The abuse and misuse of prescription (Rx) and over-the-counter (OTC) medications is a major public health crisis, placing community pharmacists on the front lines. From recognizing red flags for opioid diversion to counseling on the dangers of dextromethorphan abuse, pharmacists are key to prevention and harm reduction. This quiz for PharmD students tests your knowledge on commonly abused medications, signs of misuse, and the professional and ethical responsibilities of a pharmacist in this critical area.
1. The “opioid crisis” in the United States has been largely driven by the overprescribing and misuse of which class of medications?
- Benzodiazepines
- Prescription opioid analgesics
- Stimulants
- Antibiotics
Answer: Prescription opioid analgesics
2. A pharmacist receives a prescription for a large quantity of oxycodone from a prescriber they are not familiar with, and the patient paid with cash. These are potential “red flags” for:
- A legitimate medical need.
- Prescription drug diversion or misuse.
- A standard pharmacy transaction.
- A patient with excellent insurance coverage.
Answer: Prescription drug diversion or misuse.
3. The primary purpose of a state’s Prescription Drug Monitoring Program (PDMP) is to:
- Provide drug information to patients.
- Track the dispensing of controlled substances to identify potential doctor shopping or overlapping prescriptions.
- Help patients find the lowest price for their medication.
- Allow pharmacists to order medications.
Answer: Track the dispensing of controlled substances to identify potential doctor shopping or overlapping prescriptions.
4. A patient purchasing large quantities of pseudoephedrine-containing products might be doing so for the illicit manufacturing of which substance?
- Heroin
- Cocaine
- Methamphetamine
- LSD
Answer: Methamphetamine
5. The Combat Methamphetamine Epidemic Act of 2005 is a federal regulation that:
- Made all pseudoephedrine products prescription-only.
- Placed limits on the sale of pseudoephedrine, requiring it to be sold from behind the counter and logged.
- Banned the sale of all cough and cold products.
- Has no impact on pharmacy practice.
Answer: Placed limits on the sale of pseudoephedrine, requiring it to be sold from behind the counter and logged.
6. High doses of the over-the-counter cough suppressant dextromethorphan (DXM) can cause:
- Improved cough symptoms.
- Dissociative and hallucinogenic effects.
- A decrease in blood pressure.
- Increased alertness and focus.
Answer: Dissociative and hallucinogenic effects.
7. A pharmacist has a “corresponding responsibility” under the Controlled Substances Act. This means they must ensure that:
- Every prescription is filled as quickly as possible.
- Each controlled substance prescription they fill is issued for a legitimate medical purpose by a prescriber acting in the usual course of their professional practice.
- The patient can afford the medication.
- The pharmacy makes a profit on every controlled substance dispensed.
Answer: Each controlled substance prescription they fill is issued for a legitimate medical purpose by a prescriber acting in the usual course of their professional practice.
8. The abuse of which OTC anti-diarrheal agent in very high doses is a growing concern due to its opioid-like effects and risk of cardiotoxicity?
- Bismuth subsalicylate
- Loperamide
- Docusate sodium
- Psyllium husk
Answer: Loperamide
9. The combination of an opioid and a benzodiazepine is particularly dangerous and is a common factor in fatal overdoses due to:
- Additive respiratory depression.
- A severe drug-food interaction.
- The development of serotonin syndrome.
- The inactivation of the opioid by the benzodiazepine.
Answer: Additive respiratory depression.
10. “Pharming” is a slang term that refers to:
- The practice of agriculture.
- The act of abusing prescription or OTC drugs, often by raiding home medicine cabinets.
- The compounding of medications in a pharmacy.
- A type of online pharmacy.
Answer: The act of abusing prescription or OTC drugs, often by raiding home medicine cabinets.
11. A pharmacist can contribute to preventing Rx and OTC abuse by:
- Counseling patients on the safe and appropriate use of their medications.
- Being vigilant for forged or altered prescriptions.
- Educating the community about the dangers of medication misuse and proper disposal.
- All of the above.
Answer: All of the above.
12. Naloxone is a medication that a pharmacist can often dispense under a standing order or protocol. Its purpose is to:
- Prevent opioid withdrawal.
- Reverse the effects of an opioid overdose.
- Treat stimulant addiction.
- Help patients sleep.
Answer: Reverse the effects of an opioid overdose.
13. Which of the following is a potential sign of stimulant misuse in a young adult?
- Asking for early refills for their ADHD medication.
- Reporting lost or stolen prescriptions frequently.
- Exhibiting nervousness, agitation, and weight loss.
- All of the above.
Answer: All of the above.
14. The abuse potential of gabapentinoids (gabapentin and pregabalin) is a growing concern, as they can produce feelings of:
- Euphoria and calmness.
- Intense anxiety.
- Increased energy.
- No psychoactive effects.
Answer: Euphoria and calmness.
15. A patient presents a prescription for a “cocktail” of an opioid, a benzodiazepine, and a muscle relaxant like carisoprodol. This combination is a major red flag for:
- Standard, evidence-based pain management.
- Misuse, abuse, or diversion.
- The treatment of an acute injury.
- A patient with a low risk of addiction.
Answer: Misuse, abuse, or diversion.
16. Which of the following is an example of a harm reduction strategy that a community pharmacist can support?
- Refusing to fill any controlled substance prescriptions.
- Providing education and access to naloxone.
- Reporting all patients who use opioids to the police.
- Requiring a photo ID for all prescriptions.
Answer: Providing education and access to naloxone.
17. The primary reason for concern over the misuse of certain first-generation antihistamines like diphenhydramine is their:
- Decongestant properties.
- Sedating and anticholinergic effects, which can be sought for a “high.”
- Lack of any side effects.
- High cost.
Answer: Sedating and anticholinergic effects, which can be sought for a “high.”
18. A pharmacist’s non-judgmental and empathetic approach is crucial when talking to a patient about potential substance misuse in order to:
- Encourage honesty and maintain a therapeutic relationship.
- Make the patient feel guilty and defensive.
- Fulfill a legal requirement only.
- Ensure the patient leaves the pharmacy immediately.
Answer: Encourage honesty and maintain a therapeutic relationship.
19. A key component of a pharmacy’s “drug take-back” program is to:
- Resell unused medications to other patients.
- Provide a safe and secure way for the public to dispose of unwanted medications, preventing diversion.
- Analyze the returned medications for research.
- Return the medications to the manufacturer for a refund.
Answer: Provide a safe and secure way for the public to dispose of unwanted medications, preventing diversion.
20. The misuse of prescription laxatives is most commonly seen in individuals with:
- Chronic pain.
- Eating disorders.
- ADHD.
- Insomnia.
Answer: Eating disorders.
21. A “forged” prescription is one that is:
- Written and signed by a legitimate prescriber for a real patient.
- Sent electronically from the physician’s office.
- Completely fabricated or altered, not authorized by a prescriber.
- A verbal prescription called in by a nurse.
Answer: Completely fabricated or altered, not authorized by a prescriber.
22. When a pharmacist suspects a prescription is not legitimate, a best practice is to:
- Fill the prescription to avoid confrontation.
- Attempt to verify the prescription by contacting the prescriber’s office.
- Accuse the patient of breaking the law.
- Destroy the prescription.
Answer: Attempt to verify the prescription by contacting the prescriber’s office.
23. “Syrup,” “Purple Drank,” or “Lean” are slang terms for a concoction that typically includes the abuse of:
- Dextromethorphan-containing cough syrup.
- Prescription promethazine-codeine cough syrup.
- Pseudoephedrine tablets.
- Loperamide capsules.
Answer: Prescription promethazine-codeine cough syrup.
24. The primary reason a pharmacist should check the PDMP before dispensing a new opioid prescription is to:
- See if the patient has any known allergies.
- Assess if the patient is receiving other controlled substance prescriptions that could indicate misuse or high risk.
- Check the patient’s insurance information.
- Determine the patient’s weight.
Answer: Assess if the patient is receiving other controlled substance prescriptions that could indicate misuse or high risk.
25. Which over-the-counter product should not be recommended for a patient taking an SSRI due to the risk of serotonin syndrome?
- Acetaminophen
- Ibuprofen
- Products containing St. John’s Wort.
- Loratadine
Answer: Products containing St. John’s Wort.
26. The misuse of anabolic steroids, which are Schedule III controlled substances, is associated with which population?
- Geriatric patients for memory enhancement.
- Individuals seeking to improve athletic performance and muscle mass.
- Young children with ADHD.
- Patients with insomnia.
Answer: Individuals seeking to improve athletic performance and muscle mass.
27. A key educational point for parents is to store all Rx and OTC medications:
- In an easily accessible location like a kitchen counter.
- In a locked, secure location out of the reach of children and teenagers.
- In their original pharmacy packaging in the bathroom medicine cabinet.
- On their bedside table.
Answer: In a locked, secure location out of the reach of children and teenagers.
28. A patient who rapidly escalates their dose of a benzodiazepine without prescriber approval is demonstrating a sign of:
- Excellent adherence.
- Developing tolerance and potentially a substance use disorder.
- A normal therapeutic response.
- The medication having no effect.
Answer: Developing tolerance and potentially a substance use disorder.
29. The term “doctor shopping” refers to a patient who:
- Is looking for a new primary care physician.
- Visits multiple prescribers to obtain prescriptions for controlled substances without the prescribers’ knowledge of the other prescriptions.
- Shops around for the best price on a medication.
- Sees multiple specialists for a complex medical condition.
Answer: Visits multiple prescribers to obtain prescriptions for controlled substances without the prescribers’ knowledge of the other prescriptions.
30. What is a pharmacist’s ethical obligation if they believe a prescriber is consistently writing illegitimate prescriptions?
- To ignore the situation.
- To report the prescriber to the appropriate state board (Board of Medicine, Board of Pharmacy).
- To continue filling all the prescriptions.
- To confront the prescriber in a public setting.
Answer: To report the prescriber to the appropriate state board (Board of Medicine, Board of Pharmacy).
31. The primary psychoactive effect of abusing CNS stimulants is:
- Sedation and sleepiness.
- Euphoria, increased energy, and alertness.
- Pain relief.
- Hallucinations.
Answer: Euphoria, increased energy, and alertness.
32. Abusing “Z-drugs” like zolpidem can lead to:
- Improved morning alertness.
- Complex sleep-related behaviors and amnesia.
- A reduction in the risk of falls.
- No potential for dependence.
Answer: Complex sleep-related behaviors and amnesia.
33. The role of a pharmacist in preventing OTC abuse involves:
- Placing certain products behind the counter or in view of the pharmacy staff.
- Being aware of quantity limits and patterns of purchase.
- Educating patients on the appropriate use and dangers of misuse.
- All of the above.
Answer: All of the above.
34. Why is it important to use a “person-first” language (e.g., “a person with a substance use disorder” instead of “an addict”)?
- It is a way to reduce stigma and recognize the person before their disease.
- It is a legal requirement.
- It is less accurate.
- It makes communication more difficult.
Answer: It is a way to reduce stigma and recognize the person before their disease.
35. A “drug-seeking behavior” can include:
- A patient claiming they are “allergic” to all non-opioid pain relievers.
- A patient requesting a specific brand, strength, and quantity of a controlled substance by name.
- A patient reporting that their medication was lost or stolen.
- All of the above.
Answer: All of the above.
36. The abuse of which OTC product can cause a false positive on some urine drug screens for phencyclidine (PCP)?
- Dextromethorphan
- Loperamide
- Diphenhydramine
- Pseudoephedrine
Answer: Dextromethorphan
37. A pharmacist’s role in addressing the opioid crisis is part of their broader responsibility to:
- Public health and safety.
- Inventory management.
- Business development.
- Marketing.
Answer: Public health and safety.
38. The primary danger of abusing inhalants (e.g., from aerosol cans) is the risk of:
- Gradual liver damage.
- “Sudden Sniffing Death Syndrome” due to cardiac arrhythmia.
- Improved respiratory function.
- Increased cognitive performance.
Answer: “Sudden Sniffing Death Syndrome” due to cardiac arrhythmia.
39. A pharmacist’s professional judgment is a key component when:
- Evaluating the legitimacy of a controlled substance prescription.
- Deciding whether to sell a product that has potential for abuse.
- Counseling a patient on harm reduction.
- All of the above.
Answer: All of the above.
40. The misuse of prescription muscle relaxants like carisoprodol is common due to their:
- Stimulant effects.
- Sedating and euphoric effects.
- Lack of any side effects.
- Ability to improve memory.
Answer: Sedating and euphoric effects.
41. What is a key reason for the abuse of prescription stimulants among students?
- To help them sleep before an exam.
- The belief that the drugs will improve focus and academic performance (“study drugs”).
- To gain weight.
- To treat anxiety.
Answer: The belief that the drugs will improve focus and academic performance (“study drugs”).
42. A pharmacist who refuses to fill a prescription they believe is not legitimate:
- Is violating the law.
- Is acting in accordance with their corresponding responsibility to protect the public.
- Will be fired immediately.
- Is demonstrating poor customer service.
Answer: Is acting in accordance with their corresponding responsibility to protect the public.
43. A common sign of opioid withdrawal is:
- Pinpoint pupils (miosis).
- Dilated pupils (mydriasis), yawning, and muscle aches.
- Constipation.
- Respiratory depression.
Answer: Dilated pupils (mydriasis), yawning, and muscle aches.
44. The primary motivation for a pharmacy to implement robust controls against diversion is:
- To protect the community and comply with federal and state regulations.
- To make the workflow more complicated.
- To sell fewer controlled substances.
- To increase profits.
Answer: To protect the community and comply with federal and state regulations.
45. Which of the following is NOT a controlled substance?
- Oxycodone
- Lorazepam
- Lisinopril
- Methylphenidate
Answer: Lisinopril
46. A patient asking for an early refill of a benzodiazepine because they are “going on vacation” requires the pharmacist to:
- Refill it immediately without question.
- Use their professional judgment, possibly verifying the travel dates and checking the PDMP.
- Tell the patient to cancel their vacation.
- Refuse the refill under all circumstances.
Answer: Use their professional judgment, possibly verifying the travel dates and checking the PDMP.
47. Educating patients that it is illegal and dangerous to share their prescription medications with others is a form of:
- Harm reduction.
- Patient counseling.
- Diversion prevention.
- All of the above.
Answer: All of the above.
48. The primary risk of combining alcohol with any sedative medication is:
- A disulfiram-like reaction.
- Increased risk of liver damage.
- Additive CNS and respiratory depression.
- Inactivation of the medication.
Answer: Additive CNS and respiratory depression.
49. A pharmacist who collaborates with local law enforcement on drug take-back days is demonstrating:
- Leadership in public health and community safety.
- A conflict of interest.
- A violation of patient privacy.
- A task that is outside their role.
Answer: Leadership in public health and community safety.
50. The ultimate goal of a pharmacist’s vigilance regarding Rx and OTC abuse is to:
- Prevent any patient from receiving a controlled substance.
- Ensure medications are used safely and appropriately while preventing diversion and harm.
- Increase the pharmacy’s sales of non-controlled items.
- Make the process of getting a prescription as difficult as possible.
Answer: Ensure medications are used safely and appropriately while preventing diversion and harm.
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