Advanced | Clinical Pharmacology and Anesthesia Part II Flashcards
Administration of an opioid causes spasm of biliary smooth muscle, resulting in increases in biliary pressure. For instance, a failure of contrast material to enter the duodenum following intraoperative cholangiography. In order to reverse the spasm without necessarily antagonizing the analgesia effect of the opioid, this agent may be given:
A. Glucagon
B. Naloxone
C. Nalbuphine
D. Tramadol
A. Glucagon
It may be necessary to reverse opioid-induced biliary smooth
muscle spasm with naloxone so as to correctly interpret the cholangiogram.
- Glucagon, 2 mg IV, also reverses opioid-induced biliary smooth muscle spasm and, unlike naloxone, does not antagonize the analgesic effects of the
opioid
The central anticholinergic syndrome is LEAST likely to occur after administration of:
(A) atropine
(B) chlorpromazine
(C) diphenhydramine
(D) glycopyrrolate
(E) scopolamine
(D) glycopyrrolate
Which of the following statements concerning nalbuphine is true?
(A) It causes partial reversal of morphine-induced ventilatory depression
(B) Analgesia is partially mediated by delta receptor agonism
(C) Its antagonist effects are mediated at kappa receptors
(D) Duration of action is significantly shorter than that of morphine
(E) Ventilatory drive is not depressed
(A) It causes partial reversal of morphine-induced ventilatory depression
Nitrous oxide is contraindicated during:
(A) injection of sulfur hexafluoride for retinal tamponade
(B) repair of open eye injury
(C) scleral buckling with synthetic bands
(D) strabismus surgery
(E) trabeculectomy for glaucoma
(A) injection of sulfur hexafluoride for retinal tamponade
Which of the following is most reliable for treatment of cerebral artery vasospasm associated with subarachnoid hemorrhage?
(A) Antifibrinolytic therapy
(B) Hyperventilation
(C) Mannitol infusion
(D) Nitroprusside infusion
(E) Volume expansion
(E) Volume expansion
During halothane anesthesia with spontaneous ventilation, the most reliable sign of malignant hyperthermia is:
(A) hypertension
(B) increased temperature
(C) increased minute ventilation
(D) muscle rigidity
(E) tachycardia
(C) increased minute ventilation
A 50-year-old woman with subarachnoid hemorrhage and left hemiparesis undergoes clipping of a right cerebral aneurysm. On the second postoperative day, mental status deteriorates. Blood pressure is 110/70 mmHg. A cerebral angiogram shows vasospasm. The most appropriate management is to:
(A) administer dexamethasone
(B) administer mannitol
(C) administer phentolamine
(D) expand intravascular volume
(E) intubate and hyperventilate to a PaC02 of 28 mmHg
(D) expand intravascular volume
The concentration effect is greater with nitrous oxide than with the volatile anesthetics because nitrous oxide
(A) has a lower blood-gas partition coefficient
(B) has less effect on cardiac
output
(C) has lower lipid solubility
(D) is affected less by ventilation-perfusion mismatch
(E) is used in much higher
concentrations
(E) is used in much higher concentrations
If administered prior to induction of anesthesia, which of the following drugs is most likely to cause tachycardia?
(A) Fentanyl
(B) Meperidine
(C) Midazolam
(D) Morphine
(E) Sufentanil
(B) Meperidine
Alveolar partial pressure of an inhaled anesthetic rises more rapidly in a parturient at term than in a nonpregnant woman because
(A) functional residual capacity is decreased
(B) PaC02 is decreased
(C) uptake of inhaled agents by tissues is decreased
(D) cardiac output is increased
(E) physiologic dead space is increased
(A) functional residual capacity is decreased
Heparin-induced thrombocytopenia:
(A) does not occur with porcine mucosal heparin
(B) is caused by direct suppression of platelet production
(C) is immunologically mediated
(D) is diagnosed by peripheral blood smear
(E) occurs only with larger intravenous doses of heparin
(C) is immunologically mediated
A 34-year-old man has hyperkalemia-induced asystole. After initiating cardiopulmonary resuscitation, which of the following is the most appropriate next step in management?
(A) Administration of atropine
(B) Administration of calcium chloride
(C) Administration of sodium bicarbonate
(D) Transcutaneous pacing
(E) DC countershock at 200 joules
(B) Administration of calcium chloride
Compared with labetalol for induction of hypotension, nitroprusside is associated with
(A) greater cerebral vasodilation
(B) greater dependence on hepatic metabolism
(C) less activation of the renin-angiotensin system
(D) less intrapulmonary shunt
(E) less venodilation
(A) greater cerebral vasodilation
A 25-year-old man with Wolff-Parkinson-White syndrome has paroxysmal supraventricular tachycardia with a heart rate of 200 bpm during insertion of an intramedullary rod for a femoral fracture. Duration of the QRS complex is 0.12 sec. Each of the following antidysrhythmic agents would be appropriate for use in this patient EXCEPT
(A) lidocaine
(B) metoprolol
(C) procainamide
(D) propranolol
(E) verapamil
(E) verapamil
Acute treatment of WPW in a hemodynamically stable patient
- Regular narrow complex- treatment similar to PSVT, vagal maneuvers or IV adenosine
- Regular wide complex- IV adenosine (used with caution due to capability of rapid anterograde conduction leading to atrial fib).
- Avoid AV nodal blocking(e.g. Ca channel blockers like Verapamil) agents since this may leave only the accessory pathway for conduction.
Class I or II anti-arrhythmics (procainamide, sotalol or amiodarone) may be used to target accessory pathway. Acute treatment in hemodynamically unstable patient.
- Verapamil may precipitate ventricular dysrhythmias in patients with Wolff-Parkinson-White syndrome.
Which of the following factors will slow the induction of anesthesia in patients receiving volatile anesthetics?
(A) Addition of 70% nitrous oxide
(B) Increased cardiac output
(C) Increased minute ventilation
(D) Low blood/gas solubility coefficient
(E) Previous pneumonectomy
(B) Increased cardiac output
Each of the following can produce adequate analgesia for the first stage of labor EXCEPT
(A) subarachnoid morphine
(B) epidural bupivacaine
(C) pudendal block with lidocaine
(D) paracervical block with lidocaine
(E) lumbar sympathetic block with lidocaine
(C) pudendal block with lidocaine
A 62-year-old patient undergoes resection of a descending thoracic aneurysm under anesthesia with morphine, nitrous oxide, oxygen, and pancuronium. In spite of normal somatosensory evoked potentials (SSEP) during the procedure, the patient has paraplegia postoperatively. The factor most likely responsible for failure to note the deficit intraoperatively is:
(A) the effect of nitrous oxide on SSEP
(B) the effect of morphine on SSEP
(C) failure to test motor pathways
(D) hyperventilation to a PaC02 of 30 mmHg
(E) unintentional hypothermia to 34°C
(C) failure to test motor pathways
This specific and selective α2-receptor antagonist can rapidly and effectively reverse the sedative and cardiovascular effects of IV dexmedetomidine:
A. Atipamezole
B. Yohimbine
C. Esmirtazapine
D. Idazoxan
A. Atipamezole
In a patient with asthma, which of the following drugs used to treat supraventricular tachycardia is LEAST likely to induce bronchospasm?
(A) Adenosine
(B) Edrophonium
(C) Esmolol
(D) Propranolol
(E) Verapamil
(E) Verapamil
Verapamil has a major depressant effect on the atrioventricular node, a negative chronotropic effect on the sinoatrial node, a negative inotropic effect on cardiac
muscle, and a moderate vasodilating effect on coronary and systemic arteries.
- It is now being studied for its potential bronco-dilating effect.
Which of the following is the most likely effect of long-term exposure to nitrous oxide at a concentration of 50 ppm?
(A) Impaired cognitive function
(B) Inhibition of vitamin B-12 absorption
(C) Megaloblastic changes in bone marrow
(D) Teratogenesis
(E) Thrombocytopenia
(C) Megaloblastic changes in bone marrow
Miller | 9th edit
The potency of an inhalational anesthetic correlates best with its
(A) vapor pressure
(B) blood/gas partition coefficient
(C) molar volume
(D) brain/gas partition coefficient
(E) oil/gas partition coefficient
(E) oil/gas partition coefficient
Atropine and Scopolamine are competitive inhibitors of ACh at the parasympathetic ________ receptor and act to increase heart rate.
A. Nicotinic
B. Muscarinic
C. Both
Atropine, scopolamine, and glycopyrrolate are competitive inhibitors of ACh at the parasympathetic muscarinic receptor and act to increase heart rate
A 35-year-old patient, who is ASA physical status 1, is scheduled for open cholecystectomy under general anesthesia. Which of the following end-tidal concentrations would most likely block the adrenergic response to skin incision?
(A) Enflurane 1.7%, oxygen
(B) Isoflurane 1.2%, oxygen
(C) Enflurane 0.6%, nitrous oxide 70%, oxygen
(D) Halothane 0.4%, nitrous oxide 70%, oxygen
(E) Isoflurane 1.0%, nitrous oxide 70%, oxygen
(D) Halothane 0.4%, nitrous oxide 70%, oxygen
- MAC values are additive between the anesthetic agents.
Failure of contrast material to enter the duodenum following intraoperative cholangiography is most likely related to administration of:
(A) butorphanol
(B) fentanyl
(C) halothane
(D) nalbuphine
(E) naloxone
(B) fentanyl
Opioids can cause spasm of biliary smooth muscle, resulting in increases in biliary pressure that may be associated with epigastric distress or biliary colic.
This pain may be confused with angina pectoris. Naloxone will relieve pain caused by biliary spasm but not myocardial ischemia.
Conversely, nitroglycerin will relieve pain due to either biliary spasm or myocardial ischemia. Equal analgesic doses of fentanyl, morphine, meperidine, and
pentazocine increase common bile duct pressure 99%, 53%, 61%, and 15% above predrug levels, respectively.
It may be necessary to reverse opioid-induced biliary smooth
muscle spasm with naloxone so as to correctly interpret the cholangiogram.
- Glucagon, 2 mg IV, also reverses opioid-induced biliary smooth muscle spasm and, unlike naloxone, does not antagonize the analgesic effects of the
opioid
Local anesthetics block nerve impulses through which of the following mechanisms of action?
(A) Decreasing ATP in neuronal cell membranes
(B) Decreasing the neuronal resting membrane potential
(C) Increasing extracellular calcium concentration
(D) Inhibiting sodium ion influx across the neuronal cell membrane
(E) Opening sodium channels at the nodes of Ranvier
(D) Inhibiting sodium ion influx across the neuronal cell membrane
Which of the following EEG findings is expected during maintenance anesthesia with high-dose fentanyl (50 mcg/kg), nitrous oxide, and oxygen?
(A) Low-frequency high-voltage activity
(B) Nondominant hemispheric slowing
(C) Predominant alpha activity
(D) Prominent beta activity
(E) Spindle-shaped bursts
(A) Low-frequency high-voltage activity
Opioids produce a dose related decrease in the frequency and amplitude of the EEG.
Low dose opioids show a loss of beta waves and a slowing of alpha waves.
Moderate dose opioids show diffuse theta waves and some delta waves.
High dose opioids show delta waves (high amplitude, 0-4 Hz).
Unlike with volatile gases, barbituates, and propofol,complete isoelectric EEG waves cannot be obtained, even with high dose opioids.
ABA keywords | ABA Question Bank
With long-term administration, which of the following drugs produces the most prolonged sedative effect of diazepam?
(A) Cimetidine
(B) Famotidine
(C) Metoclopramide
(D) Ranitidine
(E) Warfarin
(A) Cimetidine
Why?
Cimetidine can prolong the effects of some benzodiazepines by inhibiting their metabolism in the liver, potentially leading to increased sedation and other side effects.
Many benzodiazepines undergo N-dealkylation and hydroxylation via the cytochrome P450 oxidase system. Cimetidine is thought to bind to cytochrome P450 oxidase and to interfere with many drugs using this path way.
- Lorazepam are two benzodiazepines not oxidatively metabolized by cytochrome P450, but are glucuronidated by glucuronyl transferase and are, therefore, not subject to metabolic inhibition by cimetidine.
The increased resistance of severely burned patients to pancuronium is primarily due to:
(A) enhanced urinary excretion of pancuronium
(B) decreased number of presynaptic cholinergic receptors
(C) increased number of postsynaptic cholinergic receptors
(D) increased rate of metabolism of pancuronium
(E) increased volume of distribution of pancuronium
(C) increased number of postsynaptic cholinergic receptors
Which of the following differentiates midazolam from diazepam administered intravenously in equipotent doses?
(A) Greater hemodynamic stability
(B) Lack of active metabolites
(C) Less respiratory depression
(D) Longer duration of action
(E) More rapid onset
(B) Lack of active metabolites
Cholinergic receptor blockade will:
(A) decrease intraocular pressure
(B) decrease lower esophageal sphincter tone
(C) increase gastrointestinal motility
(D) induce diaphoresis
(E) produce copious secretions
(B) decrease lower esophageal sphincter tone
