CNS pharma

Question 1

All opioids cause miosis except

Answer 1

meperidine

Question 2

Opioid receptors are _____ coupled

Answer 2

inhibitory G protein

Question 3

Recurrent symptoms of opioid toxicity even after nalaxone administration is due to ____

Answer 3

short half life of nalaxone <1 hour

Question 4

Opioid poisoning causes hypotension due to ____

Answer 4

opioid induced histamine release

Question 5

morphine has a vaso___ effect

Answer 5

dilator

Question 6

Effect of opioid on bladder:

Answer 6

Urinary retention

1. block urinary voiding reflexes
2. ↑ sphincter tone
3. ↑ bladder volume

Question 7

Long term use of opioid effects?

Answer 7

1. receptor downregulation and decoupling of 2nd messenger
2. upregulation of excitatory NMDA receptors

this causes tolerance and opioid induced hyperalgesia

Question 8

If pain control needed in renal failure patients___

Answer 8

fentanyl, hydromorphone

Question 9

Drugs with ____ solubility in blood = rapid induction and recovery times.

Answer 9

↓

Question 10

relation of solubility, potency and MAC

Answer 10

Drugs with ↑ solubility in lipids = ↑potency = 1 / MAC

Question 11

Nitrous oxide (N2O) has ___ blood and lipid solubility

Answer 11

↓

Question 12

Blood/gas partition coefficient corresponds to ______

Anesthetic with a high blood/gas partition coefficient ____

Answer 12

solubility of anesthetic in blood

are absorbed to a greater extent by blood and have a slower onset of action

Question 13

Steepness of arterial tension curve depends on ___

partial pressure in blood rises more rapidly with

Answer 13

solubility in blood

less soluble anesthetic, producing steeper curve

Question 14

AV concentration gradiant influences ______ not _______

Answer 14

rate of induction, not anesthetic potency

Question 15

Malignant hyperthermia is inherited as

Answer 15

autosomal dominant with variable penetrance

Question 16

d/d of Malignant hyperthermia:

Answer 16

Thyroid storm precipitated by surgery → hyperpyrexia but donot cause sustained muscle contraction

Question 17

Etomidate:
MOA:
adverse effect:
avoided in:

Answer 17

GABA agonist

inhibits cortisol synthesis

Septic shock

Question 18

Malignant hyperthermia abnormalities in serum

Answer 18

↑K+, ↑CK, acute hypercarbia

Question 19

All inhalation anesthetics except ____ cause respiratory depression

Answer 19

nitrous oxide

Question 20

_______ and ______ have bronchodilation properties and are preferred in patients with asthma.

Answer 20

Halothane and sevoflurane

Question 21

Order of loss with local anesthetic

Answer 21

(1) pain, (2) temperature, (3) touch, (4) pressure.

Question 22

Depolarizing neuromuscular blocking drugs Complications include:

Answer 22

hypercalcemia, hyperkalemia, malignant hyperthermia.

Question 23

Duration of action of succinylcholine is _____

Increased in?

Answer 23

<10 mins
Pseudocholinesterase deficiency: genetic polymorphism in BCHE gene
heterozygote: double time
homozygote: several hours

Question 24

succinylcholine is metabolized by ____

Answer 24

Pseudocholinesterase

Question 25

Nicotinic ACh receptor is a non-selective cation channel which allows:

Answer 25

influx of Na+, Ca++

efflux of K+

Question 26

Atracurium metabolism:

Answer 26

metabolized to laudanosine

spontaneously degrades in plasma and organ tissue → “Hofmann elimination”

Question 27

Cyclobenzaprine Structurally related to:

Side effects:

Answer 27

TCAs.

May cause anticholinergic side effects, sedation.

Question 28

Carbidopa, a peripheral DOPA decarboxylase inhibitor, is given with L-DOPA to ______ of L-DOPA in the brain and to limit ______

Answer 28

↑ bioavailability

peripheral side effects.

Question 29

Initial treatment of Parkinson disease

Answer 29

SAC
selegiline
amantidine
anti-Cholinergic

Question 30

how to treat CNS effects of L-dopa/Carbidopa if decreasing dose donot work

Answer 30

Atypical antipsychotic i.e. Clozapine