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Controlled Substances Unit 2 – NU 578 (2025/2026) | 70+ Solved Exam Questions | Opioid Pharmacology, Pain Management, Agonist-Antagonist Opioids, Narcan Use | Nursing, NP, Pharmacology, PA Students

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This comprehensive document contains over 70 fully solved and updated exam questions for Unit 2 of NU 578: Controlled Substances, designed for the 2025/2026 academic year. The material is focused on the clinical pharmacology and safe administration of opioids and opioid-related agents, covering everything from therapeutic uses to mechanisms of action, side effects, contraindications, and emergency reversal protocols. Key content areas include: Morphine pharmacodynamics: analgesia, sedation, euphoria, respiratory depression, miosis, and neurotoxicity Detailed comparisons between strong opioid agonists like morphine, fentanyl, methadone, and hydromorphone Adverse effects and management strategies for opioid-induced constipation, urinary retention, emesis, and biliary colic Agonist-antagonist opioids (e.g., pentazocine, buprenorphine, nalbuphine): indications, ceiling effects, receptor activity, and safety profile Opioid antagonists such as naloxone (Narcan) and methylnaltrexone (Relistor): clinical uses, dosing routes, and reversal strategies Discussion on opioid tolerance, cross-tolerance, and physical dependence Special considerations in pregnancy, pediatrics, and liver/renal impairment Pharmacokinetics including first-pass metabolism, CYP interactions, and duration of action for multiple routes of administration This resource is ideal for: Nursing students (BSN, MSN) Nurse practitioner (NP) candidates Pharmacology and pathophysiology students Physician Assistant (PA) programs Medical students focusing on pain management and substance use disorders NCLEX, AANP, ANCC, or PANCE/PANRE exam prep It serves as a detailed guide for mastering controlled substance pharmacology, with clinically relevant examples and updated therapeutic information. The Q&A format enables active recall and precise exam readiness, while aligning with advanced pharmacology standards required in clinical practice. Keywords: opioids, morphine, fentanyl, methadone, opioid antagonists, naloxone, narcan, controlled substances, NU 578, pain management, pharmacology, nurse practitioner, opioid agonists, opioid withdrawal, agonist-antagonist opioids, opioid toxicity, side effects, nursing pharmacology, opioid receptors, respiratory depression, CYP interactions, subQ administration, Narcan reversal

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September 16, 2025
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Controlled Substances Unit 2- NU 578
2025/2026 Exam Questions and Correct
Answers | New Update



Morphine (standard) - 🧠 ANSWER ✔✔Relieve pain, causes drowsiness and

mental clouding, reduces anxiety and creates a sense of well-being

o Actions through CNS and peripherycan cause resp depression,

constipation, urinary retention, orthostatic hypotension, emesis, miosis

(pinpoint pupils), cough

suppression, and biliary colic

o Relieves pain w/o affecting other senses or LOC

o Large doses affective against sharp pain

o ability to cause mental clouding, sedation, euphoria, and anxiety

reduction can contribute to pain relief.

,Morphine actions: - 🧠 ANSWER ✔✔Analgesia, eurpohia, sedation, cough

suppression, biliary colic, emesis, elevated ICP, Miosis, Neurotoxicity,

Hormonal changes w prolonged use.


Adverse affects of Morphine - 🧠 ANSWER ✔✔Resp Depression


Tolerance to resp depression-long term use


When to NOT give Morphine: - 🧠 ANSWER ✔✔elderly/young (monitor)


Hx of Resp disease (COPD/Asthma)

Concurrent with CNS depressant

RR less than 12

*REVERSE WITH NARCAN*


Morphine depression varies by route: - 🧠 ANSWER ✔✔IV 7 min


IM 30 min

SQ 90 min

Spinal 4-5 hours

,Morphine S/E: Constipation tx - 🧠 ANSWER ✔✔Activation of mu receptors

of the gut, suppress propulsive intestinal contractions, intensify

nonpropulsive contractions, increase the tone of the anal sphincter,

inhibit secretion of fluid into the intestinal lumen

AEfecal impaction, bowel perf, rectal tearing, hemorrhoids


Prophylactic drugs for constipation - 🧠 ANSWER ✔✔stimulant lax- senna


polyethylene glycol (osmotic lax)

lactulose/sodium phosphate

methylnaltrexone (Relistor) aka: rescue therapy


Morphine Side effect: Orthostatic hypotension - 🧠 ANSWER ✔✔o R/t the

blunting of the baroreceptor relex and dilating peripheral arterioles and

veins. Causes the release of histamine


Morphine: urinary retention-- 3 mechanisms - 🧠 ANSWER ✔✔Increases

tone in the bladder sphincter

Increases tone in the detrusor muscle thereby elevating pressure within

the bladder causing a sense of urinary urgency

Interfere w voiding by suppressing awareness of bladder stimuli


COPYRIGHT©PROFFKERRYMARTIN 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE.
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, Tx of urinary retention with morphine - 🧠 ANSWER ✔✔encourage urination

q 4 hours

Hesitancy and retention esp likely in pt w BPH and drugs with

anticholinergic properties (tricyclic antidepressants, antihistamines) can

exacerbate the

prob


Morphine also used as - 🧠 ANSWER ✔✔Cough suppression


o Act at opioid receptors in the medulla


Morphine: side effect: Biliary colic - 🧠 ANSWER ✔✔Biliary Colic


o Induce spasm of the common bile duct, causing pressure w/in the biliary

tract to rise dramatically

Symptoms epigastric distress to biliary colic

Certain opioids cause less smooth muscle spam r/t morhpine admin? - 🧠

ANSWER ✔✔Demerol


Morphine side effect: emesis - 🧠 ANSWER ✔✔Emesis


o Caused by direct stimulation of the chemoreceptor trigger zone of the

medulla

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