Contraindications

Question 1

Methohexital sodium

Answer 1

patients with latent or manifest porphyria

Question 2

Etomidate

Answer 2

Geriatric patients

Question 3

Ketamine

Answer 3

contraindicated in those in whom a significant elevation of blood pressure would constitute a serious hazard

Question 4

Succinylcholine

Answer 4

personal or family history of MH or skeletal muscle myopathies;
following major burns, multiple traumas, extensive denervation of skeletal muscle, or upper motor neuron injury because this results in the formation of many new, basically nonfunctional nerves that can fire and increase serum K+
*may result in severe hyperkalemia which may cause cardiac arrest

Question 5

Vecuronium

Answer 5

none

Question 6

Pancuronium

Answer 6

neonates, including premature infants, because formulation contains benzyl alcohol which is toxic to them (undeveloped metabolic pathway of benzyl alcohol)

Question 7

Cisatracurium

Answer 7

Neonates and premature infants because formulation contains benzyl alcohol

Question 8

Rocuronium

Answer 8

Patients with hypersensitivity (e.g., anaphylaxis) to Roc or other neuromuscular blocking agents

Question 9

Atropine Sulfate

Answer 9

Patients with glaucoma, pyloric stenosis, or prostatic hypertrophy, except in doses ordinarily used for preanesthetic medication

Question 10

Glycopyrrolate

Answer 10

Patients with glaucoma, obstructive uropathy (e.g., bladder neck obstruction due to prostatic hypertrophy), obstructive disease of the gastrointestinal tract (e.g., achalasia, pyloroduodenal stenosis, etc.), paralytic ileus, intestinal atony of the elderly or debilitated patient, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, and myasthenia gravis

Question 11

Lidocaine

Answer 11

patients with a known history of hypersensitivity to local anesthetics of the amide type

Question 12

Midazolam

Answer 12

patients with acute narrow-angle glaucoma

Question 13

Labetolol

Answer 13

bronchial asthma, overt cardiac failure, greater-than-first-degree heartblock, cardiogenic shock, severe brachycardia, other conditions associated with severe and prolonger hypotension

Question 14

Metoprolol

Answer 14

sinus brachycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure

Question 15

Esmolol

Answer 15

Severe sinus bradycardia: May precipitate or worsen bradycardia resulting in cardiogenic shock and cardiac arrest
Heart block greater than first degree: Second- or third-degree atrioventricular block may precipitate or worsen bradycardia resulting in cardiogenic shock and cardiac arrest
Sick sinus syndrome: May precipitate or worsen bradycardia resulting in cardiogenic shock and cardiac arrest
Decompensated heart failure: May worsen heart failure.
Cardiogenic shock: May precipitate further cardiovascular collapse and cause cardiac arrest.
IV administration of cardiodepressant calcium-channel antagonists (e.g.,verapamil) and BREVIBLOC in close proximity (i.e., while cardiac effects from the other are still present); fatal cardiac arrests have occurred in patients receiving BREVIBLOC and intravenous verapamil.
Pulmonary hypertension: May precipitate cardiorespiratory compromise.
Hypersensitivity reactions, including anaphylaxis, to esmolol or any of the inactive ingredients of the product (cross-sensitivity between beta blockers is possible).

Question 16

Neostigmine

Answer 16

should not be used in patients with a history of reaction to bromides, or for patients with peritonitis or mechanical obstruction of the intestinal or urinary tract

Question 17

Edrophonium

Answer 17

Intestinal and urinary obstructions of mechanical type

Question 18

Hydromorphone

Answer 18

Patients with respiratory depression in the absence of resuscitative equipment, and in patients with status asthmaticus

Question 19

Fentanyl

Answer 19

Patients with known intolerance to the drug or other opioid agonists

Question 20

Meperidine HCl

Answer 20

Patients who are receiving monoamine oxidase (MAO) inhibitors or those who have recently received such agents. Therapeutic doses of meperidine have occasionally precipitated unpredictable, severe, and occasionally fatal reactions in patients who have received such agents within 14 days. The mechanism of these reactions is unclear, but may be related to a preexisting hyperphenylalaninemia. Some have been characterized by coma, severe respiratory depression, cyanosis, and hypotension, and have resembled the syndrome of acute narcotic overdose. Serotonin syndrome with agitation, hyperthermia, diarrhea, tachycardia, sweating, tremors and impaired consciousness may also occur. In other reactions the predominant manifestations have been hyperexcitability, convulsions, tachycardia, hyperpyrexia, and hypertension.
Other narcotics are free of the risk of such reactions, virtually all of the reported reactions have occurred with meperidine. If a narcotic is needed in such patients, a sensitivity test should be performed in which repeated, small, incremental doses of morphine are administered over the course of several hours while the patient’s condition and vital signs are under careful observation.

Question 21

Morphine Sulfate

Answer 21

Significant respiratory depression
Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
Known or suspected paralytic ileus

Question 22

Dexamethasone

Answer 22

Systemic fungal infections

Patients with diabetes (corticosteroid increases blood glucose)

Question 23

Ketorolac

Answer 23

TORADOL is contraindicated in patients with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or perforation and in patients with a history of peptic ulcer disease or gastrointestinal bleeding.
TORADOL should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients (see WARNINGS: Anaphylactoid Reactions, and PRECAUTIONS: Preexisting Asthma).
TORADOL is contraindicated as prophylactic analgesic before any major surgery.
TORADOL is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS).
TORADOL is contraindicated in patients with advanced renal impairment or in patients at risk for renal failure due to volume depletion (see WARNINGS for correction of volume depletion).
TORADOL is contraindicated in labor and delivery because, through its prostaglandin synthesis inhibitory effect, it may adversely affect fetal circulation and inhibit uterine contractions, thus increasing the risk of uterine hemorrhage.
TORADOL inhibits platelet function and is, therefore, contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis and those at high risk of bleeding (see WARNINGS and PRECAUTIONS).
TORADOL is contraindicated in patients currently receiving aspirin or NSAIDs because of the cumulative risks of inducing serious NSAID-related adverse events.
The concomitant use of TORADOL and probenecid is contraindicated.
The concomitant use of ketorolac tromethamine and pentoxifylline is contraindicated.

Question 24

Metoclopramide

Answer 24

Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation.
Metoclopramide is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phentolamine.
Metoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug.
Metoclopramide should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.

Question 25

Ondansetron

Answer 25

Patients known to have hypersensitivity (e.g., anaphylaxis) to this product or any of its components
Concomitant use of apomorphine with ondansetron is contraindicated based on reports of profound hypotension and loss of consciousness

Question 26

Ephedrine Sulfate

Answer 26

Patients hypersensitive to other sympathomimetics

Question 27

Phenylephrine HCl

Answer 27

Severe hypertension
Ventricular tachycardia
Pheochromocytoma
Ophthalmic 10% solution contraindicated in infants and patients with aneurysms
Low birth weight infants
Anatomically narrow angles or narrow-angle glaucoma
During intraocular procedures when the corneal epithelial barrier has been disrupted
Elderly patients with severe arteriosclerotic CV or cerebrovascular disease
MAOI use or 14 days after stopping an MAOI
Severe coronary artery disease

Question 28

Epinephrine HCl

Answer 28

none

Question 29

Propofol

Answer 29

egg, egg product, soybean, and soy product allergies