist?
Answer: required for patients who take 120 mme per day of
morphine milligram equivalents
◉ What is used to calculate pt's overdose risk?
Answer: total morphine milligram equivalent (MME) per day to help
assess the patient's overdose risk. If it is high (≥50 MME/day and
especially ≥90 MME/day)
Calculate total daily dose: 1. daily amount of each opioid that patient
takes 2. convert to MME, multiply dose for each opioid by conversion
factor 3. add them together
,◉ What is MME and when to use?
Answer: morphine milligram equivalent, represents the potency of
an opioid in comparison to morphine, used to identify opioid
prescription burden of a person
◉ What is the prescription drug monitoring program?
Answer: electronic databases enable providers to access information
regarding a patient's prescription history of controlled substances.
Nearly all states have implemented PDMPs, and some states require
providers to check the PDMP before prescribing controlled
substances.
◉ When should PDMP be used?
Answer: anytime a controlled substance is prescribed, refilled, or
filled
◉ Why is PDMP important?
Answer: identify those at risk for overdose
◉ Assess someone for possible drug diversion?
Answer: Urine test at least yearly
PDMP routinely
,◉ How does renal and hepatic function impact medication levels in
body?
Answer: Patients with renal or hepatic insufficiency can experience
greater peak effect and longer duration of action for medications,
thereby reducing the dose at which respiratory depression and
overdose may occur. Similarly, for patients ages 65 years and older,
reduced renal function and medication clearance due to age can
result in a smaller therapeutic window between safe dosages and
dosages associated with respiratory depression and overdose.
◉ How do elderly metabolize differently than younger people?
Answer: Older adults metabolize opioids slowly and therefore
require lower doses than younger adults.
◉ When should naloxone be prescribed?
Answer: with every opioid prescription
◉ What is the typical dose of naloxone and how is it administered?
Answer: 4 mg, nasal spray- one spray to one nostril
If no response, additional doses can be given every 2 to 3 minutes
until emergency services arrive
◉ In regards to dosage, why do we need to be cautious when giving
naloxone?
, Answer: Dosage must be titrated carefully bc if too much is given the
patient will swing from a state of intoxication to withdrawal
◉ What is the half-life of naloxone?
Answer: Short- naloxone must be administered every few hours
until opioid concentrations have dropped to nontoxic levels
◉ US Drug Enforcement Administration description of the scheduled
drugs
Answer: The DEA enacted the Controlled Substances Act (CSA) in
1970 to regulate drugs and other substances based on their
potential for abuse and dependency. Five schedules of controlled
substances were created that are updated annually. Classes of
scheduled substances include narcotics, depressants, stimulants,
hallucinogens, and anabolic steroids. The DEA issues eligible
providers with a registration number to write prescriptions for
controlled substances.
◉ Schedule I
Answer: high potential for abuse and no current accepted medical
use
◉ example of schedule I
