GENERAL P H A R M A C O L O G Y | Part I Flashcards
Receptor responsible for the shivering effect of opioid?
A. Mu-1
B. Kappa
C. Mu-2
D. Gamma
Kappa
What receptor(s) is blocked by esmolol?
A. Beta-1
B. Beta-2
C. Both
Beta-1
Selective for Beta-1 along with atenolol and metoprolol. Lower risk of causing bronchoconstriction
Which bolus dose of succinylcholine is necessary for phase 2 block to occur?
A. 4mg/kg
B. 6 mg/kg
C. 8mg/kg
4mg/kg
OIH can be prevented by which of the following drug?
A. Butorphanol
B. Ketamine
C. Lidocaine
B. Ketamine
Morphine 0.1 - 0.25 mg/kg
Ketamine
The following are conditions associated with UPREGULATION of acetylcholine receptors EXCEPT:
A. Multiple Sclerosis
B. GBS (Guillain Barre Syndrome)
C. Burn <12 hours
D. Stroke more than 1 month
C. Burn <12 hours
BURN
STROKE
SPINAL CORD INJURY
PROLONGED IMMOBILITY
PROLONGED EXPOSURE TO NMB
Multiple Sclerosis
GBS (Guillain Barre Syndrome)
Which is NOT associated with DOWNREGULATION of acetylcholine receptors?
A. Myasthenia Gravis
B. Anticholinesterase Poisoning
C. Organophosphate Poisoning
D. Multiple Sclerosis
D. Multiple Sclerosis
Conditions with DOWNREGULATED ach-receptors:
Myasthenia Gravis
Anticholinesterase Poisoning
Organophosphate Poisoning
PHYSIOLOGIC EFFECT OF PROPOFOL except:
A. decrease in CBF
B. increase in CPP
C. decrease in SVR
D. decrease in CMRO2
B. increase in CPP
CPP is unchanged!
The most potent form of KETAMINE is:
A. S+ form
B. R+ form
C. Norketamine
S+ form is most potent
It has half life of 2-3 hours and highly lipid soluble.
- The active metabolite is norketamine and is 1/3 as potent compared to the parent drug.
When increasing the speed of onset of an NMB agents, utilizing 10% of its intubating dose. This is known as:
A. Priming
B. Taming
C. Phase II block
PRIMING
TRUE or FALSE
The amnestic effect of MIDAZOLAM is more potent than its sedative effect
TRUE
The amnestic effect of MIDAZOLAM is more potent than its sedative effect thus a patient may be awake following a dose of midazolam but remain amnestic for events and conversations for several hours.
The metabolism of Midazolam is slowed down in the presence of which drug except:
A. Erythromycin
B. Ca channel blocker
C. Antifungal drugs
D. Cimetidine
E. Diuretics
E. Diuretics
Inhibitors of Cyto P450(i.e. Cimetidine, Ca-Channel blocker l, etc) slows down the metabolism of midazolam thus resulting to unexpected profound CNS depression.
Stoelting | 6th edit
TRUE or FALSE
The elimination half-time and clearance of MIDAZOLAM is are not altered by renal failure.
TRUE
Which volatile anesthetic has the highest VAPOR PRESSURE?
A. Nitrous Oxide
B. Desflurane
C. Halothane
D. Sevoflurane
Nitrous Oxide
Sevoflurane VAPORIZER mistakenly filled with ISOFLURANE results to:
A. Underdose
B. Overdose
C. Unchanged
OVERDOSE
Iso to Sevo is OVER
ISOflurane VAPORIZER mistakenly filled with SEVOflurane results to:
A. Underdose
B. Overdose
C. Unchanged
UNDERDOSE
Sevo to Iso is UNDER
Acetazolamide affect on urine and acid-base balance:
A. alkalinazation of urine
B. decrease bicarbonate excretion
C. hypochloremic metabolic alkalosis
A. alkalinazation of urine
Acetazolamide is a carbonic anhydrase inhibitor
Causes an increase in renal bicarbonate excretion, resulting to alkalization of urine
Adverese effect:
May cause mild HyperChloremic metabolic acidosis
How does morphine improves coronary perfusion?
Due to reduction in preload and a reduction in end-diastolic pressures (EDP) in the ventricles –> increase coronary perfusion
Which of the following drugs POTENTIATES non-depolarizing NMBD?
A. Lithium
B. Carbamazepine
C. Neostigmine
D. Phenytoin
A. Lithium
- Antibiotics (e.g. streptomycin, clindamycin, tetracyclines, aminoglycosides)
- Antiarrhythmics (e.g. calcium channel blockers)
- Dantrolene
- Ketamine
- Local anesthetics (high doses only)
- Lithium
- Magnesium
- Volatile anesthetic agents
Which of the following drugs INHIBITS or decreases the potency of non-depolarizing NMBD?
A. Lidocaine
B. Lithium
C. Phenytoin
D. Ketamine
C. Phenytoin
- Anticonvulsants (e.g. phenytoin {chronic administration}, carbamazepine)
- Cholinesterase inhibitors (e.g. neostigmine)
Which of the following opioid can act as weak SSRI thus can cause Serotonin Syndrome if mistakenly combined with MAO inhibitor?
A. Tramadol
B. Morphine
C. Buprenorphine
D. Nalbuphine
A. Tramadol
THREE opioids which act as weak SSRIs and thus can cause serotonin syndrome when combined with an MAOI:
MEPERIDINE
METHADONE
TRAMADOL
TRUE or FALSE
Dopamine-1 INHIBITS adenylate cyclase
FALSE
Dopamine-1 receptors are postsynaptic → linked to Gs proteins → activates adenylate cyclase
Dopamine-1 > Activates!
TRUE or FALSE
Dopamine-2 INHIBITS adenylate cyclase
TRUE
Dopamine-2 receptors are presynaptic → linked to Gi proteins → inhibits adenylate cyclase
Dopamine-2 > Inhibits!
1 atm is also equivalent to:
A. 10 bar
B. 1000 kPa
C. 7600 torr
D. 1033 cm H2O
1 atm
760 mmHg
760 torr
1 bar
100 kPa
1033 cm H2O
14.7 lb/inch2
Which of the following contributes in the pruritus seen among the patients given intrathecal opioid:
A. 5-HT3
B. mast cell degranulation
C. histamine receptors
D. kappa receptors
A. 5-HT3
Intrathecal opioids are more likely to cause pruritis that is mediated by 5-HT3 and μ opioid receptors in the trigeminal nucleus
- Pruritis is mediated by 5-HT3 receptors, not histamine receptors
- Pruritis is seen centrally - head, neck, torso
- Not mediated by mast cell degranulation.
TRUE or FALSE
Halothane is reduced in the liver by CYP-2E1 to Trifluoroacetic acid
FALSE!
Halothane is OXIDIZED in the liver by CYP-2E1 to Trifluoroacetic acid
A patient with a history o medically managed glaucoma presents or preoperative anesthetic assessment. Which glaucoma treatment may increase the duration of action of succinylcholine?
(A) acetazolamide
(B) brimonidine
(C) cyclopentolate
(D) echothiophate
(E) bimatoprost
(D) echothiophate
Echothiophate is a cholinesterase inhibitor. It will prolong the duration o action o succinylcholine ( or an additional 2 to 14 minutes).
Acetazolamide inhibits carbonic anhydrase
and reduces aqueous humor production.
Brimonidine (Alphagan) is an alpha-2 receptor agonist. Cyclopentolate is a muscarinic antagonist. Bimatoprost (Lumigan) is a prostaglandin analog that increases uveoscleral outflow.
Preoperatively, a patient is evaluated and elt to be at increased risk o pulmonary aspiration. Best evidence suggests which of the following preoperative pharmacologic agents is most effective at reducing gastric acidity?
(A) metoclopramide
(B) ranitidine
(C) lansoprazole
(D) ondansetron
(E) glycopyrrolate
(B) ranitidine
H2 receptor antagonists (ranitidine, cimetidine) reduce gastric acidity and volume (Category A1 evidence).
Proton pump inhibitors (lansoprazole, omeprazole)
also reduce gastric acidity and volume (Category A2
evidence). There is equivocal evidence that anticholinergics (glycopyrrolate, atropine) reduce gastric acidity and volume (Category C2 evidence). Metoclopramide reduces gastric volume but there is equivocal evidence that is reduces gastric acidity (Category C1 evidence).
Ondansetron reduces nausea and vomiting but does not alter gastric pH or motility.
Evidence:
- Category A1—multiple randomized controlled trials (RC s), supported by meta-analysis.
- Category A2—multiple RCTs, no meta-analysis.
- Category B—suggestive literature
- Category C1—meta-analysis did not find significant differences
- Category C2—RCTs report inconsistent results or
no differences, no meta-analysis.
An oral dose of morphine is subject to metabolism in the liver. After hepatic extraction, approximately 33% of the morphine enters the systemic circulation unchanged.
Which of the following terms best describes this reaction for drug that reaches the systemic circulation?
(A) volume of distribution
(B) first-pass elimination
(C) extraction ratio
(D) clearance
(E) bioavailability
(E) bioavailability
Bioavailability is the portion o drug that reaches the
systemic circulation unchanged. Volume of distribution (Vd) is the ratio of drug in the body to concentration in plasma or blood.
First-pass elimination is the metabolism of drug
be ore it reaches the systemic circulation. Extraction ratio is the clearance of drug from the liver divided by the hepatic blood flow. Clearance is the rate of drug elimination divided by the drug concentration.
Which mechanism of transport is most important or drugs to redistribute from the epidural space to the spinal cord?
(A) endocytosis
(B) active transport
(C) facilitated diffusion
(D) passive diffusion
(E) exocytosis
(D) passive diffusion
Which of the following hypnotics causes LEAST cardiac depression?
A. Etomidate
B. Thiopental
C. Ketamine
D. Propofol
A. Etomidate
TRUE or FALSE
Premedication does not affect the speed to apnea after administration of propofol
TRUE
TRUE or FALSE
Propofol causes relative inhibition of pulmonary vasoconstriction
FALSE
Which of the following is MOST ACCURATE regarding the pharmaco-properties of Etomidate?
A. It is metabolized by hepatic ester hydrolysis
to inactive metabolite, which is then renally secreted
B. Reduced dose is required in patients with renal insufficiency
C. Etomidate significantly reduces cerebral perfusion pressure
D. Etomidate is a GABA-B agonist
A. It is metabolized by hepatic ester hydrolysis
to inactive metabolite, which is then renally secreted
- No renal dosing is required
- CPP is maintained!
- It is a GABA-A agonist
Compared with halothane, desflurane has which of the following characteristics?
(A) Greater potency
(B) A higher boiling point
(C) Increased blood solubility
(D) Less airway irritability
(E) Less biodegradation
(E) Less biodegradation
The decreased duration of action of an intravenous dose of fentanyl compared with an intravenous dose of morphine is best explained by
(A) greater lipid solubility
(B) increased hepatic metabolism
(C) less protein binding
(D) shorter elimination half-life
(E) smaller volume of distribution
(A) greater lipid solubility
The metabolism of which of the following hypotensive agents is most likely to be affected in patients with severe renal disease?
(A) Esmolol
(B) Hydralazine
(C) Nitroglycerin
(D) Nitroprusside
(E) Trimethaphan
(D) Nitroprusside
thiocyanate toxicity is a potential side effect.
Thiocyanate is an active metabolite and it is nephrotoxic!
The following are clinical side-effects of NEOSTIGMINE except:
A. bradycardia
B. constipation
C. bronchoconstriction
D. increased urinary bladder tone
Constipation
bradycardia
bronchoconstriction
increased gastric motility
Diarrhea
increased urinary bladder tone
The low fetal/maternal plasma ratio of bupivacaine compared with lidocaine is due to
(A) fetal tissue binding
(B) fetal plasma protein binding
(C) maternal plasma protein binding
(D) ionization in maternal blood
(E) ionization in fetal blood
(C) maternal plasma protein binding
Which of the following decreases the clearance of atracurium?
(A) Administration of cimetidine
(B) Cholinesterase deficiency
(C) Hepatic insufficiency
(D) Hypothermia
(E) Renal insufficiency
(D) Hypothermia
Hoffman elimination is dependent on TWO things:
pH and temperature
Acidosis and Hypothermia > Decreases the HOFFMAN elimination
Which of the following is the most likely effect of intramuscular ketamine used for induction of anesthesia in a 2-year-old child undergoing elective surgery?
(A) Bronchoconstriction
(B) Decreased heart rate
(C) Decreased intracranial pressure
(D) Increased salivation
(E) Respiratory depression
(D) Increased salivation
Metoclopramide acts to
(A) block dopamine receptors
(B) decrease gastric acid production
(C) decrease lower esophageal sphincter tone
(D) delay gastric emptying
(E) facilitate central cholinergic stimulation
(A) block dopamine receptors
Bupivacaine is more likely than lidocaine to cause refractory cardiac arrest because bupivacaine
(A) has a lower rate of plasma clearance
(B) has a secondary blocking effect on cardiac beta,-adrenergic receptors
(C) dissociates more slowly from sodium channels in cardiac muscle
(D) inhibits spontaneous phase 4 depolarization in pacemaker cells
(E) preferentially blocks calcium channels in Purkinje fibers
(C) dissociates more slowly from sodium channels in cardiac muscle
Phase II neuromuscular block is characterized by
(A) depressed twitch height, sustained tetanus, post-tetanic potentiation
(B) depressed twitch height, tetanic fade, post-tetanic potentiation
(C) depressed twitch height, tetanic fade, no post-tetanic potentiation
(D) normal twitch height, tetanic fade, post-tetanic potentiation
(E) normal twitch height, tetanic fade, no post-tetanic potentiation
B. depressed twitch height, tetanic fade, post-tetanic potentiation
Termination of effect of intravenous anesthetics is by ________________ , not biotransformation and breakdown:
A. Redistribution
B. Active transport
C. Exocytosis
A. Redistribution
Clinically considered to be the drug of choice for the induction of anesthesia for electroconvulsive therapy (ECT):
A. Propofol
B. Thiopental
C. Methohexital
D. Etomidate
C. Methohexital
It has anticonvulsant properties but minimal effect on duration of ECT-induced seizure activity
Dopamine primarily act on:
A. Preganglionic
B. Postganglionic
B. Postganglionic
The GABA receptor complex is composed of two a-subunits and two b-subunits. Where does the benzodiazepine bind to?
A. alpha subunit
B. beta subunit
C. both
A. alpha subunit
Which of the following drugs is primarily excreted thru biliary?
A. Meperidine
B. Rocuronium
C. Butorphanol
D. Remimazolam
E. Fentanyl
B. Rocuronium
Which of the following is considered an ultrashort-acting arteriolar vasodilator:
A. Na Nitroprusside
B. Nitroglycerine
C. Milrinone
D. Clevidipine
D. Clevidipine
Which of the following intravenous induction agents reduce both CBF and CMRO2 in the setting of an increased ICP:
A. Thiopental
B. Etomidate
C. Remifentanil
D. Dexmedetomidine
A. Thiopental
Thiopental and Propofol are the 2 preferred intravenous induction agents because they reduce both CBF and CMRO2 even in increased ICP!
On the other hand, KETAMINE and ETOMIDATE should be avoided because ketamine increases CBF and ICP and the propylene glycol formulation of etomidate may induce neurologic deficits in at-risk tissue!
In cardiac arrest, the maximum dose of Amiodarone in a day is:
A. 1g
B. 2g
C. 3g
D. 4g
2g
In cardiac arrest, amiodarone is initially administered as a
300-mg rapid infusion. Supplemental infusions of 150 mg can be repeated as necessary for recurrent or resistant dysrhythmias to a maximum total daily
dose of 2 g.
(For dysrhythmias with an intact circulation, amiodarone is
usually administered as 150 mg intravenously over 10 minutes, followed by a 1 mg/min infusion for 6 hours and 0.5 mg/min thereafter.)
A drug is considered fully eliminated after __ half lives:
A. 2 half-lives
B. 4-5 half-lives
C. 2-3 half-lives
B. 4-5 half-lives
Clopidogrel interferes with platelet aggregation via:
A. inhibition of ADP binding to P2Y12
B. inhibition of GP IIb/IIIa receptor
C. inhibition of factor Xa
A. inhibition of ADP binding to P2Y12
Ephedra has sympathomimetic effects and interact with ___ to cause serotonin syndrome:
A. Mono-amine inhibitors
B. Atropine
C. Physostigmine
D. TCA
A. Mono-amine inhibitors
Fat depositions in Cushing’s syndrome causes moon facies, buffalo humps, and truncal obesity is primarily attributed to:
A. mineralocorticoid activity
B. glucocorticoid activity
B. glucocorticoid activity
Based on their affinity to GABA, rank the following benzodiazepine’s POTENCY from most to least:
A. Lorazepam > midazolam > diazepam
B. Diazepam > Lorazepam > midazolam
C. Midazolam > midazolam > diazepam
A. Lorazepam > midazolam > diazepam
- Lorazepam is more potent than diazepam because of increased affinity for GABA receptors.
- Least potent = Diazepam
- Most potent = Lorazepam
