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ANESTHESIA | Basic > P H A R M A C O L O G Y | Basic > Flashcards

P H A R M A C O L O G Y | Basic Flashcards

1
Q

Receptor responsible for the shivering effect of opioid?

A. Mu-1

B. Kappa

C. Mu-2

D. Gamma

A

Kappa

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2
Q

What receptor(s) is blocked by esmolol?

A. Beta-1

B. Beta-2

C. Both

A

Beta-1

Selective for Beta-1 along with atenolol and metoprolol. Lower risk of causing bronchoconstriction

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3
Q

Which bolus dose of succinylcholine is necessary for phase 2 block to occur?

A. 4mg/kg

B. 6 mg/kg

C. 8mg/kg

A

4mg/kg

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4
Q

OIH can be prevented by which of the following drug?

A. Butorphanol

B. Ketamine

C. Lidocaine

A

B. Ketamine

Morphine 0.1 - 0.25 mg/kg
Ketamine

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5
Q

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

A

C. Burn <12 hours

BURN
STROKE
SPINAL CORD INJURY
PROLONGED IMMOBILITY
PROLONGED EXPOSURE TO NMB
Multiple Sclerosis
GBS (Guillain Barre Syndrome)

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6
Q

Which is NOT associated with DOWNREGULATION of acetylcholine receptors?

A. Myasthenia Gravis
B. Anticholinesterase Poisoning
C. Organophosphate Poisoning
D. Multiple Sclerosis

A

D. Multiple Sclerosis

Conditions with DOWNREGULATED ach-receptors:

Myasthenia Gravis
Anticholinesterase Poisoning
Organophosphate Poisoning

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7
Q

PHYSIOLOGIC EFFECT OF PROPOFOL except:

A. decrease in CBF
B. increase in CPP
C. decrease in SVR
D. decrease in CMRO2

A

B. increase in CPP

CPP is unchanged!

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8
Q

The most potent form of KETAMINE is:

A. S+ form
B. R+ form
C. Norketamine

A

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.

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9
Q

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

A

PRIMING

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10
Q

TRUE or FALSE

The amnestic effects of MIDAZOLAM are more potent than its sedative effect

A

TRUE

The amnestic effects of MIDAZOLAM are more potent than its sedative effect thus a pt may be awake following a dose of midazolam but remain amnestic for events and conversations for several hours.

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11
Q

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

A

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

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12
Q

TRUE or FALSE

The elimination half-time and clearance of MIDAZOLAM is are not altered by renal failure.

A

TRUE

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13
Q

Which volatile anesthetic has the highest VAPOR PRESSURE?

A. Nitrous Oxide

B. Desflurane

C. Halothane

D. Sevoflurane

A

Nitrous Oxide

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14
Q

Sevoflurane VAPORIZER mistakenly filled with ISOFLURANE results to:

A. Underdose

B. Overdose

C. Unchanged

A

OVERDOSE

Iso to Sevo is OVER

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15
Q

ISOflurane VAPORIZER mistakenly filled with SEVOflurane results to:

A. Underdose

B. Overdose

C. Unchanged

A

UNDERDOSE

Sevo to Iso is UNDER

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16
Q

Acetazolamide affect on urine and acid-base balance:

A. alkalinazation of urine

B. decrease bicarbonate excretion

C. hypochloremic metabolic alkalosis

A

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

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17
Q

How does morphine improves coronary perfusion?

A

Due to reduction in preload and a reduction in end-diastolic pressures (EDP) in the ventricles –> increase coronary perfusion

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18
Q

Which of the following drugs POTENTIATES non-depolarizing NMBD?

A. Lithium
B. Carbamazepine
C. Neostigmine
D. Phenytoin

A

A. Lithium

  1. Antibiotics (e.g. streptomycin, clindamycin, tetracyclines, aminoglycosides)
  2. Antiarrhythmics (e.g. calcium channel blockers)
  3. Dantrolene
  4. Ketamine
  5. Local anesthetics (high doses only)
  6. Lithium
  7. Magnesium
  8. Volatile anesthetic agents
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19
Q

Which of the following drugs INHIBITS or decreases the potency of non-depolarizing NMBD?

A. Lidocaine
B. Lithium
C. Phenytoin
D. Ketamine

A

C. Phenytoin

  1. Anticonvulsants (e.g. phenytoin {chronic administration}, carbamazepine)
  2. Cholinesterase inhibitors (e.g. neostigmine)
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20
Q

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

A. Tramadol

THREE opioids which act as weak SSRIs and thus can cause serotonin syndrome when combined with an MAOI:

MEPERIDINE
METHADONE
TRAMADOL

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21
Q

TRUE or FALSE

Dopamine-1 INHIBITS adenylate cyclase

A

FALSE

Dopamine-1 receptors are postsynaptic → linked to Gs proteins → activates adenylate cyclase

Dopamine-1 > Activates!

22
Q

TRUE or FALSE

Dopamine-2 INHIBITS adenylate cyclase

A

TRUE

Dopamine-2 receptors are presynaptic → linked to Gi proteins → inhibits adenylate cyclase

Dopamine-2 > Inhibits!

23
Q

1 atm is also equivalent to:

A. 10 bar

B. 1000 kPa

C. 7600 torr

D. 1033 cm H2O

A

1 atm
760 mmHg
760 torr
1 bar
100 kPa
1033 cm H2O
14.7 lb/inch2

24
Q

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

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.
25
Q

TRUE or FALSE

Halothane is reduced in the liver by CYP-2E1 to Trifluoroacetic acid

A

FALSE!

Halothane is OXIDIZED in the liver by CYP-2E1 to Trifluoroacetic acid

26
Q

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

A

(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.

27
Q

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

A

(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.
28
Q

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

A

(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.

29
Q

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

A

(D) passive diffusion

30
Q

Which of the following hypnotics causes LEAST cardiac depression?

A. Etomidate

B. Thiopental

C. Ketamine

D. Propofol

A

A. Etomidate

31
Q

TRUE or FALSE

Premedication does not affect the speed to apnea after administration of propofol

A

TRUE

32
Q

TRUE or FALSE

Propofol causes relative inhibition of pulmonary vasoconstriction

A

FALSE

33
Q

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

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
34
Q

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

A

(E) Less biodegradation

35
Q

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

(A) greater lipid solubility

36
Q

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

A

(D) Nitroprusside

thiocyanate toxicity is a potential side effect.

Thiocyanate is an active metabolite and it is nephrotoxic!

37
Q

The following are clinical side-effects of NEOSTIGMINE except:

A. bradycardia
B. constipation
C. bronchoconstriction
D. increased urinary bladder tone

A

Constipation

bradycardia
bronchoconstriction
increased gastric motility
Diarrhea
increased urinary bladder tone

38
Q

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

A

(C) maternal plasma protein binding

39
Q

Which of the following decreases the clearance of atracurium?

(A) Administration of cimetidine
(B) Cholinesterase deficiency
(C) Hepatic insufficiency
(D) Hypothermia
(E) Renal insufficiency

A

(D) Hypothermia

Hoffman elimination is dependent on TWO things:

pH and temperature

Acidosis and Hypothermia > Decreases the HOFFMAN elimination

40
Q

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

A

(D) Increased salivation

41
Q

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

(A) block dopamine receptors

42
Q

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

A

(C) dissociates more slowly from sodium channels in cardiac muscle

43
Q

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

A

B. depressed twitch height, tetanic fade, post-tetanic potentiation

44
Q

Termination of effect of intravenous anesthetics is by ________________ , not biotransformation and breakdown:

A. Redistribution

B. Active transport

C. Exocytosis

A

A. Redistribution

45
Q

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

A

C. Methohexital

It has anticonvulsant properties but minimal effect on duration of ECT-induced seizure activity

46
Q

Dopamine primarily act on:

A. Preganglionic

B. Postganglionic

A

B. Postganglionic

47
Q

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

A. alpha subunit

48
Q

Which of the following drugs is primarily excreted thru biliary?

A. Meperidine

B. Rocuronium

C. Butorphanol

D. Remimazolam

E. Fentanyl

A

B. Rocuronium

49
Q

Which of the following is considered an ultrashort-acting arteriolar vasodilator:

A. Na Nitroprusside

B. Nitroglycerine

C. Milrinone

D. Clevidipine

A

D. Clevidipine

50
Q

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

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!

51
Q

In cardiac arrest, the maximum dose of Amiodarone in a day is:

A. 1g

B. 2g

C. 3g

D. 4g

A

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.)

ANESTHESIA | Basic (17 decks)

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