NU 578 Controlled Substances Question and
Answer 2026 | Comprehensive Review with
Detailed Rationales | Grade A+
• Opioids Drugs. CORRECT ANSWER: Drugs:
• Opioids - MOA. CORRECT ANSWER: - Bind to "opiate receptors" in the brain, which
disrupts the transmission of pain signals in the CNS.
- Mimic actions of endogenous opiates
(endorphins, enkephalins, dynorphins).
- Primarily activate mu receptors, but also activate Kappa
• Opioids - Effect. CORRECT ANSWER: * Relieve pain & induce euphoria
Also cause sedation, respiratory depression, miosis, constipation, nausea, & suppress
the cough reflex.
• Opioids - Uses. CORRECT ANSWER: - Pain relief
- Cough suppression
- Relief of dyspnea
- Preoperative sedation
• Opioids - Side Effects. CORRECT ANSWER: Hypotension
sedation
nausea
itching
miosis
muscle weakness
constipation
Urinary Retention
Biliary Colic
Increased ICP
• Treatment of Opioid- Induced Constipation. CORRECT ANSWER: methylnaltrexone
(Relistor)
naloxegol (Movantik)
Blocks opioid receptors in the GI tract
* Does not cross blood-brain barrier, so does not reverse analgesia
• Opioids - Drug Interactions. CORRECT ANSWER: CNS depressants!
,Anticholinergics
Drugs that lower BP
• Opioids - Contraindications/Warnings. CORRECT ANSWER: Decreased respiratory
reserve
Labor and delivery
Inflammatory Bowel disease
Head Injury
• Opioids - Patient Educaiton. CORRECT ANSWER:
• Opioid toxicity. CORRECT ANSWER: 3 signs:
- coma
- pinpoint pupils
- respiratory depression - may be fatal!
• Tolerance. CORRECT ANSWER: a state in which a drug user needs larger amounts
of the drug to produce the same effect on the body
• Physical Dependence. CORRECT ANSWER: A state in which an abstinence
syndrome will occur if drug use is abruptly stopped
• Abuse. CORRECT ANSWER: drug use that is inconsistent with medical or social
norms
• Addiction. CORRECT ANSWER: disease characterized by and individual
pathologically pursuing rewards and relief by substance use and other behaviors
• Full opioid agonists. CORRECT ANSWER: - Good for severe pain
- May give a feeling of euphoria
Example: Morphin, codeine, hydromorphone
• Partial opioid agonists (Agonist-antagonist). CORRECT ANSWER: - Good for
moderate pain
- May act as antagonists at some receptors and
precipitate withdrawal.
Example: pentazocine, Suboxone, buprenorphine, nalbuphine
• Partial opioid agonists (Agonist-antagonist) Drugs:. CORRECT ANSWER:
Pentazocine
Suboxone
Buprenorphine
, Nalbuphine
• Partial opioid agonists (Agonist-antagonist) Action. CORRECT ANSWER: Acts as
antagonists at mu receptors, and agonists at kappa receptors
• Buprenorphine (Suboxone) Action:. CORRECT ANSWER: Acts as a partial agonist at
mu receptors, and an antagonist at kappa receptors
• Medications for those with hx of Opioid abuse. CORRECT ANSWER:
morphine/naltrexone (Embeda)
• Opioid antagonists. CORRECT ANSWER: Reverse all narcotic effects including pain
relief, euphoria, and respiratory depression.
• Naloxone (Narcan) Action:. CORRECT ANSWER: Competes for opioid receptors,
thereby blocking opioid actions
Structural analog of morphine
• Tramadol (Ultram) action. CORRECT ANSWER: - Weak agonist at mu receptors
- Blocks NE and serotonin uptake, thereby activating monoaminergic spinal inhibition of
pain
• Tramadol (Ultram) Drug Interactions. CORRECT ANSWER: CNS Depressants
MAOIs
SSRIs/TCAs/Triptans --> Serotonin syndrome
• Schedule II Prescribing rules. CORRECT ANSWER: 1) Can write several C-II Rx's
on the same day, for the same patient, for the same drug...for up to a 90 day supply.
2) Must indicate the earliest date the patient can fill each Rx and sign and date
TODAY'S date.
3) If patient is in a LTCF or is terminally ill, an Rx may be partially filled. Note this on the
Rx.
• CNS Stimulants - Drugs. CORRECT ANSWER: amphetamine
Lisdexamphetamine
Dextroamphetamine
Methamphetamine
Methylphenidate
Dexmethylphenidate
• CNS Stimulants - Action. CORRECT ANSWER: ↑ release of NE & dopamine in CNS
Inhibit reuptake of NE and dopamine
Answer 2026 | Comprehensive Review with
Detailed Rationales | Grade A+
• Opioids Drugs. CORRECT ANSWER: Drugs:
• Opioids - MOA. CORRECT ANSWER: - Bind to "opiate receptors" in the brain, which
disrupts the transmission of pain signals in the CNS.
- Mimic actions of endogenous opiates
(endorphins, enkephalins, dynorphins).
- Primarily activate mu receptors, but also activate Kappa
• Opioids - Effect. CORRECT ANSWER: * Relieve pain & induce euphoria
Also cause sedation, respiratory depression, miosis, constipation, nausea, & suppress
the cough reflex.
• Opioids - Uses. CORRECT ANSWER: - Pain relief
- Cough suppression
- Relief of dyspnea
- Preoperative sedation
• Opioids - Side Effects. CORRECT ANSWER: Hypotension
sedation
nausea
itching
miosis
muscle weakness
constipation
Urinary Retention
Biliary Colic
Increased ICP
• Treatment of Opioid- Induced Constipation. CORRECT ANSWER: methylnaltrexone
(Relistor)
naloxegol (Movantik)
Blocks opioid receptors in the GI tract
* Does not cross blood-brain barrier, so does not reverse analgesia
• Opioids - Drug Interactions. CORRECT ANSWER: CNS depressants!
,Anticholinergics
Drugs that lower BP
• Opioids - Contraindications/Warnings. CORRECT ANSWER: Decreased respiratory
reserve
Labor and delivery
Inflammatory Bowel disease
Head Injury
• Opioids - Patient Educaiton. CORRECT ANSWER:
• Opioid toxicity. CORRECT ANSWER: 3 signs:
- coma
- pinpoint pupils
- respiratory depression - may be fatal!
• Tolerance. CORRECT ANSWER: a state in which a drug user needs larger amounts
of the drug to produce the same effect on the body
• Physical Dependence. CORRECT ANSWER: A state in which an abstinence
syndrome will occur if drug use is abruptly stopped
• Abuse. CORRECT ANSWER: drug use that is inconsistent with medical or social
norms
• Addiction. CORRECT ANSWER: disease characterized by and individual
pathologically pursuing rewards and relief by substance use and other behaviors
• Full opioid agonists. CORRECT ANSWER: - Good for severe pain
- May give a feeling of euphoria
Example: Morphin, codeine, hydromorphone
• Partial opioid agonists (Agonist-antagonist). CORRECT ANSWER: - Good for
moderate pain
- May act as antagonists at some receptors and
precipitate withdrawal.
Example: pentazocine, Suboxone, buprenorphine, nalbuphine
• Partial opioid agonists (Agonist-antagonist) Drugs:. CORRECT ANSWER:
Pentazocine
Suboxone
Buprenorphine
, Nalbuphine
• Partial opioid agonists (Agonist-antagonist) Action. CORRECT ANSWER: Acts as
antagonists at mu receptors, and agonists at kappa receptors
• Buprenorphine (Suboxone) Action:. CORRECT ANSWER: Acts as a partial agonist at
mu receptors, and an antagonist at kappa receptors
• Medications for those with hx of Opioid abuse. CORRECT ANSWER:
morphine/naltrexone (Embeda)
• Opioid antagonists. CORRECT ANSWER: Reverse all narcotic effects including pain
relief, euphoria, and respiratory depression.
• Naloxone (Narcan) Action:. CORRECT ANSWER: Competes for opioid receptors,
thereby blocking opioid actions
Structural analog of morphine
• Tramadol (Ultram) action. CORRECT ANSWER: - Weak agonist at mu receptors
- Blocks NE and serotonin uptake, thereby activating monoaminergic spinal inhibition of
pain
• Tramadol (Ultram) Drug Interactions. CORRECT ANSWER: CNS Depressants
MAOIs
SSRIs/TCAs/Triptans --> Serotonin syndrome
• Schedule II Prescribing rules. CORRECT ANSWER: 1) Can write several C-II Rx's
on the same day, for the same patient, for the same drug...for up to a 90 day supply.
2) Must indicate the earliest date the patient can fill each Rx and sign and date
TODAY'S date.
3) If patient is in a LTCF or is terminally ill, an Rx may be partially filled. Note this on the
Rx.
• CNS Stimulants - Drugs. CORRECT ANSWER: amphetamine
Lisdexamphetamine
Dextroamphetamine
Methamphetamine
Methylphenidate
Dexmethylphenidate
• CNS Stimulants - Action. CORRECT ANSWER: ↑ release of NE & dopamine in CNS
Inhibit reuptake of NE and dopamine
