NURS 8024 Pharmacology Final Exam 2025 GUIDE
Physical Dependence =
“dependence”
Psychological dependence = “addiction”
As a general rule, all addictive drugs activate the mesolimbic dopamine system.
Schedules for Controlled Substances
Schedule I
The drug or other substance has a high potential for abuse
Has no currently accepted medical use in the treatment in the U.S.
Has no accepted safe use under medical supervision
Ex: Heroin, marijuana
Schedule II
The drug or other substance has a high potential for abuse
Has a currently accepted medical use in treatment in the U.S. or
Has a currently accepted medical use but w/ severe restrictions and
Abuse of the drug or other substance may lead to severe psychological or physical dependence
Ex: Morphine, Oxycodone, Hydromorphone, Meperidine, anabolic steroids, Cocaine
Schedule III
The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I
and II
Has a currently accepted medical use in treatment in the U.S.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high
psychological dependence
Ex: Codeine
Schedule IV
The drug or other substance has a low potential for abuse relative to the drugs or other substances in
Schedule III
Has a currently accepted medical use in treatment in the U.S.
Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence
relative to the drugs or other substances in Schedule III
Ex: Benzos, propoxyphene combinations
Schedule V
The drug or other substance has a low potential for abuse relative to the drugs or other substances in
Schedule IV
Has a currently accepted medical use in treatment in the U.S.
Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence
relative to the drugs or other substances in Schedule IV
Ex: Diphenoxylate combinations, cough syrups
CNS STIMULANTS
Psychomotor stimulants
o Cause excitement, euphoria, decrease feelings of fatigue
Drugs: Caffeine, nicotine, cocaine, amphetamines
Have diverse clinical uses and are important as drugs of abuse
Drug Class MOA Effects on body Pharmacokinetics Adverse Effects
,Methylxanthines Multifactorial CNS Well-absorbed Withdrawal ~
Decreases fatigue, orally, distributes fatigue, sedation,
-Theophylline (tea) increases mental throughout body headaches, irritability
-Theobromine alertness, anxiety, including the brain, in patients routinely
(cocoa) tremors can cross the consuming > 600
-Caffeine (most placenta and is mg/day
widely consumed Gastric mucosa secreted in breast
stimulant in the Stimulate secretion milk, metabolized in Moderate doses ~
world!) of hydrochloric liver, excreted in insomnia, anxiety,
acid (avoid in urine agitation
PUD)
High dosage
CV required for toxicity
+inotropic ~ emesis,
+chronotropic convulsions
(avoid in pts w/
angina) Lethal dose = 10
-Can trigger ectopy grams of coffee (100
-Mild diuretic cups of coffee),
action induces cardiac
arrythmias
Respiratory
Relax bronchiole
smooth muscles
Nicotine CNS Highly lipid-soluble, MANY!
Pleasure, arousal, readily absorbed via
2nd most widely used enhanced vigilance, oral mucosa, lungs, Cancers, pulmonary
stimulant in the improved task GI mucosa, and skin, disease, CV disease,
world! performance, crosses placenta, reproductive effects,
anxiety relief secreted in breast cataracts,
milk, crosses BBB, osteoporosis,
CV metabolized in the periodontitis, poor
Increased HR, CO, liver and lungs, surgical outcomes
BP, coronary and excreted in urine
peripheral Irritability, tremors,
vasoconstriction, intestinal cramps,
cutaneous diarrhea, increased
vasoconstriction HR/BP
Other
Appetite
suppression,
increased
metabolic rate,
skeletal muscle
relaxation
Cocaine Blockade of CNS Peak effect in 15-20 Highly addictive,
reuptake of the Behavioral effects minutes after use, anxiety (HTN,
monoamines d/t stimulation of high disappears in 1- tachycardia,
(norepinephrine, the cortex and 1.5 hours sweating, paranoia,
serotonin, brainstem, irritability),
dopamine) into the increased mental Potential for depression (follows
presynaptic awareness, feelings overdosing and use when high wears
terminals of well-being and dependence is off)
euphoria, greatest with IV
Prolongations of hallucinations and injection or smoking Toxic effects include
dopaminergic delusions of crack (onset is most seizures, fatal
effects in the paranoia or rapid) arrythmias (can use
, brain’s pleasure grandiosity, IV Diazepam and
system (limbic increases motor Rapidly metabolized, Propranolol to treat
system) produces activity excreted in urine symptoms)
intense euphoria
Sympathetic NS
Chronic intake Potentiates action
depletes dopamine of norepinephrine
(Fight or Flight),
Only local tachycardia, HTN,
anesthetic that pupillary dilation,
causes peripheral
vasoconstriction! vasoconstriction
Hyperthermia
Amphetamines Similar to cocaine, CNS Completely absorbed Addiction,
releases Behavioral effects by GI, metabolized dependence,
Dextroamphetamine, intracellular stores come from by liver, excreted in tolerance, drug-
Methamphetamine, of catecholamines combination of urine seeking behavior
Modafinil dopamine and
(narcolepsy) Used to treat norepinephrine Insomnia, irritability,
ADHD (improves release-enhancing weakness, dizziness,
attention, properties, tremor, hyperactive
behavioral increased alertness, reflexes, confusion,
problems) and decreased fatigue, delirium, panic,
narcolepsy decreased appetite, suicidal tendencies,
(promotes insomnia palpitations,
wakefulness, arrythmias, HTN,
produces fewer angina, circulatory
psychoactive effects collapse, h/a, chills,
than other sweating, anorexia,
stimulants) N/V/D, abd cramps
Treat OD w/ Modafinil ~ h/a,
Chlorpromazine nausea, rhinitis
or Haloperidol
Nicotine & Smoking Cessation
Nicotine is addictive, physical dependence develops rapidly and can be severe
Withdrawal is characterized by irritability, anxiety, restlessness, difficulty concentrating, headaches, and
insomnia
Smoking cessation ~ combining pharmacologic and behavioral therapy is most successful to stop smoking
Transdermal patch and chewing gum can reduce nicotine withdrawal symptoms
Bupropion can reduce cravings for cigarettes
The 5 As
o Ask (about tobacco use)
o Advise (tobacco users to quit)
o Assess (readiness to make a quit attempt)
o Assist (with the quit attempt)
o Arrange (follow-up care)
STAR
o Set a quit date
o Tell family and friends that you want to quit and need help
o Anticipate challenges and make plans
o Remove tobacco products from the environment
Physical Dependence =
“dependence”
Psychological dependence = “addiction”
As a general rule, all addictive drugs activate the mesolimbic dopamine system.
Schedules for Controlled Substances
Schedule I
The drug or other substance has a high potential for abuse
Has no currently accepted medical use in the treatment in the U.S.
Has no accepted safe use under medical supervision
Ex: Heroin, marijuana
Schedule II
The drug or other substance has a high potential for abuse
Has a currently accepted medical use in treatment in the U.S. or
Has a currently accepted medical use but w/ severe restrictions and
Abuse of the drug or other substance may lead to severe psychological or physical dependence
Ex: Morphine, Oxycodone, Hydromorphone, Meperidine, anabolic steroids, Cocaine
Schedule III
The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I
and II
Has a currently accepted medical use in treatment in the U.S.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high
psychological dependence
Ex: Codeine
Schedule IV
The drug or other substance has a low potential for abuse relative to the drugs or other substances in
Schedule III
Has a currently accepted medical use in treatment in the U.S.
Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence
relative to the drugs or other substances in Schedule III
Ex: Benzos, propoxyphene combinations
Schedule V
The drug or other substance has a low potential for abuse relative to the drugs or other substances in
Schedule IV
Has a currently accepted medical use in treatment in the U.S.
Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence
relative to the drugs or other substances in Schedule IV
Ex: Diphenoxylate combinations, cough syrups
CNS STIMULANTS
Psychomotor stimulants
o Cause excitement, euphoria, decrease feelings of fatigue
Drugs: Caffeine, nicotine, cocaine, amphetamines
Have diverse clinical uses and are important as drugs of abuse
Drug Class MOA Effects on body Pharmacokinetics Adverse Effects
,Methylxanthines Multifactorial CNS Well-absorbed Withdrawal ~
Decreases fatigue, orally, distributes fatigue, sedation,
-Theophylline (tea) increases mental throughout body headaches, irritability
-Theobromine alertness, anxiety, including the brain, in patients routinely
(cocoa) tremors can cross the consuming > 600
-Caffeine (most placenta and is mg/day
widely consumed Gastric mucosa secreted in breast
stimulant in the Stimulate secretion milk, metabolized in Moderate doses ~
world!) of hydrochloric liver, excreted in insomnia, anxiety,
acid (avoid in urine agitation
PUD)
High dosage
CV required for toxicity
+inotropic ~ emesis,
+chronotropic convulsions
(avoid in pts w/
angina) Lethal dose = 10
-Can trigger ectopy grams of coffee (100
-Mild diuretic cups of coffee),
action induces cardiac
arrythmias
Respiratory
Relax bronchiole
smooth muscles
Nicotine CNS Highly lipid-soluble, MANY!
Pleasure, arousal, readily absorbed via
2nd most widely used enhanced vigilance, oral mucosa, lungs, Cancers, pulmonary
stimulant in the improved task GI mucosa, and skin, disease, CV disease,
world! performance, crosses placenta, reproductive effects,
anxiety relief secreted in breast cataracts,
milk, crosses BBB, osteoporosis,
CV metabolized in the periodontitis, poor
Increased HR, CO, liver and lungs, surgical outcomes
BP, coronary and excreted in urine
peripheral Irritability, tremors,
vasoconstriction, intestinal cramps,
cutaneous diarrhea, increased
vasoconstriction HR/BP
Other
Appetite
suppression,
increased
metabolic rate,
skeletal muscle
relaxation
Cocaine Blockade of CNS Peak effect in 15-20 Highly addictive,
reuptake of the Behavioral effects minutes after use, anxiety (HTN,
monoamines d/t stimulation of high disappears in 1- tachycardia,
(norepinephrine, the cortex and 1.5 hours sweating, paranoia,
serotonin, brainstem, irritability),
dopamine) into the increased mental Potential for depression (follows
presynaptic awareness, feelings overdosing and use when high wears
terminals of well-being and dependence is off)
euphoria, greatest with IV
Prolongations of hallucinations and injection or smoking Toxic effects include
dopaminergic delusions of crack (onset is most seizures, fatal
effects in the paranoia or rapid) arrythmias (can use
, brain’s pleasure grandiosity, IV Diazepam and
system (limbic increases motor Rapidly metabolized, Propranolol to treat
system) produces activity excreted in urine symptoms)
intense euphoria
Sympathetic NS
Chronic intake Potentiates action
depletes dopamine of norepinephrine
(Fight or Flight),
Only local tachycardia, HTN,
anesthetic that pupillary dilation,
causes peripheral
vasoconstriction! vasoconstriction
Hyperthermia
Amphetamines Similar to cocaine, CNS Completely absorbed Addiction,
releases Behavioral effects by GI, metabolized dependence,
Dextroamphetamine, intracellular stores come from by liver, excreted in tolerance, drug-
Methamphetamine, of catecholamines combination of urine seeking behavior
Modafinil dopamine and
(narcolepsy) Used to treat norepinephrine Insomnia, irritability,
ADHD (improves release-enhancing weakness, dizziness,
attention, properties, tremor, hyperactive
behavioral increased alertness, reflexes, confusion,
problems) and decreased fatigue, delirium, panic,
narcolepsy decreased appetite, suicidal tendencies,
(promotes insomnia palpitations,
wakefulness, arrythmias, HTN,
produces fewer angina, circulatory
psychoactive effects collapse, h/a, chills,
than other sweating, anorexia,
stimulants) N/V/D, abd cramps
Treat OD w/ Modafinil ~ h/a,
Chlorpromazine nausea, rhinitis
or Haloperidol
Nicotine & Smoking Cessation
Nicotine is addictive, physical dependence develops rapidly and can be severe
Withdrawal is characterized by irritability, anxiety, restlessness, difficulty concentrating, headaches, and
insomnia
Smoking cessation ~ combining pharmacologic and behavioral therapy is most successful to stop smoking
Transdermal patch and chewing gum can reduce nicotine withdrawal symptoms
Bupropion can reduce cravings for cigarettes
The 5 As
o Ask (about tobacco use)
o Advise (tobacco users to quit)
o Assess (readiness to make a quit attempt)
o Assist (with the quit attempt)
o Arrange (follow-up care)
STAR
o Set a quit date
o Tell family and friends that you want to quit and need help
o Anticipate challenges and make plans
o Remove tobacco products from the environment
