Naplex 2026

NAPLEX 2026 EXAM QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) Hydromorphone (Dilaudid) Answer BBW: risk of medication error with high-potency injection (use in opioid-tolerant pts only) Oral: 2-4 mg q4-6h prn IV: 0.2-1 mg q2-3h prn Potent: high risk for overdose Methadone (Dolophine) Answer BBW: life-threatening QT prolongation and serious arrhythmias Warning: serotonin syndrome Du to variable half-life, hard to dose safely can decrease testosterone and contribute to sexual dysfunction *Major CYP3A4 substrate Meperidine (Demerol) Answer Warning: renal impairment/elderly at risk for CNS toxicity No longer rec as analgesic; short DOA *used off-label for post-operative rigors (shivering) Mormeperidine (metabolite) renally cleared and can accumulate and cause CNS toxicity, seizures Serotonergic, can inc risk of serotonin syndrome Morphine (ER: MS Contin, Kadian) Injection: Duramorph, Infumorph Answer AE: pruritiis (diphenhydramine) Oxycodone (Roxicodone) ER: Oxycontin + APAP (Percocet) Answer BBW: initiation of CYP3A4 inhibitors or stopping inducers AEs: pruritis Oxymorphone (Opana) Answer Take on empty stomach Opioid drug interactions Answer Hydrocodone, fentanyl, methadone, and oxycodone are CYP3A4 substrates Opioid dosing conversions Answer Morphine: 10 mg IV/IM : PO 30 mg Hydromorphone: 1.5 mg IV/IM : PO 7.5 mg Oxycodone: ------ : PO 20 mg *reduce equivalent dose at least 25% to account for cross tolerance Fentanyl patch conversions use a dosing table in the package insert Opioid allergy Answer Common drugs in same chemical class have -COD or -MORPH in the name CODeine, hydro/oxyCODone MORPHine, hydro/oxyMORPHone bupreNORPHine (Tramadol has warning of cross-rxn) Opioid-induced constipation Answer Stimulant laxatives first line PAMORAS: peripherally acting mu-opioid receptor antagonists - block opioid receptors in the gut to reduce OIC - Methylnaltrexone (Rellistor): risk of GI perforation, abdominal pain, flatulence; only for pts who have failed OTC laxatives - Naloxegol (Movantik): risk of GI perforation, abdominal pain, flatulence; only for pts who have failed OTC laxatives Chloride channel activator: approved for other indications in addition to OIC - Lubiprostone (Amitiza) Centrally acting analgesics Answer Mu-opioid receptor agonists, inhibitors of NE reuptake Tramadol (ultram): C-IV - BBW: respiratory depression and death in children - warnings: seizure risk, serotonin syndrome, hypoglycemia - CI: do not use in children 12 or 18 following tonsilectomy/adenoidectomy - AE: dizziness, constipation, nausea, somnolence - requires conversion to active metabolite by CYP2D6 Tapentadol (Nucynta): C-II - can increase seizure risk, serotonin syndrome - AEs: dizziness, constipation, nausea, somnolence Treatment of opioid abuse Answer Naloxone (Narcan): opioid antagonist; - AEs: acute withdrawal symptoms Buprenorphine (C-III): partial mu-opioid agonist at low doses (pain tx), antagonist at high doses (addiction tx) - Belbuca: buccal film, do not eat/drink for 30 mins after placement - Butrans: patch, change weekly, cover only with bioclusive or tegaderm; dizziness, HA, application site rxns, N/V - +naloxone (Suboxone, zubsolv) Oral adjuvants for neuropathic pain (neuropathy, PHN, fibromyalgia) Answer Gabapentin (Neurontin): dizziness, somnolence, peripheral edema/weight gain Pregabalin (Lyrica): C-V; dizziness, somnolence, peripheral edema/weight gain, mild anxiolytic - approved for use in fibromyalgia, PHN, and neuropathic pain Carbamazepine (Tegretol): only FDA-approved med for trigeminal neuralgia SNRIs and TCAs for pain Answer Milnacipran: indicated only for fibromyalgia Amitriptyline (Elavil) Desipramine Duloxetine (Cymbalta) Oral adjuvants for musculoskeletal pain/spasms Answer Antispasmodics with analgesic effects: excessive sedation, dizziness, confusion, asthenia - Baclofen (Lioresal) - Cyclobenzaprine (Amrix, Fexmid, Flexeril): dry mouth, serotonergic - Tizanidine (zanaflex): hypotension, dry mouth Antispasmodics that exert effects by sedation