NR 565 PHARMACOLOGY TEST PAPER 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔Opioid Epidemic & Responsible Prescribing - ✔✔
✔✔Opioid Use Disorder - ✔✔a pattern of use that leads to significant impairment or
distress. Typically, this disorder is marked by unsuccessful efforts to reduce or control
use resulting in the inability to fulfill work, school, or home responsibilities. Opioid use
disorder is different from drug tolerance and physical dependence, which may also
exist. Opioid use creates high levels of positive reinforcement, increasing the likelihood
of continued use. It is often a chronic lifelong disorder, leading to serious consequences
such as disability and death. Although it is similar to other substance use disorders, it
has distinct features that have fueled the current opioid epidemic. Opioids can lead to
physical dependence in only 4-8 weeks. Abruptly stopping use in chronic users leads to
severe symptoms, which motivates continued use to prevent withdrawal. The 2016 CDC
guidelines for prescribing opioids recommends calculating the total daily dose of opioids
to help identify patients who might benefit from the reduction or tapering of opioids,
given the risk of overdose
✔✔State Prescription Drug - ✔✔Clinicians should review the patient's history of
controlled substance prescriptions using state prescription drug monitoring program
(PDMP) data to determine whether the patient is receiving opioid dosages or dangerous
combinations that put him or her at high risk for overdose. Clinicians should review
PDMP data when starting opioid therapy for chronic pain and periodically during opioid
therapy for chronic pain, ranging from every prescription to every 3 months.
✔✔Monitoring Programs - ✔✔safeguards to address the opioid public health crisis
include prescription drug monitoring programs (PDMPs). These 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.
According to the CDC (2020), PDMPs have shown promising results in changing
prescribing behaviors, decreasing the use of multiple providers by patients, and
decreasing substance abuse treatment admissions.
✔✔Drug Schedules - ✔✔Each drug preparation regulated under the CSA has been
assigned to one of five categories: schedule I, II, III, IV, or V. Drugs in schedule I have a
high potential for abuse and no approved medical use in the United States. In contrast,
drugs in schedules II through V all have approved applications. Assignment to
schedules II through V is based on abuse potential and potential for causing physical or
psychological dependence. Of the drugs that have medical applications, those in
schedule II have the highest potential for abuse and dependence. Drugs in the
remaining schedules have decreasing abuse and dependence liabilities.
,✔✔The therapeutic window - ✔✔is the amount of a medication between the amount
that gives an effect (effective dose) and the amount that gives more adverse effects
than desired effects. For instance, medication with a small pharmaceutical window must
be administered with care and control, e.g. by frequently measuring blood concentration
of the drug, since it easily loses effects or gives adverse effects
✔✔Antagonist - ✔✔A drug that attenuates the effect of an agonist. Can be competitive
or non-competitive, each of which can be reversible or irreversible. A competitive
antagonist binds to the same site as the agonist but does not activate it, thus blocks the
agonist's action. A non-competitive antagonist binds to an allosteric (non-agonist) site
on the receptor to prevent activation of the receptor. A reversible antagonist binds non-
covalently to the receptor, therefore can be "washed out". An irreversible antagonist
binds covalently to the receptor and cannot be displaced by either competing ligands or
washing.
✔✔Agonist - ✔✔A drug that binds to and activates a receptor. Can be full, partial or
inverse. A full agonist has high efficacy, producing a full response while occupying a
relatively low proportion of receptors. A partial agonist has lower efficacy than a full
agonist. It produces sub-maximal activation even when occupying the total receptor
population, therefore cannot produce the maximal response, irrespective of the
concentration applied. An inverse agonist produces an effect opposite to that of an
agonist, yet it binds to the same receptor binding-site as an agonist
✔✔Silent Antagonist - ✔✔A drug that attenuates the effects of agonists or inverse
agonists, producing a functional reduction in signal transduction. Affects only ligand-
dependent receptor activation and displays no intrinsic activity itself. Also known as a
neutral antagonist.
✔✔The duration of action of a drug - ✔✔is the length of time that particular drug is
effective. Duration of action is a function of several parameters including plasma half-
life, the time to equilibrate between plasma and target compartments, and the off rate of
the drug from its biological target.
✔✔Schedule I Drugs - ✔✔Substances, or chemicals are defined as drugs with no
currently accepted medical use and a high potential for abuse.
-heroin, LSD, marijuana, methylenedioxymethamphetamine (ecstasy), methaqualone,
and peyote
✔✔Schedule II Drugs - ✔✔Substances, or chemicals are defined as drugs with a high
potential for abuse, with use potentially leading to severe psychological or physical
dependence
All prescriptions for schedule II drugs must be typed or filled out in ink or indelible pencil
and signed by the prescriber. Alternatively, prescribers may submit prescriptions using
, an electronic prescribing procedure. Oral prescriptions may be called in but only in
emergencies, and a written prescription must follow within 72 hours. Prescriptions for
schedule II drugs cannot be refilled. However, a DEA rule allows a prescriber to write
multiple prescriptions on the same day—for the same patient and same drug
-combination products with less than 15 milligrams of hydrocodone per dosage unit.
-Vicoden, cocaine, methamphetamine, methadone, hydromorphone, meperidine,
oxycodone, fentanyl, adderall, ritalin
✔✔Schedule III Drugs - ✔✔Substances, or chemicals, are defined as drugs with a
moderate to low potential for physical and psychological dependence. Less potential
abuse than schedule I and II.
-Products containing less than 90 milligrams of codeine per dosage unit (tylenol with
codeine), ketamine, anabolic steroids, testosterone.
Prescriptions for drugs in schedules III may be oral, written, or electronic. If authorized
by the prescriber, these prescriptions may be refilled up to 5 times. Refills must be
made within 6 months of the original order. If additional medication is needed beyond
the amount provided for in the original prescription, a new prescription must be written
✔✔Schedule IV Drugs - ✔✔Substances, or chemicals are defined as drugs with a low
potential for abuse and low risk of dependence.
-Xanax, soma, darvon, darvocet, valium, ativan, ambien, tramadol
Prescriptions for drugs in schedules IV may be oral, written, or electronic. If authorized
by the prescriber, these prescriptions may be refilled up to 5 times. Refills must be
made within 6 months of the original order. If additional medication is needed beyond
the amount provided for in the original prescription, a new prescription must be written
✔✔Schedule V Drugs - ✔✔preparations containing limited quantities of certain
narcotics. Used mainly for antidiarrheal, antitussives, and analegesic purposes.
-cough preparations with less than 200 milligrams of codeine or per 100 mililiters
(robitussion AC), lomotil, motofen, lyrica, parepectolin
✔✔Effects of certain pain medications on the heart - ✔✔
✔✔How to assess patient's overdose risk - ✔✔
✔✔Use of benzodiazepines with opioids - ✔✔
✔✔Assessing and Addressing OUD - ✔✔
✔✔Determining whether to initiate opioids for chronic pain - ✔✔
QUESTIONS AND SOLUTIONS RATED A+
✔✔Opioid Epidemic & Responsible Prescribing - ✔✔
✔✔Opioid Use Disorder - ✔✔a pattern of use that leads to significant impairment or
distress. Typically, this disorder is marked by unsuccessful efforts to reduce or control
use resulting in the inability to fulfill work, school, or home responsibilities. Opioid use
disorder is different from drug tolerance and physical dependence, which may also
exist. Opioid use creates high levels of positive reinforcement, increasing the likelihood
of continued use. It is often a chronic lifelong disorder, leading to serious consequences
such as disability and death. Although it is similar to other substance use disorders, it
has distinct features that have fueled the current opioid epidemic. Opioids can lead to
physical dependence in only 4-8 weeks. Abruptly stopping use in chronic users leads to
severe symptoms, which motivates continued use to prevent withdrawal. The 2016 CDC
guidelines for prescribing opioids recommends calculating the total daily dose of opioids
to help identify patients who might benefit from the reduction or tapering of opioids,
given the risk of overdose
✔✔State Prescription Drug - ✔✔Clinicians should review the patient's history of
controlled substance prescriptions using state prescription drug monitoring program
(PDMP) data to determine whether the patient is receiving opioid dosages or dangerous
combinations that put him or her at high risk for overdose. Clinicians should review
PDMP data when starting opioid therapy for chronic pain and periodically during opioid
therapy for chronic pain, ranging from every prescription to every 3 months.
✔✔Monitoring Programs - ✔✔safeguards to address the opioid public health crisis
include prescription drug monitoring programs (PDMPs). These 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.
According to the CDC (2020), PDMPs have shown promising results in changing
prescribing behaviors, decreasing the use of multiple providers by patients, and
decreasing substance abuse treatment admissions.
✔✔Drug Schedules - ✔✔Each drug preparation regulated under the CSA has been
assigned to one of five categories: schedule I, II, III, IV, or V. Drugs in schedule I have a
high potential for abuse and no approved medical use in the United States. In contrast,
drugs in schedules II through V all have approved applications. Assignment to
schedules II through V is based on abuse potential and potential for causing physical or
psychological dependence. Of the drugs that have medical applications, those in
schedule II have the highest potential for abuse and dependence. Drugs in the
remaining schedules have decreasing abuse and dependence liabilities.
,✔✔The therapeutic window - ✔✔is the amount of a medication between the amount
that gives an effect (effective dose) and the amount that gives more adverse effects
than desired effects. For instance, medication with a small pharmaceutical window must
be administered with care and control, e.g. by frequently measuring blood concentration
of the drug, since it easily loses effects or gives adverse effects
✔✔Antagonist - ✔✔A drug that attenuates the effect of an agonist. Can be competitive
or non-competitive, each of which can be reversible or irreversible. A competitive
antagonist binds to the same site as the agonist but does not activate it, thus blocks the
agonist's action. A non-competitive antagonist binds to an allosteric (non-agonist) site
on the receptor to prevent activation of the receptor. A reversible antagonist binds non-
covalently to the receptor, therefore can be "washed out". An irreversible antagonist
binds covalently to the receptor and cannot be displaced by either competing ligands or
washing.
✔✔Agonist - ✔✔A drug that binds to and activates a receptor. Can be full, partial or
inverse. A full agonist has high efficacy, producing a full response while occupying a
relatively low proportion of receptors. A partial agonist has lower efficacy than a full
agonist. It produces sub-maximal activation even when occupying the total receptor
population, therefore cannot produce the maximal response, irrespective of the
concentration applied. An inverse agonist produces an effect opposite to that of an
agonist, yet it binds to the same receptor binding-site as an agonist
✔✔Silent Antagonist - ✔✔A drug that attenuates the effects of agonists or inverse
agonists, producing a functional reduction in signal transduction. Affects only ligand-
dependent receptor activation and displays no intrinsic activity itself. Also known as a
neutral antagonist.
✔✔The duration of action of a drug - ✔✔is the length of time that particular drug is
effective. Duration of action is a function of several parameters including plasma half-
life, the time to equilibrate between plasma and target compartments, and the off rate of
the drug from its biological target.
✔✔Schedule I Drugs - ✔✔Substances, or chemicals are defined as drugs with no
currently accepted medical use and a high potential for abuse.
-heroin, LSD, marijuana, methylenedioxymethamphetamine (ecstasy), methaqualone,
and peyote
✔✔Schedule II Drugs - ✔✔Substances, or chemicals are defined as drugs with a high
potential for abuse, with use potentially leading to severe psychological or physical
dependence
All prescriptions for schedule II drugs must be typed or filled out in ink or indelible pencil
and signed by the prescriber. Alternatively, prescribers may submit prescriptions using
, an electronic prescribing procedure. Oral prescriptions may be called in but only in
emergencies, and a written prescription must follow within 72 hours. Prescriptions for
schedule II drugs cannot be refilled. However, a DEA rule allows a prescriber to write
multiple prescriptions on the same day—for the same patient and same drug
-combination products with less than 15 milligrams of hydrocodone per dosage unit.
-Vicoden, cocaine, methamphetamine, methadone, hydromorphone, meperidine,
oxycodone, fentanyl, adderall, ritalin
✔✔Schedule III Drugs - ✔✔Substances, or chemicals, are defined as drugs with a
moderate to low potential for physical and psychological dependence. Less potential
abuse than schedule I and II.
-Products containing less than 90 milligrams of codeine per dosage unit (tylenol with
codeine), ketamine, anabolic steroids, testosterone.
Prescriptions for drugs in schedules III may be oral, written, or electronic. If authorized
by the prescriber, these prescriptions may be refilled up to 5 times. Refills must be
made within 6 months of the original order. If additional medication is needed beyond
the amount provided for in the original prescription, a new prescription must be written
✔✔Schedule IV Drugs - ✔✔Substances, or chemicals are defined as drugs with a low
potential for abuse and low risk of dependence.
-Xanax, soma, darvon, darvocet, valium, ativan, ambien, tramadol
Prescriptions for drugs in schedules IV may be oral, written, or electronic. If authorized
by the prescriber, these prescriptions may be refilled up to 5 times. Refills must be
made within 6 months of the original order. If additional medication is needed beyond
the amount provided for in the original prescription, a new prescription must be written
✔✔Schedule V Drugs - ✔✔preparations containing limited quantities of certain
narcotics. Used mainly for antidiarrheal, antitussives, and analegesic purposes.
-cough preparations with less than 200 milligrams of codeine or per 100 mililiters
(robitussion AC), lomotil, motofen, lyrica, parepectolin
✔✔Effects of certain pain medications on the heart - ✔✔
✔✔How to assess patient's overdose risk - ✔✔
✔✔Use of benzodiazepines with opioids - ✔✔
✔✔Assessing and Addressing OUD - ✔✔
✔✔Determining whether to initiate opioids for chronic pain - ✔✔
