NR 565 MIDTERM EXAM EXAM PREPARATION
PACK 2026 KEY CONCEPTS AND REVISION
NOTES
◉ Acute Pain Management.
Answer:
◉ Chronic Pain Management.
Answer:
◉ Opioid Management.
Answer:
◉ Regulations of Controlled Substances.
Answer: The U.S. Department of Justice Drug Enforcement Agency
(DEA) coordinates with local, state, and federal agents to reduce
illicit drug use. 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. Characteristics of a valid DEA number
include:
-The first letter identifies the type of provider: A=before 1985;
B=after 1985; F=after 2007; M=nurse practitioner or physician
assistant
-The 2nd letter the 1st letter of the provider's last name at the time
of initial registration
Example: Tammy Greene applies for and receives a DEA number of
MG2705208
M=nurse practitioner and G=Greene
◉ Opioid Epidemic & Responsible Prescribing.
Answer:
◉ Opioid Use Disorder.
Answer: 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.
Answer: 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.
Answer: 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.
Answer: 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.
Answer: 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.
Answer: A drug that attenuates the effect of an agonist. Can be
competitive or non-competitive, each of which can be reversible or
PACK 2026 KEY CONCEPTS AND REVISION
NOTES
◉ Acute Pain Management.
Answer:
◉ Chronic Pain Management.
Answer:
◉ Opioid Management.
Answer:
◉ Regulations of Controlled Substances.
Answer: The U.S. Department of Justice Drug Enforcement Agency
(DEA) coordinates with local, state, and federal agents to reduce
illicit drug use. 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. Characteristics of a valid DEA number
include:
-The first letter identifies the type of provider: A=before 1985;
B=after 1985; F=after 2007; M=nurse practitioner or physician
assistant
-The 2nd letter the 1st letter of the provider's last name at the time
of initial registration
Example: Tammy Greene applies for and receives a DEA number of
MG2705208
M=nurse practitioner and G=Greene
◉ Opioid Epidemic & Responsible Prescribing.
Answer:
◉ Opioid Use Disorder.
Answer: 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.
Answer: 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.
Answer: 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.
Answer: 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.
Answer: 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.
Answer: A drug that attenuates the effect of an agonist. Can be
competitive or non-competitive, each of which can be reversible or
