MCQ Quiz: Opioid Reversal

The opioid overdose crisis is a major public health emergency, and naloxone is a life-saving reversal agent. Pharmacists, as accessible healthcare providers, are on the front lines of this crisis, a role that draws on knowledge from pharmacotherapy, law, and public health as taught throughout the PharmD curriculum ,. This quiz will test your knowledge on the pharmacology of naloxone, the practical steps of overdose response, and the pharmacist’s critical role in naloxone dispensing and education.

1. The life-threatening event in an opioid overdose is primarily caused by:

• a. A massive increase in blood pressure.
• b. Severe respiratory depression.
• c. A sudden drop in blood glucose.
• d. Anaphylaxis.

Answer: b. Severe respiratory depression.

2. What is the mechanism of action of naloxone?

• a. It is a partial agonist at the mu-opioid receptor.
• b. It is a pure, competitive antagonist at the mu-opioid receptor.
• c. It stimulates the respiratory drive through a separate pathway.
• d. It increases the metabolism of opioids.

Answer: b. It is a pure, competitive antagonist at the mu-opioid receptor.

3. Which of the following is a classic sign of an opioid overdose?

• a. Dilated pupils (mydriasis)
• b. Rapid, deep breathing
• c. Pinpoint pupils (miosis) and unresponsiveness
• d. High fever

Answer: c. Pinpoint pupils (miosis) and unresponsiveness

4. A person administers a dose of intranasal naloxone to someone who has overdosed. What is the most important next step?

• a. To immediately administer a second dose.
• b. To leave the person alone to let the medication work.
• c. To call 911 immediately, as the effects of naloxone may wear off.
• d. To give the person a caffeinated beverage.

Answer: c. To call 911 immediately, as the effects of naloxone may wear off.

5. Naloxone has a _____ duration of action than most opioids like heroin or oxycodone.

• a. much longer
• b. slightly longer
• c. identical
• d. shorter

Answer: d. shorter

6. The “Pharmacology of Analgesics,” which covers opioids, is a lecture in which course?

• a. PHA5878C Patient Care 3
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5787C Patient Care 5

Answer: a. PHA5878C Patient Care 3

7. A person who is physically dependent on opioids is given naloxone. What is the expected outcome?

• a. No effect.
• b. A rapid and pleasant reversal of their “high.”
• c. The precipitation of an acute, severe withdrawal syndrome.
• d. A gradual return to consciousness over several hours.

Answer: c. The precipitation of an acute, severe withdrawal syndrome.

8. Narcan® Nasal Spray should be administered by:

• a. Spraying half the dose in each nostril.
• b. Spraying the full dose into one nostril.
• c. Having the patient inhale deeply during administration.
• d. Spraying it into the mouth.

Answer: b. Spraying the full dose into one nostril.

9. The primary goal of administering naloxone during an overdose is to:

• a. Restore full consciousness and alertness.
• b. Induce withdrawal.
• c. Restore adequate spontaneous breathing.
• d. Punish the user for taking opioids.

Answer: c. Restore adequate spontaneous breathing.

10. Administering naloxone to a person who has NOT taken any opioids will result in:

• a. Severe respiratory depression.
• b. An opioid withdrawal syndrome.
• c. A state of euphoria.
• d. No significant pharmacological effect.

Answer: d. No significant pharmacological effect.

11. A pharmacist dispensing naloxone under a statewide standing order is acting in what capacity?

• a. A public health advocate.
• b. A dispenser of a legend drug.
• c. An educator.
• d. All of the above.

Answer: d. All of the above.

12. A “standing order” for naloxone allows a pharmacist to:

• a. Prescribe any controlled substance.
• b. Dispense naloxone to individuals at risk or their caregivers without a patient-specific prescription from a doctor.
• c. Refuse to dispense naloxone.
• d. Only dispense naloxone to healthcare professionals.

Answer: b. Dispense naloxone to individuals at risk or their caregivers without a patient-specific prescription from a doctor.

13. Which of the following is NOT a sign of opioid withdrawal?

• a. Nausea, vomiting, and diarrhea
• b. Yawning and sweating
• c. Muscle aches and agitation
• d. Respiratory depression

Answer: d. Respiratory depression

14. A key counseling point for a family member receiving a naloxone kit is:

• a. How to recognize the signs of an overdose.
• b. How to properly administer their specific naloxone product.
• c. The importance of calling 911 for every overdose.
• d. All of the above.

Answer: d. All of the above.

15. A patient who is revived with naloxone may become responsive and then unresponsive again 30-60 minutes later because:

• a. The naloxone dose was too high.
• b. The naloxone has a shorter half-life than the opioid, and the respiratory depression can return.
• c. The patient is having an allergic reaction.
• d. The naloxone has stopped working.

Answer: b. The naloxone has a shorter half-life than the opioid, and the respiratory depression can return.

16. The principles of pharmacy law are foundational to understanding naloxone access laws.

• a. True
• b. False

Answer: a. True

17. The “Pharmacotherapy of Pain” is a topic within the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

18. Which of the following patients should be offered a naloxone prescription?

• a. A patient on a high daily dose of opioids for chronic pain.
• b. A patient with a history of opioid use disorder.
• c. A patient taking an opioid concurrently with a benzodiazepine.
• d. All of the above.

Answer: d. All of the above.

19. Naloxone is a controlled substance.

• a. True
• b. False

Answer: b. False

20. An active learning session on pain management is part of the Patient Care 3 course.

• a. True
• b. False

Answer: a. True

21. A patient is found unresponsive after taking a large amount of alprazolam (a benzodiazepine). Will naloxone be effective?

• a. Yes, it reverses all sedative overdoses.
• b. No, naloxone only reverses the effects of opioids.
• c. Yes, but only if given intravenously.
• d. No, the correct reversal agent is epinephrine.

Answer: b. No, naloxone only reverses the effects of opioids.

22. “Good Samaritan” laws in many states are designed to:

• a. Punish bystanders who try to help.
• b. Protect individuals who act in good faith to provide emergency assistance from civil liability.
• c. Require every citizen to carry naloxone.
• d. Pay people for responding to an overdose.

Answer: b. Protect individuals who act in good faith to provide emergency assistance from civil liability.

23. The pharmacist’s role in promoting public health is a key objective in the IPPE curriculum.

• a. True
• b. False

Answer: a. True

24. An active learning session on pain is part of which course?

• a. PHA5878C Patient Care 3
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5878C Patient Care 3

25. A pharmacist providing naloxone and clean syringes to a person who injects drugs is participating in what type of public health strategy?

• a. Harm reduction
• b. Law enforcement
• c. A prescribing cascade
• d. A medication error

Answer: a. Harm reduction

26. The primary difference between Narcan (4 mg) and Kloxxado (8 mg) nasal sprays is the:

• a. Route of administration
• b. Active ingredient
• c. Dose of naloxone per spray
• d. Expiration date

Answer: c. Dose of naloxone per spray

27. A second dose of naloxone should be considered if:

• a. The patient wakes up immediately.
• b. The patient does not respond with improved breathing after 2-3 minutes.
• c. The patient becomes agitated.
• d. EMS has already arrived.

Answer: b. The patient does not respond with improved breathing after 2-3 minutes.

28. An active learning session on pain is part of which course module?

• a. Module 1: Introduction to Pain and Treatment Options
• b. Module 3: Dyslipidemia
• c. Module 5: Acute Coronary Syndrome
• d. Module 8: Introduction to Pulmonary Disease

Answer: a. Module 1: Introduction to Pain and Treatment Options

29. The purpose of a naloxone standing order is to:

• a. Increase barriers to accessing a life-saving medication.
• b. Decrease barriers to accessing a life-saving medication.
• c. Ensure only physicians can prescribe naloxone.
• d. Track all opioid users.

Answer: b. Decrease barriers to accessing a life-saving medication.

30. The law and ethics course PHA5703 would cover the state-specific regulations for dispensing naloxone.

• a. True
• b. False

Answer: a. True

31. Which of the following opioids has a very long half-life, meaning a patient who overdoses on it may require multiple doses of naloxone or a continuous infusion?

• a. Fentanyl
• b. Morphine
• c. Methadone
• d. Hydrocodone

Answer: c. Methadone

32. After administering naloxone and calling 911, the responder should place the person in what position if they are breathing on their own?

• a. The recovery position (on their side)
• b. Sitting upright
• c. Lying flat on their back
• d. In a comfortable chair

Answer: a. The recovery position (on their side)

33. The pharmacist’s counseling is critical to ensure that a caregiver knows:

• a. Naloxone is not a substitute for calling 911.
• b. The naloxone kit has an expiration date.
• c. The steps for administration.
• d. All of the above.

Answer: d. All of the above.

34. The increasing prevalence of illicitly manufactured fentanyl has led to:

• a. A decreased need for naloxone.
• b. A potential need for multiple or higher doses of naloxone to achieve reversal.
• c. Opioid overdoses that are not reversible.
• d. A decrease in the number of overdoses.

Answer: b. A potential need for multiple or higher doses of naloxone to achieve reversal.

35. A pharmacist dispensing naloxone should do so in a(n) ____ manner.

• a. judgmental and condescending
• b. rushed and dismissive
• c. empathetic and non-judgmental
• d. secretive

Answer: c. empathetic and non-judgmental

36. Buprenorphine is a partial opioid agonist. If a patient overdoses on buprenorphine, naloxone will:

• a. Have no effect.
• b. Require much higher doses to be effective due to buprenorphine’s high receptor affinity.
• c. Be more effective than for a full agonist.
• d. Cause a severe hypertensive crisis.

Answer: b. Require much higher doses to be effective due to buprenorphine’s high receptor affinity.

37. Opioid reversal is a key component of managing the risks associated with pain pharmacotherapy.

• a. True
• b. False

Answer: a. True

38. The “Pharmacotherapy of Pain” is a lecture in which course?

• a. PHA5878C Patient Care 3
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5878C Patient Care 3

39. A key part of the public health response to the opioid crisis is:

• a. Increasing access to naloxone.
• b. Increasing access to treatment for opioid use disorder.
• c. Preventing new cases of addiction through judicious prescribing.
• d. All of the above.

Answer: d. All of the above.

40. An active learning session covering pain management is part of which course?

• a. PHA5878C Patient Care 3
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5878C Patient Care 3

41. The term “opioid antagonist” means the drug:

• a. Binds to the opioid receptor and activates it.
• b. Binds to the opioid receptor and blocks it without causing an effect.
• c. Partially activates the opioid receptor.
• d. Is a type of opioid.

Answer: b. Binds to the opioid receptor and blocks it without causing an effect.

42. Which of the following is NOT a symptom of opioid overdose?

• a. Slow, shallow breathing
• b. Blue or gray skin, lips, and nails
• c. Pinpoint pupils
• d. Agitation and rapid speech

Answer: d. Agitation and rapid speech

43. A pharmacist’s role includes identifying patients at risk for overdose and proactively offering naloxone.

• a. True
• b. False

Answer: a. True

44. After a successful reversal with naloxone, the patient should be monitored for at least how long by medical professionals?

• a. 30 minutes
• b. 1 hour
• c. 2-4 hours
• d. They can be immediately discharged.

Answer: c. 2-4 hours

45. What is the primary reason it is critical to call 911 even if naloxone successfully revives someone?

• a. The naloxone can wear off, and the person can become unresponsive again.
• b. The person needs medical evaluation for other complications of the overdose.
• c. The person may need access to treatment for opioid use disorder.
• d. All of the above.

Answer: d. All of the above.

46. “Naloxone co-prescribing” refers to the practice of:

• a. Prescribing two different naloxone formulations.
• b. Prescribing naloxone at the same time a high-risk opioid prescription is written.
• c. Prescribing naloxone with an antibiotic.
• d. A patient asking for naloxone.

Answer: b. Prescribing naloxone at the same time a high-risk opioid prescription is written.

47. A pharmacist is the most accessible healthcare professional for many people, making them critical for naloxone distribution.

• a. True
• b. False

Answer: a. True

48. An active learning session on pain is part of which course module?

• a. Module 1: Introduction to Pain and Treatment Options
• b. Module 2: Hypertension
• c. Module 4: Ischemic Heart Disease
• d. Module 7: Arrhythmias

Answer: a. Module 1: Introduction to Pain and Treatment Options

49. The overall goal of widespread naloxone access is to:

• a. Encourage opioid use.
• b. Reduce deaths from opioid overdose.
• c. Increase pharmacy profits.
• d. Punish people who use drugs.

Answer: b. Reduce deaths from opioid overdose.

50. The ultimate reason to learn about opioid reversal is to:

• a. Be equipped with the knowledge to save a life in an emergency overdose situation.
• b. Pass the pain management module.
• c. Fulfill a legal requirement.
• d. Be able to counsel on the risks of naloxone.

Answer: a. Be equipped with the knowledge to save a life in an emergency overdose situation.