Levorphanol tartrate MCQs With Answer

Levorphanol tartrate MCQs With Answer is an essential revision tool for B. Pharm students studying opioid pharmacology. Levorphanol tartrate is a potent morphinan opioid analgesic with mu‑opioid agonism, NMDA antagonism and monoamine reuptake inhibition that make it useful in severe and neuropathic pain. This set covers mechanism of action, pharmacokinetics (hepatic glucuronidation, long half‑life), clinical uses, adverse effects, drug interactions, dosing principles and safety considerations. Questions are written to deepen conceptual understanding and prepare you for exams and clinical practice. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Levorphanol is best described as which of the following?

• A racemic mixture of morphinan isomers
• The levo‑isomer of racemorphan
• An opioid peptide analogue
• A synthetic non‑opioid analgesic

Correct Answer: The levo‑isomer of racemorphan

Q2. The primary opioid receptor responsible for levorphanol’s analgesic effects is:

• Dopamine D2 receptor
• Alpha‑2 adrenergic receptor
• Mu‑opioid receptor
• Nicotinic acetylcholine receptor

Correct Answer: Mu‑opioid receptor

Q3. Besides mu‑agonism, which additional pharmacologic action contributes to levorphanol’s efficacy in neuropathic pain?

• Beta‑blockade
• Sodium channel opening
• NMDA receptor antagonism
• GABA reuptake inhibition

Correct Answer: NMDA receptor antagonism

Q4. Compared with morphine, levorphanol’s analgesic potency is approximately:

• Less potent than morphine
• About equal to morphine
• Approximately 4 times more potent than morphine
• More than 100 times more potent than morphine

Correct Answer: Approximately 4 times more potent than morphine

Q5. The main metabolic pathway for levorphanol in the liver is:

• CYP3A4 oxidative demethylation
• Glucuronidation
• Reduction by monoamine oxidase
• Amidation

Correct Answer: Glucuronidation

Q6. The clinically relevant elimination half‑life of levorphanol is best described as:

• Very short (30–60 minutes)
• Intermediate (2–4 hours)
• Long (approximately 11–16 hours)
• Extremely long (>72 hours)

Correct Answer: Long (approximately 11–16 hours)

Q7. Which formulation is commonly used to improve levorphanol solubility for pharmaceutical use?

• Levorphanol hydrochloride
• Levorphanol acetate
• Levorphanol tartrate
• Levorphanol sulfate

Correct Answer: Levorphanol tartrate

Q8. A major adverse effect that limits opioid dosing, including levorphanol, is:

• Hypoglycemia
• Respiratory depression
• Hyperthyroidism
• Renal stone formation

Correct Answer: Respiratory depression

Q9. Which drug class poses a risk of serotonin syndrome when combined with levorphanol due to its monoamine reuptake effects?

• Proton pump inhibitors
• Selective serotonin reuptake inhibitors (SSRIs)
• Beta‑blockers
• Loop diuretics

Correct Answer: Selective serotonin reuptake inhibitors (SSRIs)

Q10. Levorphanol is classified under which schedule of controlled substances in many jurisdictions (e.g., US)?

• Schedule V
• Schedule III
• Schedule II
• Not a controlled substance

Correct Answer: Schedule II

Q11. Which clinical indication is levorphanol particularly suited for due to its pharmacologic profile?

• Mild tension headache
• Chronic severe neuropathic pain
• Primary dysmenorrhea responsive to NSAIDs
• Acute uncomplicated cystitis

Correct Answer: Chronic severe neuropathic pain

Q12. The principal route of excretion for levorphanol metabolites is:

• Exhalation via lungs
• Biliary excretion only
• Renal excretion of glucuronide metabolites
• Unchanged drug in sweat

Correct Answer: Renal excretion of glucuronide metabolites

Q13. In patients with significant hepatic impairment, the main concern when using levorphanol is:

• Increased renal clearance
• Reduced absorption from the GI tract
• Decreased metabolism leading to accumulation and prolonged effect
• Increased protein binding reducing effect

Correct Answer: Decreased metabolism leading to accumulation and prolonged effect

Q14. Which of the following is a common opioid adverse effect that requires prophylactic management during chronic levorphanol therapy?

• Rash requiring antihistamines
• Constipation requiring laxatives
• Neutropenia requiring granulocyte colony‑stimulating factor
• Hyperkalemia requiring potassium binders

Correct Answer: Constipation requiring laxatives

Q15. Which pharmacodynamic interaction is most dangerous when levorphanol is combined with benzodiazepines?

• Increased risk of nephrotoxicity
• Enhanced respiratory depression and sedation
• Reduced analgesic effect of levorphanol
• Antagonism of benzodiazepine anxiolysis

Correct Answer: Enhanced respiratory depression and sedation

Q16. The analgesic effect of levorphanol can be reversed by which opioid antagonist?

• Flumazenil
• Naloxone
• Atropine
• Pralidoxime

Correct Answer: Naloxone

Q17. Compared with morphine, levorphanol typically causes:

• More histamine release and more pruritus
• Less histamine release and similar opioid adverse effects
• No risk of constipation
• A completely different adverse effect profile unrelated to opioids

Correct Answer: Less histamine release and similar opioid adverse effects

Q18. Which receptor activities are attributed to levorphanol besides mu‑opioid agonism?

• NMDA antagonism and monoamine (serotonin/norepinephrine) reuptake inhibition
• Direct GABA agonism and benzodiazepine receptor agonism
• Beta‑adrenergic receptor antagonism and calcium channel blockade
• Adenosine receptor activation

Correct Answer: NMDA antagonism and monoamine (serotonin/norepinephrine) reuptake inhibition

Q19. For dosing frequency, levorphanol’s long duration suggests it is often dosed approximately:

• Every 1–2 hours
• Every 4 hours
• Every 8–12 hours
• Once weekly

Correct Answer: Every 8–12 hours

Q20. Which of the following conditions is a contraindication to initiating levorphanol?

• Controlled hypertension
• Acute severe bronchial asthma with respiratory depression
• Stable chronic osteoarthritis pain
• Mild migraine responsive to triptans

Correct Answer: Acute severe bronchial asthma with respiratory depression

Q21. Which monitoring parameter is most important during levorphanol titration in an inpatient setting?

• Serum sodium concentration
• Respiratory rate and level of consciousness
• Electrocardiogram every hour
• Fasting blood glucose

Correct Answer: Respiratory rate and level of consciousness

Q22. Levorphanol’s activity at kappa receptors contributes primarily to which effect?

• Anticholinergic side effects
• Dysphoric and psychotomimetic effects at higher doses
• Renal excretion of unchanged drug
• Local anesthetic actions

Correct Answer: Dysphoric and psychotomimetic effects at higher doses

Q23. A key counseling point for patients starting levorphanol is to avoid which activity until tolerance is established?

• Driving or operating heavy machinery
• Consuming leafy green vegetables
• Daily moderate exercise
• Using topical emollients

Correct Answer: Driving or operating heavy machinery

Q24. Which statement about levorphanol and CYP‑mediated metabolism is most accurate?

• Levorphanol is exclusively metabolized by CYP2D6
• Levorphanol undergoes major glucuronidation with relatively minor CYP contribution
• Levorphanol is not metabolized and is excreted unchanged
• Levorphanol is activated by CYP3A4 to a toxic metabolite

Correct Answer: Levorphanol undergoes major glucuronidation with relatively minor CYP contribution

Q25. Which withdrawal symptom is characteristic of opioid cessation, including levorphanol?

• Miosis and decreased lacrimation
• Yawning, rhinorrhea and lacrimation
• Bradycardia and hypothermia
• Hyperpigmentation of the skin

Correct Answer: Yawning, rhinorrhea and lacrimation

Q26. Combining levorphanol with monoamine oxidase inhibitors (MAOIs) is:

• Recommended to enhance analgesia
• Generally contraindicated due to risk of severe interactions
• Required for conversion to active metabolite
• Irrelevant since MAOIs increase renal clearance

Correct Answer: Generally contraindicated due to risk of severe interactions

Q27. In patients with renal impairment, what is the primary pharmacokinetic concern with levorphanol?

• Increased protein binding leading to toxicity
• Accumulation of glucuronide metabolites and prolonged effect
• Complete loss of analgesic efficacy
• Increased first‑pass metabolism

Correct Answer: Accumulation of glucuronide metabolites and prolonged effect

Q28. Which characteristic of levorphanol explains its utility in some chronic neuropathic pain syndromes more than pure mu‑agonists?

• Its long‑acting local anesthetic property
• Combined NMDA antagonism and monoamine reuptake inhibition
• High anticholinergic activity
• Strong alpha‑adrenergic agonism

Correct Answer: Combined NMDA antagonism and monoamine reuptake inhibition

Q29. Which of the following is NOT a typical opioid adverse effect seen with levorphanol?

• Constipation
• Respiratory depression
• Serotonin syndrome in isolation without interacting agents
• Miosis

Correct Answer: Serotonin syndrome in isolation without interacting agents

Q30. Which patient education point is important regarding abrupt discontinuation of levorphanol?

• Abrupt stopping is safe and causes no symptoms
• Abrupt discontinuation may precipitate opioid withdrawal
• Stopping abruptly increases analgesic effect
• Discontinuation requires simultaneous initiation of MAOI

Correct Answer: Abrupt discontinuation may precipitate opioid withdrawal

Q31. Which route(s) of administration are commonly used for levorphanol in clinical practice?

• Oral and parenteral (injectable) routes
• Inhalational only
• Topical patch only
• Transdermal insulin pump delivery

Correct Answer: Oral and parenteral (injectable) routes

Q32. The chemical class of levorphanol is best described as:

• Benzodiazepine
• Phenylpiperidine
• Morphinan derivative
• Opioid peptide

Correct Answer: Morphinan derivative

Q33. In the context of postoperative analgesia, levorphanol’s long half‑life implies which advantage?

• No need to monitor respiratory status
• Potential for less frequent dosing and sustained analgesia
• Guaranteed absence of nausea
• Immediate reversal of effects when needed

Correct Answer: Potential for less frequent dosing and sustained analgesia

Q34. Which laboratory or clinical sign may indicate opioid overdose including levorphanol?

• Tachypnea and mydriasis
• Hypotension, profound sedation and respiratory depression
• Elevated liver enzymes only
• Polyuria and polydipsia

Correct Answer: Hypotension, profound sedation and respiratory depression

Q35. Which statement about analgesic tolerance to levorphanol is correct?

• Tolerance does not develop with opioids
• Tolerance to analgesic effects can develop with prolonged use
• Tolerance leads to permanent loss of effect that cannot be managed
• Tolerance only occurs with nonopioid analgesics

Correct Answer: Tolerance to analgesic effects can develop with prolonged use

Q36. Regarding pharmacovigilance, what is essential when prescribing levorphanol in outpatient settings?

• No documentation is necessary due to its safety
• Careful documentation, prescription limits and monitoring for misuse or diversion
• Encouraging patients to double the dose if pain persists
• Prescribing concurrently with MAOIs to improve efficacy

Correct Answer: Careful documentation, prescription limits and monitoring for misuse or diversion

Q37. Which effect on the biliary system is a concern with opioid therapy including levorphanol?

• Decrease in sphincter of Oddi tone
• Increase in sphincter of Oddi tone and potential biliary colic
• Stimulation of bile acid production lowering cholesterol
• Complete prevention of gallstone formation

Correct Answer: Increase in sphincter of Oddi tone and potential biliary colic

Q38. Levorphanol’s analgesic properties are primarily mediated through which intracellular mechanism after receptor binding?

• Activation of adenylate cyclase increasing cAMP
• Inhibition of adenylate cyclase leading to decreased cAMP
• Direct DNA binding and gene transcription
• Opening of voltage‑gated potassium channels causing depolarization

Correct Answer: Inhibition of adenylate cyclase leading to decreased cAMP

Q39. Compared to tramadol, levorphanol is characterized by which of the following?

• It is a prodrug requiring CYP2D6 activation like tramadol
• It is a stronger opioid with direct mu‑agonism and NMDA effects
• It has no opioid receptor activity
• It is less potent and used only for mild pain

Correct Answer: It is a stronger opioid with direct mu‑agonism and NMDA effects

Q40. Signs of serotonin syndrome when levorphanol is combined with serotonergic drugs include:

• Bradykinesia and hyporeflexia only
• Hyperthermia, hyperreflexia and autonomic instability
• Isolated alopecia
• Progressive hyperglycemia

Correct Answer: Hyperthermia, hyperreflexia and autonomic instability

Q41. Which population requires extra caution due to increased risk of neonatal respiratory depression with maternal opioid use?

• Pregnant women near term
• Healthy nonpregnant adults
• Pediatric patients above 12 years only
• Postmenopausal women

Correct Answer: Pregnant women near term

Q42. If a patient on levorphanol develops severe constipation despite laxatives, which class of drug can be considered to treat opioid‑induced constipation?

• Peripherally acting mu‑opioid receptor antagonists (PAMORAs)
• Systemic corticosteroids
• ACE inhibitors
• Antifungals

Correct Answer: Peripherally acting mu‑opioid receptor antagonists (PAMORAs)

Q43. When converting patients from morphine to levorphanol, which principle is most important?

• Use a direct 1:1 mg substitution regardless of potency
• Account for relative potency and apply appropriate conversion factors with caution
• Stop opioid therapy completely and restart levorphanol at high doses
• Combine both drugs at full doses for cross‑tolerance

Correct Answer: Account for relative potency and apply appropriate conversion factors with caution

Q44. Which adverse effect is less commonly associated with levorphanol compared with morphine?

• Severe respiratory depression at equianalgesic doses
• Histamine‑mediated hypotension and pruritus
• Constipation
• Miosis

Correct Answer: Histamine‑mediated hypotension and pruritus

Q45. The presence of which comedication would prompt caution and close monitoring rather than routine co‑prescription with levorphanol?

• A topical hydrocortisone cream
• A benzodiazepine such as lorazepam
• Oral vitamin C
• Topical antifungal for athlete’s foot

Correct Answer: A benzodiazepine such as lorazepam

Q46. Which symptom cluster would most likely suggest opioid withdrawal rather than opioid overdose?

• Severe sedation and respiratory depression
• Hypertension, mydriasis, yawning and lacrimation
• Profound bradycardia and coma
• Hypothermia and pinpoint pupils

Correct Answer: Hypertension, mydriasis, yawning and lacrimation

Q47. For which reason might levorphanol be preferred over a pure mu agonist in certain chronic pain patients?

• It has no potential for dependence
• Its multimodal actions (NMDA antagonism, monoamine effects) may help refractory neuropathic pain
• It causes no sedation at any dose
• It is available over the counter

Correct Answer: Its multimodal actions (NMDA antagonism, monoamine effects) may help refractory neuropathic pain

Q48. Which regulatory practice is important when storing levorphanol in a hospital pharmacy?

• Store on open shelf with OTC analgesics
• Secure storage with controlled‑substance record‑keeping
• No record of dispensing is required
• Mandatory refrigeration at 2–8°C

Correct Answer: Secure storage with controlled‑substance record‑keeping

Q49. An important pharmacokinetic consideration when switching from immediate‑release to extended‑release opioid formulations like levorphanol is:

• They always reduce risk of overdose
• Dosing intervals and cumulative exposure must be recalculated to avoid accumulation
• No dose adjustments are ever needed
• They are ineffective for chronic pain

Correct Answer: Dosing intervals and cumulative exposure must be recalculated to avoid accumulation

Q50. Which counselling point addresses safe use and diversion prevention for patients prescribed levorphanol?

• Share medication only with family members in pain
• Store securely, do not share, and return unused tablets to pharmacy if required
• Increase dose if pain returns without consulting prescriber
• Use alcohol to enhance analgesic effect as needed

Correct Answer: Store securely, do not share, and return unused tablets to pharmacy if required

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com