Anesthesia Buddy: Pharmacology Flashcards
Which intravenous agent is also known as 2, 6-diisopropylphenol)?
A) Etomidate
B) Ketamine
C) Propofol
D) Midazolam
C) Propofol
Which component is NOT part of propofol formulation?
A) Egg lecithin
B) Soybean oil
C) Glycerol
D) Silica gel
D) Silica gel
Which compound is added to generic propofol formulations as an antimicrobial?
A) Sodium metabisulfite
B) Hydroxycobalamin
C) Sodium nitrite
D) Sodium thiosulfate
A) Sodium metabisulfite
Which agent hyperpolarizes neurons by increasing chloride conductance?
A) Lidocaine
B) Fentanyl
C) Propofol
D) Rocuronium
C) Propofol
Which of the following effects is INCREASED by propofol administration?
A) Systemic vascular resistance
B) Myocardial contractility
C) Preload
D) Respiratory depression
D) Respiratory depression
Which effect is MOST likely to occur from propofol administration?
A) Myoclonus
B) Increased cerebral blood flow
C) Increased intraocular pressure
D) Analgesia
A) Myoclonus
Which intravenous agent possess antioxidant properties?
A) Propofol
B) Midazolam
C) Etomidate
D) Ketamine
A) Propofol
Which intravenous agent is likely to produce green color urine?
A) Propofol
B) Midazolam
C) Etomidate
D) Ketamine
A) Propofol
Which is NOT part of propofol infusion syndrome?
A) Metabolic acidosis
B) Rhabdomyolysis
C) Kidney failure
D) Hypokalemia
D) Hypokalemia
Which intravenous agent possess long chain triglycerides?
A) Propofol
B) Midazolam
C) Etomidate
D) Ketamine
A) Propofol
Clearance of propofol from the — exceeds hepatic blood flow.
plasma
— is added to soda lime absorbent granules to provide hardness and minimize alkaline dust formation.
Silica
— formulation is composed of long chain triglycerides (soybean oil and egg lecithin)
Propofol
Generic formulation of propofol contains — as the preservative
sodium metabisulfite
Sodium thiosulfate, sodium nitrite and hydroxycobalamin are used in the treatment of —
cyanide toxicity
Propofol is a relatively selective modulator of —
y-aminobutyric acid (GABAA)
Mechanism of action of —: Activation of GABAA increases transmembrane chloride conductance and results in hyperpolarization of the postsynaptic cell membrane. Subsequently, functional inhibition of the postsynaptic neuron occurs.
propofol
Mechanism of action of —: blockade of voltage-gated sodium channels
lidocaine
Mechanism of action of —: Fentanyl binds to opioid receptors, especially the mu opioid receptor, which are coupled to G-proteins
fentanyl
Mechanism of action of —: Nondepolarizing neuromuscular blocking agent that competes with acetylcholine on the neuromuscular nicotinic receptors
rocuronium
— is the principal inhibitory neurotransmitter in the brain
GABA
Negative inotropic effect may result due to decrease in intracellular — availability
calcium
Propofol administration has been associated with —
myoclonus
Propofol — cerebral metabolic rate for oxygen (CMRO2), cerebral blood flow, and intracranial pressure (ICP)
decreases
Propofol has the ability to produce burst — on electroencephalography (EEG)
suppression
— has potent antioxidant properties similar to endogenous vitamin E
Propofol
— scavenges free radicals and inhibits lipid peroxidation
Propofol
Prolonged infusions of propofol can cause excretion of green urine due to the presence of —
phenols
Cloudy urine may occur after — administration due urinary uric acid excretion
propofol
Propofol infusion syndrome has been described in patients after prolonged high dose propofol infusions for longer than — hours
24
Common clinical findings associated with — include anion-gap metabolic acidosis, cardiac dysfunction, rhabdomyolysis, hypertriglyceridemia, elevated liver enzymes, hyperkalemia, and renal failure
propofol infusion syndrome
Measurement of the — can be used to differentiate hyperchloremic metabolic acidosis from lactic acidosis
anion gap
— formulation is composed of long chain triglycerides (soybean oil and egg lecithin)
Propofol
Propofol — prolong the QTc interval on the electrocardiogram
does not
Which effect is NOT likely to occur from propofol administration?
A) Antiemetic effect
B) Antiprutitic effect
C) Anticonvulsant effect
D) Analgesic effect
D) Analgesic effect
Which intravenous agent is a phencyclidine derivative?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
D) Ketamine
Which intravenous agent antagonizes glutamate?
A) Midazolam
B) Dexmedetomidine
C) Etomidate
D) Ketamine
D) Ketamine
Which effect is NOT likely to occur from ketamine administration?
A) Bronchodilation
B) Antisialogue
C) Increased cerebral oxygen consumption (CMRO2)
D) Nystagmus
B) Antisialogue
Which agent is most effective at preventing emergence delirium from ketamine administration?
A) Atropine
B) Physostigmine
C) Midazolam
D) Sevoflurane
C) Midazolam
Which intravenous agent is a carboxylated imidazole?
A) Propofol
B) Fentanyl
C) Etomidate
D) Ketamine
C) Etomidate
Which is CORRECT about the imidazole ring of etomidate?
A) Imidazole ring closes at an acidic pH
B) Imidazole ring opens at physiologic pH
C) At an acidic pH, imidazole ring has increased lipid solubility
D) When the imidazole ring is closed, lipid solubility increases
D) When the imidazole ring is closed, lipid solubility increases
Which intravenous agent should be avoided in patients with adrenal failure?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
C) Etomidate
Which intravenous agent can inhibit cortisol and aldosterone synthesis?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
C) Etomidate
Which intravenous agent can inhibit 11-beta-hydroxylase enzyme?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
C) Etomidate
Does propofol relieve nociceptive pain?
No
Regardless of anesthetic technique, propofol administration reduces incidence of —.
postoperative nausea and vomiting
— is a phencyclidine derivative that produces dissociative anesthesia
Ketamine
Phencyclidine (PCP) is an illegal street
drug also known as —.
angel dust
Ketamine inhibits activation of — receptors by glutamate and decreases presynaptic release of glutamate
NMDA
— is the most abundant excitatory neurotransmitter in the brain
Glutamate
Ketamine — cerebral blood flow and cerebral oxygen consumption (CMRO2)
increases
Ketamine produces — effects such as sympathomimetic action, bronchodilation, and emergence delirium
anticholinergic
Ketamine administration — salivary and tracheobronchial mucous gland secretions
increases
Ketamine may produce a sensation of bodily — or — in space
detachment or floating
Benzodiazepines such as midazolam have proven most effective at reducing the incidence of emergence delirium after — administration
ketamine
— may increase the incidence of emergence delirium
Atropine
— is a carboxylated imidazole– containing compound
Etomidate
— and — also contain an imidazole nucleus
Midazolam and dexmedetomidine
The imidazole nucleus renders etomidate — soluble at an acidic pH and — soluble at physiologic pH
water ; lipid
Etomidate 99% — at physiologic pH
unionized
— can transiently depress adrenocortical function
Etomidate
— produces a dose-dependent inhibition of the conversion of cholesterol to cortisol
Etomidate
The enzyme inhibited by — is 11-beta-hydroxylase
etomidate
Which intravenous agent is MOST likely to cause postoperative nausea and vomiting (PONV)?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
C) Etomidate
Which agent is derived from barbituric acid?
A) Propofol
B) Methohexital
C) Etomidate
D) Ketamine
B) Methohexital
Which agent is likely to cause histamine release and hypotension?
A) Propofol
B) Thiopental
C) Etomidate
D) Ketamine
B) Thiopental
Which agent is SAFEST to administer to patient with acute intermittent porphyria?
A) Propofol
B) Thiopental
C) Etomidate
D) Ketamine
A) Propofol
Which agent decreases cAMP and inhibits the locus ceruleus?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
B) Dexmedetomidine
Which agent produces sedative effects by stimulation of pre-synaptic alpha 2 adrenergic receptors?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
B) Dexmedetomidine
Which agent is MOST likely to cause bradycardia and hypotension?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
B) Dexmedetomidine
Which agent has an anti-shivering effect?
A) Dexmedetomidine
B) Ketamine
C) Fentanyl
D) Etomidate
A) Dexmedetomidine
Which agent is LEAST likely to provide reliable amnesia?
A) Propofol
B) Sevoflurane
C) Midazolam
D) Dexmedetomidine
D) Dexmedetomidine
Which agent does NOT have an imidazole ring?
A) Propofol
B) Midazolam
C) Etomidate
D) Dexmedetomidine
A) Propofol
Which agent is NOT associated with myoclonus?
A) Propofol
B) Methohexital
C) Etomidate
D) Dexmedetomidine
A) Propofol
Negative effects associated with — administration include myoclonus, pain on injection, adrenocortical suppression and increased incidence of postoperative nausea and vomiting
etomidate
— seems to occur due to disinhibition of subcortical structures that generally suppress extrapyramidal motor activity
Myoclonus
— possess hypnotic properties, lowers the seizure threshold, and causes myoclonus on induction
Methohexital
The decreased anticonvulsant effect of methohexital is useful during —
electroconvulsive therapy
— can cause an allergic reaction in the absence of prior exposure (anaphylactoid response)
Thiopental
— administration is associated with direct release of histamine from tissue mast cells
Thiopental
Barbiturates, especially phenobarbital, produce liver enzyme induction and may exacerbate acute intermittent —
porphyria
The — are a group of inherited disorders of heme biosynthesis
porphyrias
Ketamine, etomidate, and thiopental are considered unsafe and possibly —
porphyrinogenic
— is a highly selective, and potent alpha 2-adrenergic agonist
Dexmedetomidine
The pontine locus ceruleus has one of the highest densities of — receptors
alpha 2
Central alpha2-binding at presynaptic neurons inhibits the release of —
norepinephrine
It is well known that alpha 2 receptors are coupled to Gi (G protein) and cause suppression of — levels
cAMP
The elimination half-time of dexmedetomidine approximately — hours
2
— is an effective treatment for nonthermally induced shivering
Dexmedetomidine
— has sympatholytic actions and may be accompanied by systemic hypotension and bradycardia
Dexmedetomidine
— produces decreases in systemic blood pressure, but heart rate normally remains unchanged. However, bradycardia and asystole have rarely been observed with induction
Propofol
At therapeutic doses, — produces minimal changes in heart rate at induction
etomidate
— generally produces cardiovascular stimulation and increases in heart rate at induction
Ketamine
— has been reported to be effective at decreasing the postanesthetic delirium effects of ketamine
Dexmedetomidine
— is an effective treatment for nonthermally induced shivering
Dexmedetomidine
The analgesic effects of — originate at the level of the spinal cord
dexmedetomidine
— administration generally results in a calm, easily arousable patient to full consciousness
Dexmedetomidine
— produces sedation by decreasing sympathetic nervous system activity
Dexmedetomidine
Midazolam, ketamine, and dexmedetomidine are — compounds
imidazole
— is a substituted isopropylphenol
Propofol
— can effectively prevent the incidence of etomidate-induced myoclonus
Dexmedetomidine
— seems to occur due to disinhibition of subcortical structures that generally suppress extrapyramidal motor activity
Myoclonus
Which agent is least likely to produce an isoelectric EEG?
A) Midazolam
B) Propofol
C) Thiopental
D) Isoflurane
A) Midazolam
Which is NOT an effect of intravenous midazolam?
A) Anterograde amnesia
B) Anticonvulsant
C) Anxiolysis
D) Analgesia
D) Analgesia
Which agent antagonizes the actions of benzodiazepines?
A) Flumazenil
B) Glucagon
C) N-acetylcysteine
D) Physostigmine
A) Flumazenil
Which inhaled anesthetic is classified as an ether?
A) Halothane
B) Nitrous oxide
C) Sevoflurane
D) Xenon
C) Sevoflurane
Which inhaled anesthetic is classified as an alkane?
A) Halothane
B) Nitrous oxide
C) Isoflurane
D) Desflurane
A) Halothane
Which inhaled anesthetic requires a heated vaporizer?
A) Sevoflurane
B) Nitrous oxide
C) Isoflurane
D) Desflurane
D) Desflurane
Which agent undergoes the greatest hepatic biotransformation?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous oxide
A) Sevoflurane
Which agent has the lowest blood:gas coefficient of 0.42?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous oxide
B) Desflurane
Which agent has a blood:gas coefficient of 0.65?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous oxide
A) Sevoflurane
Which agent has been associated with the toxic byproduct Compound A?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous oxide
A) Sevoflurane
Which agent has a vapor pressure of 669 mmHg?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous oxide
B) Desflurane
—, in contrast to barbiturates and propofol, is unable to produce an isoelectric EEG
Midazolam
Isoflurane appears to cause burst suppression at about — MAC, and electrical silence at — MAC
1.5 ; 2
Midazolam produces significant — amnesia
ANTEROGRADE
Midazolam decreases anesthetics requirements of volatile anesthetics, but does NOT produce — when administered intravenously
analgesia
— may be an effective treatment for paradoxical vocal cord motion
Midazolam
— is a COMPETITIVE benzodiazepine antagonist
Flumazenil
The recommended initial dose of flumazenil is — mg IV
0.2
The duration of action of flumazenil is — to — minutes
30 to 60
— is a fluorinated methyl isopropyl ETHER
Sevoflurane
— is a halogenated ALKANE derivative
Halothane
— is a colorless, odorless to sweet-smelling INORGANIC gas
Nitrous oxide
— is an INERT gas with anesthetic properties
Xenon
— is nonpungent and produces bronchodilation
Sevoflurane
— administration has been associated with postoperative liver dysfunction
Halothane
Isoflurane, desflurane, and sevoflurane are halogenated —
ETHERS
— can boil at normal operating room temperature and it requires a heated and pressurized vaporizer that needs an electrical power. This creates an environment in which the agent has a lower and more predictable volatility
Desflurane
— produces the highest carbon monoxide concentrations in desiccated CO2 absorbents.
Desflurane
Desflurane has a vapor pressure near — atm (— mmHg) at 20 C
1 atm (669 mmHg)
— is not suitable for inhalational induction due to its pungency and airway irritant effects.
Desflurane
— results from the interaction between sevoflurane and the carbon dioxide absorbent. This can occur with soda lime or baralyme
Compound A
— is nephrotoxic in rats, causing renal proximal tubular injury
Compound A
Isoflurane, desflurane, and sevoflurane all prolong the electrocardiographic — interval
QT
Blood:gas coefficients of inhalational agents:
Sevoflurane —
Desflurane —
Nitrous oxide —
Isoflurane —
Sevoflurane 0.65
Desflurane 0.42
Nitrous oxide 0.47
Isoflurane 1.4
— increases cerebral blood flow (CBF) with a mild increase in cerebral metabolic rate of oxygen consumption (CMRO2)
N2O
— decrease the cerebral metabolic rate of oxygen consumption (CMRO2)
Volatile anesthetics
All volatile anesthetics are biotransformed in the — to a variable extent
liver
— undergoes oxidative metabolism of 15- 40%
Halothane
Metabolism of — leads to release of inorganic fluoride
sevoflurane
Which factor INCREASES FA/FI and speeds onset of inhaled anesthetics?
A) Low alveolar ventilation
B) High agent solubility
C) Low functional residual capacity (FRC)
D) Low fresh gas flow
C) Low functional residual capacity (FRC)
Which factor DECREASES FA/FI and slows onset of inhaled anesthetics?
A) Right to left intracardiac shunt
B) Low cardiac output
C) Low agent solubility
D) High fresh gas flow
A) Right to left intracardiac shunt
Which agent undergoes the LEAST amount of metabolism?
A) Halothane
B) Sevoflurane
C) Isoflurane
D) Nitrous oxide
D) Nitrous oxide
Nitrous oxide is ___________ more soluble than nitrogen
A) 12 times
B) 24 times
C) 34 times
D) 50 times
C) 34 times
What is the minimum alveolar concentration (MAC) of desflurane?
A) 1.2%
B) 2.2%
C) 6.6%
D) 10%
C) 6.6%
Which agent is the MOST potent?
A) Isoflurane
B) Desflurane
C) Sevoflurane
D) Nitrous oxide
A) Isoflurane
Which factor INCREASES minimum alveolar concentration (MAC) of inhalational agents?
A) Hypernatremia
B) Hypothermia
C) Metabolic acidosis
D) Older age
A) Hypernatremia
Which evoked potentials monitor the corticospinal path?
A) SSEPs
B) MEPs
C) VEPs
D) BAEPs
B) MEPs
Which evoked potentials monitor the dorsal column medial lemniscus path?
A) SSEPs
B) MEPs
C) VEPs
D) BAEPs
A) SSEPs
Local anesthetics are:
A) Strong bases
B) Weak bases
C) Strong acids
D) Weak acids
B) Weak bases
Which is NOT part of the local anesthetic molecular structure?
A) Benzene ring
B) Intermediate chain (ester or amide)
C) Tertiary amine
D) Phenylpiperidine compound
D) Phenylpiperidine compound
Which local anesthetic is metabolized by pseudocholinesterase?
A) Chloroprocaine
B) Lidocaine
C) Ropivacaine
D) Mepivacaine
A) Chloroprocaine
All volatile anesthetics are biotransformed in the liver to a variable extent:
Sevoflurane —%
Isoflurane —%
Desflurane —%
Sevoflurane 2-5%
Isoflurane 0.2%
Desflurane 0.02%
A low FRC will — the onset of inhalational induction.
speed
Speed or delay onset of inhalational induction:
High minute ventilation
Speed
Speed or delay onset of inhalational induction:
High inspired partial pressure of anesthetic
Speed
Speed or delay onset of inhalational induction:
Low solubility of anesthetic in tissues
Speed
Speed or delay onset of inhalational induction:
Low cardiac output
Speed
Speed or delay onset of inhalational induction:
Low volume breathing circuit
Speed
— is the most pungent of the inhaled anesthetics and can potentially cause coughing, breath holding, sialorrhea, and laryngospasm
Desflurane
A right to left shunt causes a dilutional effect of shunted blood that is not mixed with anesthetic. This — the rate of inhalational induction.
slows
All of the inhaled anesthetics except — are greenhouse gases. Global warming effects are based on their infrared absorption and atmospheric lifetimes
xenon
— is metabolized by anaerobic bacteria from the human intestine (0.004%)
Nitrous oxide
— possesses good analgesic properties
Nitrous oxide (N2O)
Nitrous oxide is — times more soluble than nitrogen in blood
34
— can easily diffuse out of the circulation and occupy air-filled compartments
Nitrous oxide
presence of a closed pneumothorax is a contraindication to — administration
nitrous oxide
Minimum alveolar concentration of inhaled anesthetics:
Halothane —
Isoflurane —
Sevoflurane —
Desflurane —
Nitrous oxide —
Halothane 0.75
Isoflurane 1.17
Sevoflurane 1.8
Desflurane 6.6
Nitrous oxide 104
— is an isomer of enflurane and is highly pungent
Isoflurane
Factors that increase or decrease MAC:
Pregnancy, anemia, hyponatremia, hypoxia, hypothermia, older age, acidosis
Decrease
Factors that increase or decrease MAC:
Acute use of cocaine, amphetamine, and ephedrine Chronic alcohol use
Hyperthermia and hypernatremia
Increase
Administration of lithium and verapamil — MAC
decrease
— are used to assess the integrity of the corticospinal tracts during surgery
Motor evoked potentials (MEPs)
— are used to monitor dorsal column integrity
Somatosensory evoked potentials (SSEPs)
Generally, a —% decrease in amplitude or a —% increase in latency of SSEPs is a warning signal
50 ; 10
Local anesthetics are — and have pKa values above physiologic pH
weak bases
— is unique with a pKa of 3.5 (weak acid), so it exists most likely in the nonionized form at physiologic pH
Benzocaine
The — portion is usually a tertiary amine
hydrophilic
The — portion is usually an unsaturated aromatic ring
lipophilic
An — or — bond links the hydrocarbon chain to the aromatic ring
ester or an amide
— are a subclass of opioids
Phenylpiperidines
Ester local anesthetics such as chloroprocaine undergo hydrolysis by —
plasma cholinesterase (aka pseudocholinesterase)
Lidocaine, ropivacaine, and mepivacaine are amide local anesthetics and undergo — metabolism by microsomal enzymes
liver
— is metabolized by both plasma and liver cholinesterases
Cocaine
Which local anesthetic is metabolized by hepatic CYP450?
A) Benzocaine
B) Procaine
C) Tetracaine
D) Bupivacaine
D) Bupivacaine
Which local anesthetic has a pKa of 3.5 (lower than physiologic pH)?
A) Mepivacaine
B) Lidocaine
C) Benzocaine
D) Bupivacaine
C) Benzocaine
Which local anesthetic has the MOST protein binding?
A) Bupivacaine
B) Lidocaine
C) Mepivacaine
D) Tetracaine
A) Bupivacaine
Which local anesthetic is metabolized by plasma pseudocholinesterase as well as hepatic CYP450?
A) Bupivacaine
B) Lidocaine
C) Cocaine
D) Tetracaine
C) Cocaine
Which local anesthetic has the LEAST protein binding?
A) Ropivacaine
B) Lidocaine
C) Tetracaine
D) Chloroprocaine
D) Chloroprocaine
Which modality is MOST likely to be associated with local anesthetic systemic toxicity (LAST)?
A) Spinal anesthesia
B) Epidural anesthesia
C) Peripheral nerve block
D) Topical anesthesia
C) Peripheral nerve block
Which local anesthetic has the highest pKa of 8.7?
A) Chloroprocaine
B) Lidocaine
C) Bupivacaine
D) Mepivacaine
A) Chloroprocaine
Which local anesthetic is MOST likely to cause cardiac arrest from toxicity?
A) Bupivacaine
B) Lidocaine
C) Ropivacaine
D) Prilocaine
A) Bupivacaine
Which is an ester-type local anesthetic?
A) Prilocaine
B) Mepivacaine
C) Tetracaine
D) Ropivacaine
C) Tetracaine
Which agent is the BEST option for ventricular dysrhythmias in the setting of local anesthetic systemic toxicity (LAST)?
A) Diltiazem
B) Amiodarone
C) Lidocaine
D) Procainamide
B) Amiodarone
Which of the following local anesthetics can cause methemoglobinemia?
A) Mepivacaine
B) Benzocaine
C) Bupivacaine
D) Tetracaine
C) Bupivacaine
Bupivacaine is an — local anesthetic and undergoes — metabolism by microsomal enzymes
amide ; liver
Benzocaine, procaine, and tetracaine are — local anesthetics and undergo metabolism by —
ester ; plasma cholinesterase
alpha 1-acid glycoprotein is the most important plasma protein-binding site of —
bupivacaine
Protein binding of local anesthetics:
Bupivacaine —%
Mepivacaine —%
Tetracaine —%
Lidocaine —%
Bupivacaine 96%
Mepivacaine 78%
Tetracaine 76%
Lidocaine 65%
— is thought to have the lowest central nervous system and cardiovascular toxicity of all currently used local anesthetics
Chloroprocaine
— has the lowest protein binding of all clinically used local anesthetics
Chloroprocaine
Epidurally administered — can interfere with the action of epidural opioids
chloroprocaine
Rapid onset of chloroprocaine is not associated with its pKa, but the use of high concentrations due to —
low systemic toxicity
Addition of — to local anesthetics increases pH and favors the neutral base form, speeding onset of action
bicarbonate
— can be a significant problem after administration of benzocaine to mucosal surfaces
Methemoglobinemia
— is the treatment of methemoglobinemia
Methylene blue
Most local anesthetics have a pKa greater than — (physiologic pH). An exception is benzocaine, which has a pKa of approximately 3.5. This makes benzocaine predominantly nonionized at physiologic pH
7.4
— is suited for topical anesthesia of mucous membranes
Benzocaine
Local anesthetic systemic toxicity (LAST) occurs due to excessive — drug concentration
plasma
Accidental intravascular injection of local anesthetic drug during — anesthesia is the most common cause of LAST
peripheral nerve block
At the earliest sign of local anesthetic toxicity, — is recommended for treatment
lipid emulsion
— is the most cardiotoxic agent from this list.
Bupivacaine
The more potent and lipophilic agents are generally more — (bupivacaine, tetracaine, etidocaine)
cardiotoxic
Which is metabolized by the liver to O-toluidine, which oxidizes hemoglobin (Fe2+) to methemoglobin (Fe3+)?
A) Prilocaine
B) Mepivacaine
C) Tetracaine
D) Ropivacaine
A) Prilocaine
Which additive can be combined with local anesthetics to speed onset of action?
A) Epinephrine
B) Clonidine
C) Dexamethasone
D) Sodium bicarbonate
D) Sodium bicarbonate
Which statement regarding succinylcholine is INCORRECT? A) Succinylcholine is a trigger agent for malignant hyperthermia
B) Succinylcholine increases intragastric pressure
C) Succinylcholine decreases lower esophageal sphincter tone
D) Succinylcholine is two acetylcholine molecules joined together
C) Succinylcholine decreases lower esophageal sphincter tone
Which is an amide local anesthetic that inhibits normal plasma cholinesterase?
A) Tetracaine
B) Lidocaine
C) Mepivacaine
D) Dibucaine
D) Dibucaine
Which agent undergoes Hofmann elimination?
A) Succinylcholine
B) Rocuronium
C) Cisatracurium
D) Vecuronium
C) Cisatracurium
Which non-depolarizing neuromuscular blocking agent is metabolized by pseudocholinesterase?
A) Mivacurium
B) Atracurium
C) Cisatracurium
D) Succinylcholine
A) Mivacurium
Which neuromuscular blocking agent produces metabolite laudanosine?
A) Succinylcholine
B) Rocuronium
C) Cisatracurium
D) Vecuronium
C) Cisatracurium
Which of the following statements is CORRECT regarding Hofmann elimination?
A) Reaction occurs faster with acidosis and hypothermia
B) Reaction occurs slower with alkalosis and hyperthermia
C) Reaction occurs faster with alkalosis and hypothermia
D) Reaction occurs slower with acidosis and hypothermia
D) Reaction occurs slower with acidosis and hypothermia
Which agent undergoes the GREATEST amount of renal elimination?
A) Rocuronium
B) Vecuronium
C) Cisatracurium
D) Pancuronium
D) Pancuronium
Which of the following factors ANTAGONIZES nondepolarizing neuromuscular blockers?
A) Aminoglycosides
B) Magnesium
C) Burns
D) Hypothermia
C) Burns
A metabolite of prilocaine, O-toluidine, may result in —
methemoglobinemia
methemoglobinemia generally occurs at prilocaine doses greater than — mg
600
— is an oxidizing compound (oxidizes hemoglobin to methemoglobin)
O-toluidine
— of local anesthetics speeds the onset of action
Alkalinization
Alkalinization with — increases the lipid soluble form of local anesthetic administered
sodium bicarbonate
Addition of — to lidocaine prolongs the duration of action and decreases systemic absorption
epinephrine
Administration of — is associated with an increase in intragastric and lower esophageal sphincter pressures
succinylcholine
— is mostly known for its ability to inhibit normal plasma cholinesterase
Dibucaine
— is responsible for the prolonged effects of drugs such as succinylcholine and chloroprocaine
Atypical plasma cholinesterase
— is an isomer of atracurium
Cisatracurium
— is metabolized by Hofmann elimination to laudanosine and monoquaternary alcohol metabolite
Cisatracurium
Hofmann elimination is dependent on the — and — of plasma
pH and temperature
Mivacurium’s clearance is dependent on the —
enzyme plasma cholinesterase
Mivacurium is associated with — release
histamine
Cisatracurium does — invoke histamine release
not
Hofmann elimination is an — elimination process. It is appropriate for the renally and hepatically compromised patients
organ-independent
Approximately — to —% of pancuronium is cleared by the kidney
40-60
— has vagolytic effects and it also inhibits plasma cholinesterase
Pancuronium
Factors that — nondepolarizers:
-Inhalational anesthetics
-Aminoglycoside antibiotics
-Hypothermia
-Magnesium sulfate
-Most local anesthetics
potentiate
Factors that — nondepolarizers:
-Chronic anticonvulsant therapy
-Hyperparathyroidism
-Hypercalcemia
-Burns
antagonize
— inhibits the prejunctional release of acetylcholine and can potentiate nondepolarizing neuromuscular blockers
Clindamycin
Which of the following factors POTENTIATES nondepolarizing neuromuscular blockade?
A) Respiratory acidosis
B) Carbamazepine
C) Epinephrine
D) Corticosteroids
A) Respiratory acidosis
Which of the following factors
ANTAGONIZES nondepolarizing
neuromuscular blockade? A) Clindamycin
B) Sevoflurane
C) Furosemide
D) Hypercalcemia
D) Hypercalcemia
Which of the following factors POTENTIATES nondepolarizing neuromuscular blockade?
A) Norepinephrine
B) Hypermagnesemia
C) Theophylline
D) Alkalosis
B) Hypermagnesemia
Which agent has a vagolytic effect and stimulates release of catecholamines?
A) Cisatracurium
B) Vecuronium
C) Pancuronium
D) Succinylcholine
C) Pancuronium
Which is a tertiary amine and crosses the blood brain barrier (BBB)?
A) Edrophonium
B) Neostigmine
C) Pyridostigmine
D) Physostigmine
D) Physostigmine
Which of the following agents has anti-shivering properties?
A) Dexmedetomidine
B) Morphine
C) Glycopyrolate
D) Neostigmine
A) Dexmedetomidine
Which is NOT a side effect of neostigmine?
A) Bradycardia
B) Increased salivation
C) Bronchodilation
D) Miosis
C) Bronchodilation
All of these are side effects of neostigmine EXCEPT:
A) Bronchoconstriction
B) Constipation
C) Increased secretions
D) Nausea
B) Constipation
Which agent increases heart rate the MOST?
A) Atropine
B) Glycopyrolate
C) Scopolamine
D) Milrinone
A) Atropine
Which agent may decrease the effectiveness of hormonal contraceptive (birth control) for up to 7 days?
A) Neostigmine
B) Sugammadex
C) Metoclopramide
D) Cisatracurium
B) Sugammadex
Respiratory acidosis — the blockade of most nondepolarizing neuromuscular blockers and — reversal
potentiates ; antagonizes
Carbamazepine, epinephrine, and corticosteroids — neuromuscular blockade
antagonize
Hypothermia prolongs blockade by — metabolism
decreasing
Hypocalcemia and hypokalemia — a nondepolarizing block
augment
— may be seen in preeclamptic patients managed with magnesium sulfate.
Hypermagnesemia
Magnesium competes with calcium and — nondepolarizing neuromuscular blockade
potentiates
Neonates have increased sensitivity to nondepolarizing relaxants due to their —
immature neuromuscular junctions
— produces vagal blockade (vagolytic effect) and sympathetic stimulation
Pancuronium
How does pancuronium produce tachycardia and hypertension? (3)
-Ganglionic stimulation
-Decreased catecholamine reuptake
-Catecholamine release from adrenergic nerve endings
Patients allergic to — may exhibit reactions (pancuronium bromide)
bromides
— is tertiary amine and lipid soluble. This means it freely passes the blood brain barrier
Physostigmine
— is effective as treatment for central anticholinergic toxicity from scopolamine or atropine overdose
Physostigmine
— has shown to be effective in preventing postoperative shivering
Physostigmine
— can promote perioperative hypothermia
Dexmedetomidine
— inhibits acetylcholinesterase
Neostigmine
Muscarinic side effects of — administration include: bradyarrhythmias, bronchoconstriction, increased secretions, miosis, and increased peristalsis
neostigmine
— is a quaternary ammonium, lipid insoluble molecule. It cannot pass the blood brain barrier
Neostigmine
atropine doses (<0.4 mg) have been associated with a paradoxical transient —
slowing of the heart rate
— is a modified cyclodextrin molecule
Sugammadex
Sugammadex is mainly eliminated by the —
kidneys
Hormonal contraceptive structures with steroidal structure are impaired by sugammadex for approximately — days
7
Which of the following statements is INCORRECT about succinylcholine?
A) It is a quaternary ammonium compound
B) It is two molecules of acetylcholine linked together
C) It is metabolized predominantly by acetylcholinesterase
D) Succinylcholine’s neuromuscular block can be potentiated by administration of neostigmine
C) It is metabolized predominantly by
acetylcholinesterase
Which of the following statements is INCORRECT about succinylcholine?
A) Succinylcholine produces muscarinic as well as nicotinic effects
B) Decreases intragastric pressure
C) Causes transient increased intraocular pressure
D) Normally causes muscle fasciculations
B) Decreases intragastric pressure
Which drug slightly INHIBITS plasma cholinesterase and may increase duration of action of succinylcholine?
A) Pancuronium
B) Rocuronium
C) Vecuronium
D) Cisatracurium
A) Pancuronium
Which agent is LEAST likely to cause anaphylactic reaction?
A) Atracurium
B) Mivacurium
C) Succinylcholine
D) Cisatracurium
D) Cisatracurium
What electrolyte disturbance is likely to POTENTIATE neuromuscular blocking agents?
A) Hypokalemia
B) Hypercalcemia
C) Hypernatremia
D) Hypomagnesemia
A) Hypokalemia
Which opioid is MOST unionized at physiologic pH?
A) Morphine
B) Fentanyl
C) Alfentanil
D) Sufentanil
C) Alfentanil
Which of the following opioids is chemically related to meperidine, a phenylpiperidine derivative?
A) Codeine
B) Hydrocodone
C) Oxycodone
D) Fentanyl
D) Fentanyl
Which opioid is structurally like atropine?
A) Morphine
B) Hydromorphone
C) Alfentanil
D) Meperidine
D) Meperidine
Which opioid is the LEAST potent?
A) Morphine
B) Hydromorphone
C) Meperidine
D) Alfentanil
C) Meperidine
Which opioid is the MOST potent?
A) Alfentanil
B) Sufentanil
C) Remifentanil
D) Fentanyl
B) Sufentanil
Which of the following is a side effect of neostigmine?
A) Anhidrosis
B) Xerostomia
C) Mydriasis
D) Increased peristalsis
D) Increased peristalsis
Succinylcholine is — metabolized by acetylcholinesterase
NOT
Succinylcholine is metabolized by —
plasma cholinesterase (pseudocholinesterase)
— inhibitors can prolong blockade of succinylcholine
Cholinesterase
Metoclopramide — pseudocholinesterase activity
reduces
Drugs known to — pseudocholinesterase activity: -Echothiophate
-Neostigmine
-Phenelzine
-Cyclophosphamide
-Metoclopramide
-Esmolol
-Pancuronium
-Oral contraceptives
decrease
Succinylcholine, atracurium, and mivacurium are associated with — release
histamine
Cisatracurium does — invoke histamine release
not
Hypocalcemia and hypokalemia — a nondepolarizing block
augment
Factors that — nondepolarizers:
-Inhalational anesthetics
-Aminoglycoside antibiotics
-Hypothermia
-Magnesium sulfate
-Most local anesthetics
potentiate
Factors that — nondepolarizers:
-Chronic anticonvulsant therapy
-Hyperparathyroidism
-Hypercalcemia
-Burns
antagonize
Succinylcholine and mivacurium are metabolized by —
plasma cholinesterase
Muscarinic side effects of — administration include: bradyarrhythmias, bronchoconstriction, increased secretions, miosis, and increased peristalsis
neostigmine
— is used for treatment of non-obstructive ileus
Neostigmine
— is 5 to 10 time as potent as fentanyl
Sufentanil
— is approximately 50 to 100 times as potent as morphine
Fentanyl
— is 1/10th as potent as morphine
Meperidine
— shares similar structural features to local anesthetics.
Meperidine
Structurally, — is similar to atropine
meperidine
Meperidine is likely to increase —
heart rate
Large doses of meperidine result in decreased —
myocardial contractility
— is a phenylpiperidine derivative structurally related to meperidine
Fentanyl
An estimated 75% of initial fentanyl dose undergoes first-pass — uptake
pulmonary
— has a low pKa and nearly 90% of administered drug will be in its nonionized form at physiologic pH
Alfentanil
It is the nonionized fraction of — that crosses the blood brain barrier
Alfentanil
— inhibits the metabolism of alfentanil and prolongs its effects
Erythromycin
Which is NOT a common side effect of opioids?
A) Decreased biliary pressure
B) Miosis
C) Delayed gastric emptying
D) Bradycardia
A) Decreased biliary pressure
Which is a common side effect of opioids?
A) Vasoconstriction
B) Pruritus
C) Diuresis
D) Increased cellular immunity
B) Pruritus
Metabolism of this opioid is completely unrelated to hepatic clearance mechanisms
A) Fentanyl
B) Alfentanil
C) Sufentanil
D) Remifentanil
D) Remifentanil
Which opioid has a metabolite that has analgesic and excitatory central nervous system properties? Effects from
this metabolite range from anxiety and tremors to myoclonus and franks seizures
A) Morphine
B) Meperidine
C) Alfentanil
D) Fentanyl
B) Meperidine
After administration of meperidine, the patient develops serotonin syndrome. Which is NOT a sign and symptom of serotonin syndrome?
A) Hyperthermia
B) Hyporeflexia
C) Seizures
D) Altered mental status
B) Hyporeflexia
Which opioid is MOST likely to cause anticholinergic effects such as tachycardia and mydriasis?
A) Morphine
B) Hydromorphone
C) Alfentanil
D) Meperidine
D) Meperidine
Patient is on phenelzine (MAO inhibitor). What drug is contraindicated in this patient?
A) Meperidine
B) Morphine
C) Hydromorphone
D) Alfentanil
A) Meperidine
What opioid possesses anti-shivering properties via stimulation kappa receptor?
A) Morphine
B) Meperidine
C) Hydromorphone
D) Sufentanil
B) Meperidine
Which drug is LEAST protein bound?
A) Sufentanil
B) Meperidine
C) Fentanyl
D) Morphine
D) Morphine
Which agent has an ester linkage that renders it susceptible to hydrolysis?
A) Hydromorphone
B) Alfentanil
C) Remifentanil
D) Sufentanil
C) Remifentanil
— increase biliary pressure
Opioids
Gastrointestinal — side effects include spasm of biliary smooth muscle, biliary colic, constipation, and delayed gastric emptying
opioid
Generally, — cause vasodilation, pruritus, urinary retention, and decreased cellular immunity
opioids
Paradoxically, sufentanil, fentanyl, and alfentanil may be associated with reflex —
coughing
— has an ester structure that renders it susceptible to ester hydrolysis by nonspecific and tissue esterases
Remifentanil
— metabolism is unchanged in renal and hepatic failure
Remifentanil
Independent of duration of infusion, remifentanil’s context sensitive half-time is approximately — minutes
4
— may produce myoclonus and seizures (CNS stimulation) and may also be associated with delirium (confusion and hallucinations)
Normeperidine
Normeperidine has an elimination half-time of — hours
15
Signs and symptoms of — include agitation, seizures, clonus, diaphoresis, tremor, hyperreflexia, hypertonia, and fever among others
serotonin syndrome
Serotonin syndrome is most likely to occur when certain — are taken with drugs that modulate serotonin levels
antidepressants
The duration of action of meperidine is — to — hours
2 to 4
In a substantial number of patients, — is associated with histamine release
meperidine
Stimulation of — receptors may be responsible for meperidine’s anti-shivering effects
kappa
Additionally, meperidine is an — receptor agonist, which might contribute to its anti-shivering effects
alpha 2
It is estimated less than 0.1% of intravenous — dose enters the central nervous system at peak plasma concentrations
morphine
Morphine is — lipid soluble and is — ionized at physiologic pH
poorly ; highly
Ester linkage renders — susceptible to hydrolysis by nonspecific plasma and tissue esterases
remifentanil
Remifentanil is — metabolized by plasma cholinesterase (pseudocholinesterase)
NOT
Which agent INCREASES cerebral blood flow while DECREASING cerebral metabolic rate?
A) Midazolam
B) Sevoflurane
C) Fentanyl
D) Etomidate
B) Sevoflurane
Which drug is LEAST likely to cross the placenta?
A) Midazolam
B) Bupivacaine
C) Fentanyl
D) Vecuronium
D) Vecuronium
What explains the short duration of action of a fentanyl bolus?
A) Short elimination half time
B) Low lipid solubility
C) Rapid redistribution
D) Small volume of distribution
C) Rapid redistribution
Which is LEAST likely to occur from administration of neostigmine?
A) Decreased gastric motility
B) Bronchoconstriction
C) Bradycardia
D) Increased urinary bladder tone
A) Decreased gastric motility
Which physiologic derangement results in slower metabolism of ester local anesthetics?
A) Hyperkalemia
B) Acute renal failure
C) Atypical plasma cholinesterase
D) Diabetes insipidus
C) Atypical plasma cholinesterase
Which of the following is an important stimulus for aldosterone release?
A) Low levels of antidiuretic hormone
B) Hypernatremia
C) Low serum potassium
D) High serum potassium
D) High serum potassium
Which must heparin bind to for its anticoagulant effects to take effect?
A) Thrombin
B) Antithrombin III
C) Von Willebrand factor
D) GP IIb/IIIa receptor
B) Antithrombin III
All of these are known adverse effects of amiodarone EXCEPT:
A) Hypothyroidism
B) Cinchonism
C) Pulmonary fibrosis
D) Blue skin discoloration
B) Cinchonism
What is the antidote for acetaminophen overdose?
A) Vitamin K
B) Protamine
C) Physostigmine
D) N-acetylcysteine
D) N-acetylcysteine
Which of the following receptors belongs to the tyrosine kinase family of receptors?
A) Beta adrenergic receptor
B) GABAa receptor
C) Insulin receptor
D) Nicotinic II receptor
C) Insulin receptor
After a single dose of intravenous —, the short duration of action is due to rapid redistribution to inactive tissues (skeletal muscles and fat)
fentanyl
Fentanyl is — to — times more potent than morphine
75 to 125
Ester local anesthetics are metabolized by — enzyme
plasma cholinesterase
— local anesthetics should be avoided in patients with atypical plasma cholinesterase
Ester
— is more likely to result in elevated plasma concentrations than chloroprocaine
Tetracaine
The — receptor belongs to the receptor tyrosine kinase superfamily
insulin
— is a ligand-gated ion channel
GABAa
The — receptor belongs to the family of G-protein coupled receptors
beta- adrenergic
— receptors are ligand-gated sodium channels
Nicotinic
— is an anabolic hormone secreted by the beta cells of the pancreas
Insulin
— overdoses deplete the liver of glutathione stores
Acetaminophen
— prevents hepatic injury primarily by restoring hepatic glutathione
Acetylcysteine
— can cause cinchonism (tinnitus, blurry vision, decreased hearing acuity)
Quinidine
Side effects associated with — administration:
-Pulmonary toxicity
-QT prolongation
-Bradycardia
-Hypotension
-Corneal microdeposits
-Peripheral neuropathy
-Photosensitivity
-Hyperthyroidism or hypothyroidism
-Blue skin discoloration
amiodarone
— is 37% iodine by weight and structurally resembles thyroxine
Amiodarone
Unfractionated heparin produces its effects by biding to —
antithrombin (AT) aka antithrombin III
Heparin acts as an anticoagulant by enhancing the — complex by 1,000 to 10,000 times.
thrombin-AT
Anticoagulant effect of heparin depends on adequate amounts of circulating —
antithrombin III
Aldosterone is a — hormone produced in the zona glomerulosa of the adrenal cortex
mineralocorticoid
— stimulates the release of aldosterone from the adrenal cortex
Angiotensin II
— is an aldosterone antagonist that blocks the renal tubular effects of aldosterone
Spironolactone
Which agent is likely to cause reflex bradycardia secondary to baroreceptor stimulation?
A) Phenylephrine
B) Ephedrine
C) Epinephrine
D) Glycopyrolate
A) Phenylephrine
Which drug INCREASES intrabiliary pressure?
A) Glucagon
B) Naloxone
C) Morphine
D) Atropine
C) Morphine
Inadvertent rubbing of the eyes with this drug may lead to prolonged pupillary dilation
A) Dexamethasone
B) Ondansetron
C) Metoclopramide
D) Scopolamine
D) Scopolamine
Which of the following is an effect of magnesium?
A) Potentiates effects of calcium
B) Decreases prejunctional release of acetylcholine
C) Decreases acetylcholine binding
D) Decreases acetylcholine metabolism
B) Decreases prejunctional release of acetylcholine
Acetazolamide is most likely to cause:
A) Bradycardia
B) Metabolic alkalosis
C) Increased minute ventilation
D) Hypoglycemia
C) Increased minute ventilation
Which agent is most likely to decrease ability to sweat?
A) Atropine
B) Neostigmine
C) Epinephrine
D) Phenylephrine
A) Atropine
Which is a non-selective beta antagonist?
A) Atenolol
B) Metoprolol
C) Propranolol
D) Esmolol
C) Propranolol
Which is a benzothiazepine?
A) Nifedipine
B) Diltiazem
C) Verapamil
D) Hydralazine
B) Diltiazem
Administration of succinylcholine in pregnancy rarely causes fetal neuromuscular blockade. Why?
A) It is metabolized by the liver
B) It is highly lipid soluble
C) It is highly ionized
D) It is highly protein bound
C) It is highly ionized
Administration of a nonselective beta blocker is most likely cause:
A) Hypokalemia
B) Relaxation of the uterus
C) Constipation
D) Increased airway resistance
D) Increased airway resistance
Phenylephrine predominantly stimulates —-adrenergic receptors
alpha 1
Phenylephrine mainly causes — rather than — vasoconstriction
venoconstriction ; arterial
Phenylephrine exerts a baroreceptor-mediated reflex —
bradycardia
Naloxone, nitroglycerin, atropine, and glucagon can — opioid-induced biliary spasms
reverse
Glucagon enhances —
myocardial contractility
Side effects of — include sedation, cycloplegia, drying of secretions (dry mouth), blurry vision, and photophobia
scopolamine
Scopolamine causes — upon contact with the eyes
mydriasis
— is contraindicated in patients with closed-angle glaucoma
Scopolamine
At presynaptic nerve terminal, high magnesium concentrations inhibit — channels responsible for release of acetylcholine
calcium
Magnesium sulfate can — the neuromuscular blockade of nondepolarizing neuromuscular blockers
potentiate
— has analgesic properties via antagonism of NMDA receptors and calcium regulation
Magnesium
— is a carbonic anhydrase inhibitor
Acetazolamide
Acetazolamide produces metabolic — and may stimulate the respiratory drive
acidosis
Acetazolamide prevents Na+ and HCO3- absorption (mostly in the proximal tubule). This results in — urine and metabolic —
alkaline ; acidosis
Clinical uses of —:
-Diuretic properties
-Treatment of glaucoma
-Decreases intraocular pressure
-Inhibits cerebrospinal fluid formation
-Treatment of altitude sickness
-Treatment of familial periodic paralysis
-Treatment of idiopathic intracranial hypertension
acetazolamide
Beta adrenergic blockade may produce increased plasma concentration of — due to inhibition of — uptake into skeletal muscles
potassium ; potassium
Nonselective beta blockers interfere with glycogenolysis that normally occurs with —
hypoglycemia
Beta adrenergic agonists (terbutaline and ritodrine) produce uterine — and suppress uterine — (tocolysis)
relaxation ; contractions
Chronic — administration leads to increased beta-adrenergic receptors (upregulation)
beta blocker
Succinylcholine does — have a direct action on the uterus or smooth muscle structures
not
Succinylcholine is highly — and has low —. It does not readily cross the placenta
ionized ; solubility
— is a quaternary ammonium compound
Succinylcholine
— is a benzothiazepine derivative calcium channel blocker
Diltiazem
— is a phenylalkylamine calcium channel blocker
Verapamil
— is a dihydropyridine calcium channel blocker
Nifedipine
— is a hydrazine derivative vasodilator
Hydralazine
Propranolol is a competitive antagonist at — beta 1 and beta 2 adrenoceptors
both
The cardio-selective beta blockers include?
“MANBABE”
Metoprolol, atenolol, nebivolol, betaxolol, acebutolol, bisoprolol, esmolol
Atropine may — sweat glands (sweating), which can potentially lead to — in body temperature
inhibit ; rise
Which is synthesized from tyrosine and is the immediate precursor of norepinephrine?
A) Dopamine
B) Epinephrine
C) Ephedrine
D) Dobutamine
A) Dopamine
Side effects include anal/vulvar pruritus and hyperglycemia
A) Ondansetron
B) Promethazine
C) Haloperidol
D) Dexamethasone
D) Dexamethasone
The degradation product of its metabolism is p-aminobenzoic acid
A) Lidocaine
B) Chloroprocaine
C) Bupivacaine
D) Ropivacaine
B) Chloroprocaine
Epinephrine may be added to local anesthetics for the following reason:
A) Reduce duration of anesthesia
B) Increase rate of absorption into circulation
C) Increase intensity of the block
D) Provides local vasodilation
C) Increase intensity of the block
Pruritus that occurs with administration of neuraxial opioids can be treated with all these agents EXCEPT:
A) Simvastatin
B) Naloxone
C) Ondansetron
D) Propofol
A) Simvastatin
Ionization of local anesthetics best correlates with:
A) Potency
B) Onset of action
C) Duration of action
D) Allergic potential
B) Onset of action
Which agent is MOST likely to increase pulmonary vascular resistance?
A) Sevoflurane
B) Etomidate
C) Succinylcholine
D) Nitrous oxide
D) Nitrous oxide
Epinephrine 1:400,000 solution contains:
A) 1 mcg/mL
B) 2.5 mcg/mL
C) 5 mcg/mL
D) 10 mcg/mL
B) 2.5 mcg/mL
A 1% solution of any drug contains:
A) 5 mg/mL
B) 100 mg/mL
C) 500 mg per 100 mL
D) 1000 mg per 100 mL
D) 1000 mg per 100 mL
Awakening after a single bolus of propofol is determined by the kinetics of:
A) Elimination
B) Metabolism
C) Redistribution
D) Ventilation
C) Redistribution
Which of the following is CORRECT about ketamine?
A) Decreases pulmonary vascular resistance
B) Inhibits catecholamine release
C) It is a direct myocardial depressant
D) It is a potent cerebral vasoconstrictor
C) It is a direct myocardial depressant
Tyrosine is the immediate precursor of —
dopamine
Epinephrine is synthesized from — within the adrenal medulla by the enzyme phenylethanolamine N-methyltransferase
norepinephrine
— control endorphin release and inhibit prostaglandin synthesis
Corticosteroids
Ester local anesthetics such as chloroprocaine produce metabolite paraaminobenzoic acid and are more likely than — to evoke an allergic reaction
amides
Cross-sensitivity does — exist between local anesthetic (LA) classes. An ester LA can be administered to a patient allergic to an amide LA
NOT
— produces vasoconstriction
— limits systemic absorption
— prolongs duration action of local anesthetic
— enhances intensity of block
Epinephrine x4
Addition of — to local anesthetic does not affect onset of action
epinephrine
— is the most common side effect of neuraxial opioids
Pruritus
Treatment of neuraxial opioid induced —:
-Antihistamines
-Low dose propofol
-Ondansetron
-Naloxone
pruritus
Anesthetic — is mostly associated with the ionization constant (pKa)
onset
— is mostly associated with the lipid solubility of the local anesthetic
Potency
The aromatic ring and its substitutions are responsible for — solubility.
lipid
Awakening after a single bolus of propofol occurs due to — from the brain to other compartments
redistribution
Clearance of propofol from plasma exceeds — blood flow
hepatic
Ketamine is a cerebral —
vasodilator
Ketamine — sympathetic nervous system outflow
increases
Ketamine can become a — if endogenous catecholamine stores are depleted
myocardial depressant
— receptors are thought to be involved in mental depression
NMDA
Vapor pressure is 240 mmHg at 20 C
A) Nitrous oxide
B) Desflurane
C) Sevoflurane
D) Isoflurane
D) Isoflurane
A disadvantage of intravenous benzodiazepines is their lack of:
A) Antiemetic effects
B) Analgesia
C) Anterograde amnesia
D) Anticonvulsant activity
B) Analgesia
Endogenous norepinephrine release has been found to accompany the administration of:
A) Ketamine
B) Etomidate
C) Dexmedetomidine
D) Midazolam
A) Ketamine
Which is 10 times more potent than fentanyl at equivalent doses?
A) Alfentanil
B) Remifentanil
C) Sufentanil
D) Hydromorphone
C) Sufentanil
Termination of effect is due to metabolism instead of redistribution
A) Fentanyl
B) Remifentanil
C) Sufentanil
D) Hydromorphone
B) Remifentanil
Which is CORRECT about propofol?
A) It blunts baroreceptor reflex
B) It increases cardiac output
C) It has vasoconstrictor properties
D) It increases sympathetic activity
A) It blunts baroreceptor reflex
Which drug possesses the MOST mineralocorticoid potency?
A) Fludrocortisone
B) Prednisone
C) Cortisone
D) Methylprednisolone
A) Fludrocortisone
Which antiemetic should be avoided in patients with Parkinson’s disease?
A) Scopolamine
B) Metoclopramide
C) Ondansetron
D) Dexamethasone
B) Metoclopramide
Which drug is contraindicated in pregnancy?
A) Hydralazine
B) Acetaminophen
C) Enalapril
D) Esmolol
C) Enalapril
Which drug is useful in obstetrics due to rapid hydrolysis and lower risk of systemic toxicity?
A) Chloroprocaine
B) Lidocaine
C) Ropivacaine
D) Mepivacaine
A) Chloroprocaine
Volatile agents vapor pressure at 20 C:
Desflurane — mmHg
Isoflurane — mmHg
Sevoflurane — mmHg
Desflurane 669 mmHg
Isoflurane 240 mmHg
Sevoflurane 157 mmHg
Boiling point of desflurane is — C
22.8
Intravenous benzodiazepines do not provide —
analgesia
— is unable to produce an
isoelectric EEG
Midazolam
Principal pharmacologic effects of —:
-Anxiolysis
-Sedation
-Anticonvulsant effects
-Anterograde amnesia
-Skeletal muscle relaxation (spinal cord mediated)
benzodiazepines
Ketamine administration is associated with increases in — and — plasma concentration
epinephrine and norepinephrine
— is 5 to 10 times more potent than fentanyl
Sufentanil
Sufentanil is rapidly — by N-dealkylation
metabolized
— may be associated with acute opioid tolerance and hyperalgesia
Remifentanil
Chloroprocaine is contraindicated in patients allergic to —
para-aminobenzoic acid (PABA)
— should be avoided during the second and third trimester of pregnancy
ACE inhibitors
The only intravenous ACE inhibitor is —
enalaprilat
Due to its antidopaminergic activity, — should be avoided in Parkinson’s disease and restless leg syndrome
metoclopramide
The anti-inflammatory effect of 0.75 mg dexamethasone is equivalent to 20 mg of —
cortisol
Propofol does — prolong QTc interval on ECG
not
What is the boiling point of desflurane at 760 mmHg?
A) 15.6 C
B) 22.8 C
C) 39 C
D) 45 C
B) 22.8 C
All these agents POTENTIATE neuromuscular blockers EXCEPT:
A) Cephalosporins
B) Local anesthetics
C) Volatile anesthetics
D) Aminoglycosides
A) Cephalosporins
Which is CORRECT about etomidate?
A) It has antiemetic properties
B) It induces histamine release
C) It is associated with myoclonus
D) It increases the activity of 11-beta hydroxylase enzyme
C) It is associated with myoclonus
Which drug is MOST likely to preserve airway reflexes among the IV anesthetics?
A) Propofol
B) Midazolam
C) Ketamine
D) Etomidate
C) Ketamine
Which is INCORRECT about ketamine?
A) It causes bronchodilation
B) It increases oral secretions
C) It produces profound analgesia and amnesia
D) It is associated with profound respiratory depression
D) It is associated with profound respiratory depression
Which drug INCREASES the risk of nausea and vomiting?
A) Midazolam
B) Haloperidol
C) Etomidate
D) Metoclopramide
C) Etomidate
Calcium chloride is commonly used for treatment of these conditions EXCEPT:
A) Hyperkalemia
B) Hypocalcemia
C) Hypermagnesemia
D) Hypernatremia
D) Hypernatremia
Which of the following is NOT a common side effect of atropine?
A) Dilated pupils
B) Dry mouth
C) Diuresis
D) Decreased sweating
C) Diuresis
Which is INCORRECT about albuterol?
A) It may cause tachycardia and tremors
B) It may result in hyperkalemia
C) It is a beta 2 adrenergic agonist
D) It stimulates adenylyl cyclase and increases cAMP
B) It may result in hyperkalemia
Which inhibits the release and depolarizing effect of acetylcholine?
A) Penicillin
B) Edrophonium
C) Sevoflurane
D) Magnesium
D) Magnesium
Which forms a water-soluble complex with relaxants having a steroidal nuclei?
A) Neostigmine
B) Cisatracurium
C) Sugammadex
D) Glycopyrolate
C) Sugammadex
Succinylcholine administration is contraindicated in:
A) Chronic renal failure
B) Duchene muscular dystrophy
C) Myasthenia gravis
D) Pregnancy
B) Duchene muscular dystrophy
Which agent can INCREASE emergence delirium from ketamine administration?
A) Atropine
B) Propofol
C) Midazolam
D) Fentanyl
A) Atropine
Which drug is excreted as glucuronide and sulfate conjugates in urine?
A) Propofol
B) Esmolol
C) Remifentanil
D) Chloroprocaine
A) Propofol
Which agent is LEAST likely to result in nausea and vomiting?
A) Etomidate
B) Ketamine
C) Nitrous oxide
D) Midazolam
D) Midazolam
A polar solute will be more soluble in a:
A) Lipophilic solvent
B) Hydrophilic solvent
C) Hydrophobic solvent
D) Nonpolar solvent
B) Hydrophilic solvent
Which agent antagonizes glutamate?
A) Midazolam
B) Ondansetron
C) Ketamine
D) Propofol
C) Ketamine
Which is an arylcyclohexylamine?
A) Midazolam
B) Propofol
C) Fentanyl
D) Ketamine
D) Ketamine
Opioids stimulate the chemoreceptor trigger zone located in the:
A) Amygdala
B) Area postrema
C) Substantia gelatinosa
D) Hippocampus
B) Area postrema
Which agent possess local anesthetic properties and antagonizes voltage-sensitive sodium channels?
A) Midazolam
B) Fentanyl
C) Propofol
D) Ketamine
D) Ketamine
Mechanism of action: Cyclooxygenase inhibition
A) Clopidogrel
B) Abciximab
C) Aspirin
D) Heparin
C) Aspirin
Mechanism of action: Direct factor Xa inhibition
A) Clopidogrel
B) Apixaban
C) Warfarin
D) Abciximab
B) Apixaban
All the following are opioid side effects EXCEPT:
A) Nausea and vomiting
B) Pruritus
C) Biliary tract relaxation
D) Urinary retention
C) Biliary tract relaxation
Which herbal supplement is most likely to cause INDUCTION of CYP450 enzymes?
A) Ginger
B) Ginkgo
C) Garlic
D) St. John’s wort
D) St. John’s wort
Which agent is a selective arterial vasodilator?
A) Nicardipine
B) Nitroglycerin
C) Esmolol
D) Nitrous oxide
A) Nicardipine
Which is a benzylisoquinolinium agent?
A) Succinylcholine
B) Rocuronium
C) Sugammadex
D) Cisatracurium
D) Cisatracurium
Neostigmine will result in accumulation of acetylcholine, causing the following side effect:
A) Urinary retention
B) Constipation
C) Decreased salivation
D) Bradycardia
D) Bradycardia
Which is a quaternary amine (polar molecule)?
A) Glycopyrolate
B) Fentanyl
C) Atropine
D) Propofol
A) Glycopyrolate
A muscarinic antagonist is MOST likely to:
A) Cause bronchospasm
B) Increase heart rate
C) Produce defecation
D) Increase secretions
B) Increase heart rate
Speaking of local anesthetics, the aromatic ring has:
A) Hydrophilic properties
B) Lipophilic properties
C) Lipophobic properties
D) None of the above
B) Lipophilic properties
Which drug may produce a sensation of bodily detachment or floating in space?
A) Midazolam
B) Dexmedetomidine
C) Propofol
D) Ketamine
D) Ketamine
The specific enzyme inhibited by etomidate appears to be:
A) 11-deoxycorticosterone
B) 11-B hydroxylase
C) 18-oxidase
D) Aromatase
B) 11-B hydroxylase
Which is NOT an adverse effect of succinylcholine?
A) Hyperkalemia
B) Malignant hyperthermia
C) Postoperative myalgia
D) Hyperalgesia
D) Hyperalgesia
A phosphodiesterase III (PDE III) inhibitor is MOST likely to:
A) Decrease intracellular calcium
B) Increase systemic vascular resistance
C) Cause vasodilation
D) Decreases cAMP
C) Cause vasodilation
Which is a precursor of norepinephrine synthesis?
A) Metanephrine
B) Epinephrine
C) Tyrosine
D) Vanillylmandelic acid
C) Tyrosine
Pharmacological agent of choice during acute laryngospasm
A) Albuterol
B) Ipratropium
C) Succinylcholine
D) Rocuronium
C) Succinylcholine
Which is an antimuscarinic agent?
A) Physostigmine
B) Salmeterol
C) Scopolamine
D) Clonidine
C) Scopolamine
Which agent is NOT a cholinesterase inhibitor?
A) Neostigmine
B) Edrophonium
C) Echothiophate
D) Glycopyrolate
D) Glycopyrolate
Which is contraindicated in a patient receiving cholinesterase inhibitor echothiophate?
A) Esmolol
B) Remifentanil
C) Succinylcholine
D) Etomidate
C) Succinylcholine
A farmer who uses insecticides may fall victim of cholinergic syndrome. Which drug can cause cholinergic syndrome?
A) Atropine
B) Physostigmine
C) Scopolamine
D) Glycopyrolate
B) Physostigmine
Which is most likely to decrease lower esophageal sphincter tone?
A) Glycopyrolate
B) Metoclopramide
C) Succinylcholine
D) Neostigmine
A) Glycopyrolate
Which agent is LEAST likely to cross blood brain barrier?
A) Atropine
B) Scopolamine
C) Physostigmine
D) Glycopyrolate
D) Glycopyrolate
Which is a good amnestic and can be used to treat motion sickness?
A) Glycopyrolate
B) Scopolamine
C) Physostigmine
D) Metoclopramide
B) Scopolamine
Which is derived from cholesterol?
A) Epinephrine
B) Prostaglandins
C) Acetylcholine
D) Aldosterone
D) Aldosterone
Most likely to INHIBIT hypoxic pulmonary vasoconstriction and increase shunt
A) Sufentanil
B) Propofol
C) Sodium nitroprusside
D) Dexmedetomidine
C) Sodium nitroprusside
Which agent is LEAST likely to help during an acute bronchospasm?
A) Sevoflurane
B) Albuterol
C) Ketamine
D) Hydrocortisone
D) Hydrocortisone
Which agent would be INEFFECTIVE to break a bronchospasm?
A) Epinephrine
B) Albuterol
C) Magnesium
D) Rocuronium
D) Rocuronium
Which agent is most likely to cause a bronchospasm in susceptible patients?
A) Dexmedetomidine
B) Esmolol
C) Succinylcholine
D) Ketamine
C) Succinylcholine
Which is an anticholinergic?
A) Ipratropium
B) Salmeterol
C) Fluticasone
D) Montelukast
A) Ipratropium
Which is a potent bronchodilator?
A) Phenylephrine
B) Norepinephrine
C) Isoproterenol
D) Phentolamine
C) Isoproterenol
Its action on alpha receptors is insignificant
A) Phenylephrine
B) Norepinephrine
C) Ephedrine
D) Isoproterenol
D) Isoproterenol
The immediate metabolic precursor of norepinephrine
A) Epinephrine
B) Dopamine
C) Phenylephrine
D) Tryptophan
B) Dopamine
Directly stimulates alpha receptors on blood vessels supplying the nasal mucosa
A) Oxymetazoline
B) Fenoldopam
C) Dopamine
D) Isoproterenol
A) Oxymetazoline
The boiling point of desflurane is —°C (73°F) at 1 atm
22.8
The vapor pressure of desflurane is — mm Hg at 20°C
669
Cephalosporins do — potentiate neuromuscular blockade
not
Factors that — nondepolarizers:
-Inhalational anesthetics
-Aminoglycoside antibiotics
-Hypothermia
-Magnesium sulfate
-Most local anesthetics
potentiate
Factors that — nondepolarizers:
-Chronic anticonvulsant therapy
-Hyperparathyroidism
-Hypercalcemia
-Burns
antagonize
Hypocalcemia and hypokalemia — a nondepolarizing block
augment
11 beta-hydroxylase catalyzes the conversion of 11-deoxycortisol to —
cortisol
— is a carboxylated imidazole
Etomidate
Ketamine does — produce significant respiratory depression
not
Etomidate — the incidence of postoperative nausea and vomiting
increases
Etomidate is a potent cerebral —
vasoconstrictor
— is generally administered for treatment of hyperkalemia, hypocalcemia and hypermagnesemia
Calcium chloride
— antagonizes the cardiac effects of hyperkalemia and increases the cell depolarization threshold
Calcium
— is used as an adjuvant treatment of hyperkalemia and may cause HYPOkalemia
Albuterol
At presynaptic nerve terminal, high magnesium concentrations inhibit calcium channels responsible for release of —
acetylcholine
Magnesium sulfate can — the neuromuscular blockade of nondepolarizing neuromuscular blockers
potentiate
Magnesium has analgesic properties via antagonism of — receptors and calcium regulation
NMDA
— is a modified y-cyclodextrin relaxant biding agent that results in the formation of a water-soluble guest-host complex
Sugammadex
Sugammadex does — bind to plasma protein
not
In patients with Duchene muscular dystrophy, — and — are avoided because due to the risk of severe hyperkalemia and rhabdomyolysis
succinylcholine and volatile anesthetics
— may increase the incidence of emergence delirium after ketamine administration
Atropine
— shares a binding site with local anesthetic and interacts with voltage-gated sodium channels
Ketamine
— is metabolized hepatically by conjugation to glucuronide and sulfate and excreted via the kidneys
Propofol
— is metabolized by hydrolysis of its ester linkage, mainly by the esterases in the cytosol of red blood cells
Esmolol
Polar compounds are naturally —
hydrophilic
Polar solvents love — solutes
polar
Arylcyclohexylamines include — and —
ketamine and PCP
— (phencyclidine) aka angel dust is a hallucinogen. Ketamine’s chemical structure is so similar to —
PCP ; PCP
The — trigger zone includes receptors for dopamine, serotonin, histamine, and opioids
chemoreceptor
Stimulation of the chemoreceptor trigger zone located on the floor of the — ventricle triggers the vomiting center
fourth
The area postrema is located on the — at the caudal end of the fourth ventricle
medulla oblongata
Acetylsalicylic acid (Aspirin) acts by blocking the action of the — enzymes and preventing the production of prostaglandins
COX
— is an oral direct factor Xa inhibitor
Apixaban
— irreversibly binds to P2Y12 receptors and blocks adenosine diphosphate (ADP) binding
Clopidogrel
— inhibits vitamin K epoxide reductase. This inhibits the hepatic synthesis of coagulation factors II, VII, IX, and X, and coagulation regulatory factors protein C and protein S
Warfarin
— is a glycoprotein IIb/IIIa inhibitor
Abciximab
— is a direct thrombin inhibitor
Dabigatran
— is a potent herb inducer of CYP 3A4
St. John’s wort
Valerian and kava-kava may delay — from anesthesia by prolonging sedative effects
awakening
— is a dihydropyridine calcium channel blocker that produces significant dilatation of the peripheral arterioles
Nicardipine
Nicardipine does — produce effects on the sinoatrial node and atrioventricular node
not
— is an isomer of atracurium
Cisatracurium
— is a benzylisoquinolinium compound
Cisatracurium
Cisatracurium in therapeutic dose range does not cause — release
histamine
Muscarinic side effects of — administration include: bradyarrhythmias, bronchoconstriction, increased secretions, miosis, and increased peristalsis
neostigmine
— is a quaternary amine (polar molecule)
Glycopyrolate
— does not cross the blood-brain barrier or the placenta
Glycopyrrolate
Commonly used — include atropine, scopolamine, glycopyrrolate, and ipratropium bromide
muscarinic antagonists
— consist of a lipophilic and a hydrophilic portion separated by a hydrocarbon chain
Local anesthetics
local anesthetics hydrophilic portion is usually a — amine
tertiary
local anesthetics lipophilic portion is usually an — aromatic ring
unsaturated
local anesthetics aromatic ring and its substitutions are responsible for — solubility
lipid
— administration may be associated with increased myocardial oxygen requirements (caution on coronary artery disease)
Ketamine
— produces a dose-dependent inhibition of the conversion of cholesterol to cortisol
Etomidate
Undesirable effects of —:
-Hyperkalemia
-Rhabdomyolysis
-Myalgia
-Cardiac arrhythmias
-Malignant hyperthermia
-Increased intraocular pressure
-Increased intragastric pressure
-Increased intracranial pressure
succinylcholine
— has been associated with the development of opioid-induced hyperalgesia
Remifentanil
— decrease cAMP hydrolysis, leading to increased intracellular concentrations of cAMP in the myocardium and vascular smooth muscle
Phosphodiesterase III (PDE III) inhibitors
In vascular smooth muscle, increased cAMP decreases calcium availability, leading to smooth muscle — and —
relaxation and vasodilation
— is a methylxanthine-derived phosphodiesterase inhibitor
Caffeine
Norepinephrine is synthesized from — as a precursor
tyrosine
— is a mnemonic of cholinergic crisis:
SLUDGE
S: Salivation
L: Lacrimation
U: Urination
D: Diaphoresis
G: Gastrointestinal upset
E: Emesis
—, a potent inhibitor of both true cholinesterase and pseudocholinesterase
Echothiophate
Because succinylcholine is metabolized by this enzyme, — will prolong its duration of action
echothiophate
The antidote for echothiophate iodide toxicity is —
pralidoxime chloride
— is tertiary amine and lipid soluble. This means it freely passes the blood brain barrier
Physostigmine
The antidote for physostigmine toxicity is —
atropine
Tonsillectomy and adenoidectomy carry great risk of —
laryngospasm
Glycopyrolate — lower esophageal sphincter tone
decreases
— is a tertiary amine that readily crosses the blood-brain barrier
Atropine
Side effects of — include sedation, cycloplegia, drying of secretions (dry mouth), blurry vision, and photophobia
scopolamine
— is synthesized from cholesterol
Aldosterone
— is a mineralocorticoid hormone produced in the zona glomerulosa of the adrenal cortex
Aldosterone
— is synthesized from cholesterol
Aldosterone
— biosynthesis begins with uptake of the amino acid tyrosine. Choline is a precursor to the neurotransmitter acetylcholine
Catecholamine
Prostaglandins can be produced from three different precursors. The most important one is —
arachidonic acid
Attenuation of hypoxic pulmonary vasoconstriction (HPV) may cause decreases in PaO2 after administration of —
sodium nitroprusside
Clinical effect of hydrocortisone may be seen in — to — hours.
2-4
— would not provide benefit during the ACUTE phase of bronchospasm
hydrocortisone
Magnesium sulfate is thought to produce additional —
bronchodilation
Succinylcholine is associated with — release
histamine
— is a cardioselective beta- adrenergic blocker
Esmolol
— is a long-acting beta-2 adrenergic receptor agonist
Salmeterol
— belongs to the family of medicines known as corticosteroids
Fluticasone
— is a leukotriene receptor antagonist
Montelukast
— is the most potent agonist of all the sympathomimetics with beta 1 and beta 2 receptor activity
Isoproterenol
Adverse effects of isoproterenol include — and —
vasodilation and decreased blood pressure
— may decrease coronary blood flow due to increased heart rate, decreased diastolic blood pressure and cardiac dysthymias
Isoproterenol
In therapeutic doses, — is devoid of alpha agonist activity and does not cause vasoconstriction
isoproterenol
— is the immediate precursor of dopamine
Tyrosine
— is the immediate metabolic precursor of norepinephrine
Dopamine
— is made from the essential amino acid tryptophan
Serotonin
— is also important to the reward centers of the brain
Dopamine
— is a direct-acting sympathomimetic with marked alpha- adrenergic activity
Oxymetazoline
— decreases congestion when applied to mucous membranes due to its vasoconstrictive effects
Oxymetazoline
— may be used prior to nasal intubation
Oxymetazoline
