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SRNAPharmacology II > EXAM 2 PQ > Flashcards

EXAM 2 PQ Flashcards

1
Q

Neuromuscular, nondepolarizing blockers which exhibit longer durations of action (greater than about half an hour) are most likely eliminated by:

A

Renal

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2
Q

Which one(s) of the following “intermediate-acting” steroid neuromuscular blocking drugs Exhibit elimination as a result of hepatic metabolism or biliary excretion.

A

Vecuronium and Rocuronium

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3
Q

Intermediate acting steroid NMB drugs

A

Vecuronium and Rocuronium

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4
Q

This agent is most likely to ensure maintenance of the cardiovascular reflex, a condition preferable during anesthesia

A

Vecuronium

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5
Q

Cleared most slowly by the liver:

A

Pancuronium

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6
Q

Characteristic(s) of nondepolarizing neuromuscular blocking drugs:

A

Lipid soluble

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7
Q

This intermediate-acting isoquinoline-type intermediate acting nondepolarizing drug exhibits Hofman elimination (spontaneous breakdown).

A

Atracurium

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8
Q

T/FNeuromuscular blockade associated with nondepolarizing drugs is highly correlated with the elimination half-life.

A

True

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9
Q

Quaternary, charged, neuromuscular blocking drugs) show essentially NO Central effects after typical clinical doses.

A

True

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10
Q

Pharmacokinetic properties/properties of nondepolarizing neuromuscular blocking drugs:

A

Volume of distribution comparable to the blood volume

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11
Q

This neuromuscular blocking agent exhibits a sufficient anti-vagal action such that tachycardia may ensue.

A

PANCURONIUM

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12
Q

Compared to atricurium, cisatracurium is:

A

NOT dependent on the liver for inactivation.

NOT likely to cause histamine release.

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13
Q

T/F Neuromuscular blockade due to depolarization induced by agents such as succinylcholine is initially described as a phase I block.

A

True

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14
Q

Muscle cell changes associated with prolonged depolarization include:

A

Reduced Potassium

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15
Q

Over time and with increasing succinylcholine concentrations, neuromuscular blockade may transition from a.

A

depolarizing, phase I block to a non-depolarizing phase II block

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16
Q

Neuromuscular blockade reversal agent.

A

Sugammadex

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17
Q

Phase I blockade could be potentiated by which one(s) of the following?

A

Edrophonium

Donepezil

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18
Q

The prototypical depolarizing-type neuromuscular blocking drug:

A

Succinylcholine

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19
Q

Succinylcholine, an example of a depolarizing neuromuscular blocker, exhibits longer duration compared to acetylcholine mainly due to which one(s) of the following?

A

Resistance to inactivation by acetylcholinesterase

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20
Q

_______is more clinically advantageous compared atracurium and as a result has replaced atracurium in practice.

A

Cisatracurium

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21
Q

Botulinum toxin which may be used to manage ocular blepharospasm as well as control other muscle spasms block neuromuscular transmission mainly through

A

inhibition of acetylcholine release.

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22
Q

Isoquinoline derivative:

A

atracurium

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23
Q

Vlinical condition associated with spasticity:

A

Stroke, MS

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24
Q

Spasticity Characteristics

A

muscle weakness
increased flexor muscle spasm
increase in tonic stretch reflexes

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25
Q

Sequence of events following IV neuromuscular-blocking injection (nondepolarizing drug) to an awake patient:{first presentations to last}

A

difficulty in focusing, mandibular muscle weakness, ptosis, diplopia, dysphagia

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26
Q

Nondepolarizing neuromuscular agents – elimination characteristics

A

renal elimination: long half lives – longer ration of action > 35 minutes; hepatic elimination: shorter half lives, less than 30 minutes

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27
Q

Isoquinoline derivative:

A

-Acurium

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28
Q

Liver failure will have the most significant effect on the duration of action of which NDNMB

A

Rocuronium

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29
Q

Drugs that does not decrease butyrylcholinesterase activity?

A

Ranitidine

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30
Q

This drug class causes resistance to NMB drugs

A

Anticonvulsants (carbamezipine , phenytoin)

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31
Q

Elevated Laudanosine associated with

A

ATRACURIUM

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32
Q

NDNMB with the most potent active metabolite

A

VECURONIUM

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33
Q

No active metabolite with this benzylisoquinoliniu

A

CIsatracurium

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34
Q

What is the metabolite of vecuronium

A

3-OH, 80% as potent

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35
Q

During surgery , an adult patient is given a 2nd dose of succinylcholine approx 5 minutes after the first dose, the scenario increase the chance of this side effect

A

BRADYCARDIA

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36
Q

AVOID This NDNMB is asthmatic patients

A

ATRACURIUM

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37
Q

Succ ok to use in those patient

A

Renal failure

38
Q

Succinylcholine contraindicated in the

A

routine pediatric patient

39
Q

A patient is tested for butyrylcholinesterase activity and has number of 80. she is given succinylcholine, what is most likely to occur?

A

normal response to succinylcholine

40
Q

Possible effect if anesthesiologist does not give enough glycopyrrolate

A

INTESTINAL SPASMS

41
Q

Inhaled anesthetics and TIVA can potentiate effects of NDNMB , which is the most potent at doing that?

A

DESFLURANE

42
Q

Which ABT has no effet of NMB

A

CEFAZOLIN

43
Q

HOw does MAGNESIUM SULFATE AFFECT Pharmacokinetics and phramacodynamics of VECURONIUM?

A

Will decrease the ED95 meaning enhance the effects of VECURONIUM and other NDNMB

44
Q

Which drugs augment the effects of NDNMB?

A

Lithium

Via both pre and postsynaptic effects

45
Q

Class of anesthetics most commonly LINKED to anaphylactic reations

A

MUSCLE RELAXANTS

46
Q 
Which anticholinergic is classified as quaternary amine?
A. Scopolamine
B. Atropine
C. Neogstimine
D. Glycopyrrolate
A

Glycopyrrolate

47
Q

Which anticholinergic CANNOT CROSS BBB

A

Glycopyrrolate

48
Q

Renal disease best choice NDNMB

A

cisatracurium

49
Q

Considered a Ach receptor agonist

A

Succinylcholine.

50
Q

What do you expect to happen to receptors when administering NMB to patient with Myasthenia G.

A

DOWN -REGULATION

51
Q

As compared to Other anticholinergic, what are scopalamie’s sedative effects?

A

GREATER THAN GLYCOPYRROLATE

52
Q

Compared to NEOSTIGMINE, onset of PYRIDOSTIGMINE

A

SLower

53
Q

What condition potentiate neuromuscular BLOCKADE

a. Hypomagnesemia
b. Hypercalcemia
c. Hyperkalemia
d. Hypothermia

A

HYPOTHERMIA

54
Q

Patient weight is 80kg what dose of Cisatracurium

A

16 (0.2mg/kg)

55
Q

During surgery for a bowel obstruction, you note PERSISTENT TACHYCARDIA and HYPERTENSION which NMB most likely was used?

A

PANCURONIUM; no significant CV effect with cisatracurium, atracurim and Rocuronium

56
Q

Antibiotic to avoid in MG why?

A

Gentamycin; prolong effect of NMB

57
Q

AT what dose is the onset of action of ROCURONIUM similar to that of Succinylcholine for RSI?

a. 0.9- 1.2mg/kg
b. 1.5 - 2.0 mg/kg
c. 2.0-2.5 mg/kg
d. >2.5mg/kg

A

A. 0.9 - 1.2 mg/kg

58
Q

When given NEOSTIGMINE what is the resultant MUSCARNINC effect?

A

BRADYCARDIA

59
Q

What anticholinesterase crosses the BBB

a. Edrophonium
b. Neostigmine
c. Pyridostigmine
d. Physostigmine

A

PHYSOSTIGMINE (tertiary amine)

60
Q

Your patient’s TOF is 1/4 you decide to reverse with NMB what drug combination and dose do you use

A

Neo 0.04mg/kg and glycop 0.2mg per 1 mg of neogstimine

61
Q

What is the physical structures of Succinylcholine?
A. Two joined Ach molecules
B. Benzylisoquinoline
C. Steroid ring with 2 modified ach molecules
D. Monoquaternary steroid

A

Two joined ACH molecules

62
Q 
Which of the following factors produces 4-8 hours of SUCCINYLCHOLINE INDUCED NMB?
A. Homozygous atypical enzyme
B. Hyperthermia
C. Heterozygous atypical enzyme
D. Reduce pseudocholinesterase levels.
A

A. Homozygous atypical enzyme

63
Q 
What is the anticholinergic with the least ANTISIOLOGUE effect?
A. Atropine
B. Glycopyrrolate
C. Scopolamine
D. Neostigmine
A

A. Atropine

64
Q

What is the anticholinergic with the least Tachycardia effect?

A

Scopolamine

65
Q

What is the anticholinergic with the 0 Sedtion?

A

Glycopyrrolagte

66
Q

What is the anticholinergic with the least bronchodilation ?

A

SCOPOLAMINE

67
Q

What is the anticholinergic with the MOST ANTISIOLOGUE effect?

A

Scopolamine and GLYCOPYRROLATE

68
Q

What is the anticholinergic with the MOST Sedation?

A

SCOPOLAMINE

69
Q

The patient presents for OP surgery with a hx of asthma , when using GLYCOPYRROLATE expect

A

RELEAXATION OF bronchial smooth muscle

70
Q

Avoid in Parkinson’s this med

A

METOCLOPROMIDE

71
Q

Which inhalation Agent affect BP the least ?

A

SEVOFLURANE

72
Q

Minimal cardiac depression with those 2 VA

A

ISoflurane and desflurant

73
Q

AVOID this NMB agent for renal failure

A

VECURONIUM

74
Q

This medication BLOCKS MUSCARINIC RECEPTOR

A

ATROPINE

75
Q

Which part of the structure of GLYCOPYRROLATE is responsible for the binding of acetylcholine receptors?

A

ESTER linkage

76
Q 
What manifestation occurs as a results of anticholinergic overdose?
A. Tachycardia
B. Oral secretions
C. Bradycardia
D. Cutaneous Vasoconstriction
A

A. TACHYCARDIA (central cholnergic syndrome)

77
Q

What are the 3 signs of Central cholinergic syndrom

A

Tachycardia, Excessive dry mouth, CUTANEOUS VASODILATION or flush.

78
Q

How does lithium affect NDNMB?

A

Increase DOA of VECURONIUM (or NMBs )

79
Q

How does chronic Alcoholism affect VA

A

Increase requirements

80
Q

What are the risk factors for HALOTHANE HEPATITIS (AFO)

A

Age > 40 years
Female
Obesity

81
Q

Patient taking TCAs and MAC requirements

A

MAC requirements may be increased

82
Q

Which neuromuscular disease associated with increased resistance to succinylcholine?

A

MYASTHENIA GRAVIS

83
Q

Compound A is one of the by products of degradation of VA

A

Sevoflurane

84
Q

Anticholinergic increase the heart rate the most

A

ATROPINE

85
Q

Blood gas partition coefficient of Halothane

A

2.4

86
Q

Blood gas partition coefficient of Nitrous oxide

A

0.47

87
Q

Blood gas partition coefficient of Sevoflurane

A

0.65

88
Q

Blood gas partition coefficient of ISOFLURANE

A

1.4

89
Q

Blood gas partition coefficient of DESFLURANE

A

0.42

90
Q

which inhalational agent is a HALOGENATED ALKANE

A

HALOTHANE

91
Q

NMB CONTRAINDIATED in GBS

A

Succinylcholine

92
Q

Conscious memory is suppressed by

A 
volatile anesthetics (0.45 MAC isoflurane) and nitrous (0.6 MAC).
These concentrations are similar to MAC awake.

SRNAPharmacology II (32 decks)

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