NR 565 ADVANCED PHARMACOLOGY FINAL EXAM
PAPER 2026/2027 QUESTIONS AND SOLUTIONS RATED
A+
✔✔examples of pure opioid agonist - ✔✔morphine, methadone, fentanyl, heroin,
oxycodone, hydrocodone, opium
✔✔pure opioids produce what effects? - ✔✔analgesia, euphoria, sedation, respiratory
depression, physical dependence, constipation
✔✔prototype for strong opioid agonist - ✔✔morphine
✔✔moderate to strong opioid agonist prototype - ✔✔codeine
✔✔A person who is depend on a pure opioid agonist should NEVER receive an opioid
agonist antagonist - ✔✔true
✔✔opioid agonist-antagonist - ✔✔used to treat opioid dependence and pain. They work
by reducing the affects of withdrawal symptoms and affecting pain sensors.
✔✔examples of opioid agonist-antagonist - ✔✔Buprenorphine, Pentazocine,
Butorphanol, Nalbuphine
✔✔pure opioid antagonist - ✔✔reverse and blocks opioid effects
✔✔example opioid antagonist - ✔✔naloxone
✔✔When to refer a patient to a pain specialist? - ✔✔required for patients who take 120
mme per day of morphine milligram equivalents
✔✔What is used to calculate pt's overdose risk? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔anytime a controlled substance is prescribed,
refilled, or filled
✔✔Why is PDMP important? - ✔✔identify those at risk for overdose
✔✔Assess someone for possible drug diversion? - ✔✔Urine test at least yearly
PDMP routinely
✔✔How does renal and hepatic function impact medication levels in body? -
✔✔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? - ✔✔Older adults
metabolize opioids slowly and therefore require lower doses than younger adults.
✔✔When should naloxone be prescribed? - ✔✔with every opioid prescription
✔✔What is the typical dose of naloxone and how is it administered? - ✔✔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? -
✔✔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? - ✔✔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 - ✔✔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 - ✔✔high potential for abuse and no current accepted medical use
✔✔example of schedule I - ✔✔Heroin, Lysergic Acid Diethylamide (LSD), Marijuana
(cannabis), 3,4-Methylenedioxymethamphetamine (ecstasy), Methaqualone, and
Peyote
✔✔Schedule II - ✔✔substances, or chemicals are defined as drugs with a high potential
for abuse, with use potentially leading to severe psychological or physical dependence
✔✔Examples of schedule II - ✔✔Combination products with less than 15 milligrams of
Hydrocodone per dosage unit (Vicodin), Cocaine, Methamphetamine, Methadone,
Hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (OxyContin), Fentanyl,
Dexedrine, Adderall, and Ritalin
✔✔Schedule III - ✔✔substances, or chemicals are defined as drugs with a moderate to
low potential for physical and psychological dependence. Abuse potential is less than
schedule I and II drugs, but more than schedule IV
✔✔examples of schedule III - ✔✔Products containing less than 90 milligrams of
Codeine per dosage unit (Tylenol with codeine), Ketamine, Anabolic steroids,
Testosterone
✔✔Schedule IV - ✔✔substances, or chemicals are defined as drugs with a low potential
for abuse and low risk of dependence
✔✔example schedule IV - ✔✔Xanax, Soma, Darvon, Valium, Ativan, Talwin, Ambien,
Tramadol
✔✔Schedule V - ✔✔substances or chemicals are defined as drugs with lower potential
for abuse than schedule IV and consist of preparations containing limited quantities of
certain narcotics. Are generally used for antidiarrheal, antitussive, and analgesic
purposes
✔✔example schedule V drugs - ✔✔Cough preparations with less than 200 milligrams of
Codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin
✔✔What type of analgesic for mild to moderate pain? - ✔✔tylenol, NSAID
(Advil/motrin), COX2 inhibitors (like NSAIDS)
✔✔What type of analgesic for moderate to severe pain? - ✔✔opioids
✔✔When to start using short acting opioids? - ✔✔Should be used exclusively for acute
pain in opioid naïve (never had before) patients as opposed to opioid tolerant patients
PAPER 2026/2027 QUESTIONS AND SOLUTIONS RATED
A+
✔✔examples of pure opioid agonist - ✔✔morphine, methadone, fentanyl, heroin,
oxycodone, hydrocodone, opium
✔✔pure opioids produce what effects? - ✔✔analgesia, euphoria, sedation, respiratory
depression, physical dependence, constipation
✔✔prototype for strong opioid agonist - ✔✔morphine
✔✔moderate to strong opioid agonist prototype - ✔✔codeine
✔✔A person who is depend on a pure opioid agonist should NEVER receive an opioid
agonist antagonist - ✔✔true
✔✔opioid agonist-antagonist - ✔✔used to treat opioid dependence and pain. They work
by reducing the affects of withdrawal symptoms and affecting pain sensors.
✔✔examples of opioid agonist-antagonist - ✔✔Buprenorphine, Pentazocine,
Butorphanol, Nalbuphine
✔✔pure opioid antagonist - ✔✔reverse and blocks opioid effects
✔✔example opioid antagonist - ✔✔naloxone
✔✔When to refer a patient to a pain specialist? - ✔✔required for patients who take 120
mme per day of morphine milligram equivalents
✔✔What is used to calculate pt's overdose risk? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔anytime a controlled substance is prescribed,
refilled, or filled
✔✔Why is PDMP important? - ✔✔identify those at risk for overdose
✔✔Assess someone for possible drug diversion? - ✔✔Urine test at least yearly
PDMP routinely
✔✔How does renal and hepatic function impact medication levels in body? -
✔✔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? - ✔✔Older adults
metabolize opioids slowly and therefore require lower doses than younger adults.
✔✔When should naloxone be prescribed? - ✔✔with every opioid prescription
✔✔What is the typical dose of naloxone and how is it administered? - ✔✔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? -
✔✔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? - ✔✔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 - ✔✔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 - ✔✔high potential for abuse and no current accepted medical use
✔✔example of schedule I - ✔✔Heroin, Lysergic Acid Diethylamide (LSD), Marijuana
(cannabis), 3,4-Methylenedioxymethamphetamine (ecstasy), Methaqualone, and
Peyote
✔✔Schedule II - ✔✔substances, or chemicals are defined as drugs with a high potential
for abuse, with use potentially leading to severe psychological or physical dependence
✔✔Examples of schedule II - ✔✔Combination products with less than 15 milligrams of
Hydrocodone per dosage unit (Vicodin), Cocaine, Methamphetamine, Methadone,
Hydromorphone (Dilaudid), Meperidine (Demerol), Oxycodone (OxyContin), Fentanyl,
Dexedrine, Adderall, and Ritalin
✔✔Schedule III - ✔✔substances, or chemicals are defined as drugs with a moderate to
low potential for physical and psychological dependence. Abuse potential is less than
schedule I and II drugs, but more than schedule IV
✔✔examples of schedule III - ✔✔Products containing less than 90 milligrams of
Codeine per dosage unit (Tylenol with codeine), Ketamine, Anabolic steroids,
Testosterone
✔✔Schedule IV - ✔✔substances, or chemicals are defined as drugs with a low potential
for abuse and low risk of dependence
✔✔example schedule IV - ✔✔Xanax, Soma, Darvon, Valium, Ativan, Talwin, Ambien,
Tramadol
✔✔Schedule V - ✔✔substances or chemicals are defined as drugs with lower potential
for abuse than schedule IV and consist of preparations containing limited quantities of
certain narcotics. Are generally used for antidiarrheal, antitussive, and analgesic
purposes
✔✔example schedule V drugs - ✔✔Cough preparations with less than 200 milligrams of
Codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin
✔✔What type of analgesic for mild to moderate pain? - ✔✔tylenol, NSAID
(Advil/motrin), COX2 inhibitors (like NSAIDS)
✔✔What type of analgesic for moderate to severe pain? - ✔✔opioids
✔✔When to start using short acting opioids? - ✔✔Should be used exclusively for acute
pain in opioid naïve (never had before) patients as opposed to opioid tolerant patients
