NR 565 PHARMACOLOGY 2026/2027 QUESTIONS AND
SOLUTIONS RATED A+
✔✔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
✔✔Adverse effects of opioids - ✔✔constipation
urinary retention
orthostatic hypotension
emesis
neurotoxicity (delirium, agitation)
tolerance and physical dependence
respiratory depression
✔✔What are strong opioids analgesics usually reserved for? - ✔✔moderate to severe
pain, postoperative pain, labor and delivery, cancer, chronic pain, hospice/palliative
care, end of life, acute traumatic events, burns
✔✔Use of opioids and these other medications should be avoided and why? -
✔✔respiratory depression with other drugs with CNS depressant action
CNS depressants
barbiturates
benzo
alcohol
general aesthetics
anti-histamines
, phenothiazine
anticholinergic drugs
atropine
tricyclic antidepressants (constipation and urinary retention)
✔✔what is the classic triad of symptoms for an opioid overdose? - ✔✔MAOI
(hyperpyrexia coma)
coma, resp depression, pinpoint pupuls
✔✔How does strength of fentanyl compare to morphine - ✔✔high milligram potency
(about 100 times that of morphine)
✔✔through what system is fentanyl metabolized? - ✔✔CYP34A (isoenzyme of
CYP450), levels of fentanyl can be increased by CYP34A inhibitors
✔✔What is methadone used to treat? - ✔✔relieve pain and treat opioid addiction
✔✔For what level of pain is codeine prescribed? - ✔✔mild to moderate
✔✔What does 10% of codeine convert to/black box warning - ✔✔10% of each dose of
codeine undergoes conversion to morphine, the active form of codeine (led to death in
children and toxicity in infants through breast milk)
✔✔Black box warning for hydrocodone - ✔✔products that contain Tylenol are
associated with hepatotoxicity
✔✔Black box warning opioids, fentanyl, oxycodone, hydromorphone, oxymorphone -
✔✔respiratory depression
✔✔black box warning for methadone - ✔✔prolong QT interval, fatal dysrhythmias
✔✔Do opioid agonist-antagonist have high or low potential for abuse? - ✔✔low - when
compared with opioid agonists
✔✔If you switch a patient from oxycodone to buprenorphine quickly what may we
expect to see? - ✔✔If given to a patient who is physically dependent on a pure agonist,
there drugs can precipitate withdrawal
✔✔What level of pain is tramadol approved for - ✔✔moderate to moderately severe
✔✔What schedule is tramadol classified as? - ✔✔schedule IV
✔✔What population should tramadol be AVOIDED in? - ✔✔pt's with epilepsy,
neurologic disorders, elderly
SOLUTIONS RATED A+
✔✔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
✔✔Adverse effects of opioids - ✔✔constipation
urinary retention
orthostatic hypotension
emesis
neurotoxicity (delirium, agitation)
tolerance and physical dependence
respiratory depression
✔✔What are strong opioids analgesics usually reserved for? - ✔✔moderate to severe
pain, postoperative pain, labor and delivery, cancer, chronic pain, hospice/palliative
care, end of life, acute traumatic events, burns
✔✔Use of opioids and these other medications should be avoided and why? -
✔✔respiratory depression with other drugs with CNS depressant action
CNS depressants
barbiturates
benzo
alcohol
general aesthetics
anti-histamines
, phenothiazine
anticholinergic drugs
atropine
tricyclic antidepressants (constipation and urinary retention)
✔✔what is the classic triad of symptoms for an opioid overdose? - ✔✔MAOI
(hyperpyrexia coma)
coma, resp depression, pinpoint pupuls
✔✔How does strength of fentanyl compare to morphine - ✔✔high milligram potency
(about 100 times that of morphine)
✔✔through what system is fentanyl metabolized? - ✔✔CYP34A (isoenzyme of
CYP450), levels of fentanyl can be increased by CYP34A inhibitors
✔✔What is methadone used to treat? - ✔✔relieve pain and treat opioid addiction
✔✔For what level of pain is codeine prescribed? - ✔✔mild to moderate
✔✔What does 10% of codeine convert to/black box warning - ✔✔10% of each dose of
codeine undergoes conversion to morphine, the active form of codeine (led to death in
children and toxicity in infants through breast milk)
✔✔Black box warning for hydrocodone - ✔✔products that contain Tylenol are
associated with hepatotoxicity
✔✔Black box warning opioids, fentanyl, oxycodone, hydromorphone, oxymorphone -
✔✔respiratory depression
✔✔black box warning for methadone - ✔✔prolong QT interval, fatal dysrhythmias
✔✔Do opioid agonist-antagonist have high or low potential for abuse? - ✔✔low - when
compared with opioid agonists
✔✔If you switch a patient from oxycodone to buprenorphine quickly what may we
expect to see? - ✔✔If given to a patient who is physically dependent on a pure agonist,
there drugs can precipitate withdrawal
✔✔What level of pain is tramadol approved for - ✔✔moderate to moderately severe
✔✔What schedule is tramadol classified as? - ✔✔schedule IV
✔✔What population should tramadol be AVOIDED in? - ✔✔pt's with epilepsy,
neurologic disorders, elderly
