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
