Spinal & Epidural Part 3 ( Tubog) Exam 1 Flashcards
1
Q
Which of the following are effects of high thoracic (T4) level dermatomal spread of local anesthetic? (Select 2)
a.) Increase in tidal volume
b.) Small decrease in vital capacity
c.) Decrease in expiratory reserve volume (ERV)
d.) Increase in inspiratory reserve volume
A
b.) Small decrease in vital capacity
c.) Decrease in expiratory reserve volume (ERV)
2
Q
Special considerations for patients under neuraxial anesthesia include: (Select 3)
a.) Use caution in COPD, Pickwickian syndrome
b.) Feelings of dyspnea in the normal population
c.) Loss of the ability to take big breaths and strong cough
d.) Increased respiratory rate
A
a.) Use caution in COPD, Pickwickian syndrome
b.) Feelings of dyspnea in the normal population
c.) Loss of the ability to take big breaths and strong cough
3
Q
What is the typical reason for apnea during neuraxial anesthesia?
a) Blockage of accessory muscles of respiration
b) Increased tidal volume
c) Reduced blood flow to the brainstem, affecting the brain’s breathing centers
d) Nerve paralysis due to high concentrations of local anesthetics
A
c) Reduced blood flow to the brainstem, affecting the brain’s breathing centers
4
Q
Which of the following is unchanged even with high thoracic level dermatomal spread of local anesthetic?
a) Vital capacity
b) Expiratory reserve volume (ERV)
c) Tidal volume
d) Accessory muscles of respiration
A
c) Tidal volume
5
Q
High thoracic blockade can result in the blockade of accessory muscles of respiration such as __________ and __________ muscles. (select 2)
A) intercostal
B) abdominal
C) interscalene
D) diaphagm
A
A) intercostal
B) abdominal
6
Q
High concentrations of local anesthetics in the spinal fluid rarely cause __________ that stops breathing.
A) diaphragm paralysis
B) phrenic nerve paralysis
C) nerve paralysis
D) accessory muscle weakness
A
C) nerve paralysis
7
Q
Small decreases in vital capacity during neuraxial anesthesia is due to loss of __________ muscle contribution in forced expiration.
A) intercoastal
B) abdominal
C) diaphragm
D) pec minor
A
B) abdominal
8
Q
Which of the following are functions of parasympathetic efferent innervation in the GI tract? (select 4)
a.) Tonic contractions
b.) Sphincter relaxation
c.) Peristalsis
d.) Secretion
e.) Transmit visceral pain
A
a.) Tonic contractions
b.) Sphincter relaxation
c.) Peristalsis
d.) Secretion
9
Q
The sympathetic efferent innervation of the GI tract includes: (select 4)
a.) Inhibition of peristalsis
b.) Inhibition of gastric secretion
c.) Transmission of sensations of satiety
d.) Sphincter contraction
e.) Vasoconstriction
A
a.) Inhibition of peristalsis
b.) Inhibition of gastric secretion
d.) Sphincter contraction
e.) Vasoconstriction
10
Q
What is the primary nerve involved in parasympathetic innervation of the GI tract?
a) Splanchnic nerve
b) Superior mesenteric ganglion
c) Vagus nerve
d) Inferior mesenteric ganglion
A
c) Vagus nerve
11
Q
Which of the following is a function of sympathetic afferent innervation in the GI tract?
a) Transmit sensations of satiety
b) Transmit visceral pain
c) Promote peristalsis
d) Sphincter relaxation
A
b) Transmit visceral pain
12
Q
Parasympathetic afferent innervation transmits sensations of __________, distension, and nausea.
A) hunger
B) peristalsis
C) sphincter constriction
D)satiety
A
satiety
13
Q
Sympathetic efferent innervation inhibits peristalsis and gastric secretion and causes sphincter contraction and __________.
A) vasoconstiction
B) spasm
C) vasodilation
D) relaxation
A
A) vasoconstriction
14
Q
Parasympathetic efferent innervation includes tonic contractions, sphincter relaxation, peristalsis, and __________.
A) vomiting
B) secretion
C) vasoconstriction
D) paralysis
A
B) secretion
15
Q
Which organs receive sympathetic innervation from T5 to L2? (select all that apply)
a.) Liver and Gall Bladder
b.) Stomach
c.) Small Intestine
d.) Colon
e.) Bladder
A
All the Above
* a.) Liver and Gall Bladder
* b.) Stomach
* c.) Small Intestine
* d.) Colon
* e.) Bladder
16
Q
Which of the following organs are innervated at T4? (select 2)
a.) Esophagus
b.) Heart
c.) Stomach
d.) Liver and Gall Bladder
A
a.) Esophagus
b.) Heart
17
Q
The heart receives sympathetic innervation primarily from which spinal levels?
a) T1 and T2
b) T3 and T4
c) T5 and T6
d) T7 and T8
A
b) T3 and T4
18
Q
Sympathetic innervation of the kidney and testes stems from __________ to __________. (select 2)
A) T8
B) L4
C) T10
D) L1
A
C) T10
D) L1
19
Q
Sympathetic innervation of the GI tract stems from which spinal levels?
a) T1-T5
b) T3-T7
c) T5-L2
d) L1-L5
A
c) T5-L2
20
Q
Which of the following are results of increased parasympathetic activity due to neuraxial anesthesia?(select 3)
a.) Relaxes sphincters
b.) Increases peristalsis
c.) Decreases GI blood flow
d.) Small, contracted gut with active peristalsis
A
a.) Relaxes sphincters
b.) Increases peristalsis
d.) Small, contracted gut with active peristalsis
21
Q
Changes resulting from unopposed vagal tone include: (select 2)
a.) Increased GI blood flow
b.) Nausea and vomiting
c.) Decreased incidence of ileus
d.) Large, contracted gut with slowed peristalsis
A
a.) Increased GI blood flow
b.) Nausea and vomiting
22
Q
What effect does neuraxial anesthesia have on sympathetic tone?
a) Increases sympathetic tone
b) Reduces sympathetic tone
c) Has no effect on sympathetic tone
d) Inhibits parasympathetic tone
A
b) Reduces sympathetic tone
23
Q
What is the incidence of nausea and vomiting in patients due to the changes in unopposed vagal tone caused by neuraxial anesthesia?
a) 10%
b) 15%
c) 20%
d) 25%
A
c) 20%
24
Q
Local anesthetics used in neuraxial blocks decrease the activity of __________ nerves.
A) sympathetic
B) parasympathetic
C) autonomic
D) peripheral
A
A) sympathetic
25
One of the resulting changes in unopposed vagal tone is a __________, contracted gut with active peristalsis.
A)tiny
B)small
C)large
D)medium
B) small
26
With less sympathetic inhibition, the __________ system becomes more dominant.
A)parasympathetic
B)sympathetic
C)autonomic
D)peripheral
A) parasympathetic
27
True or false
Neuraxial anesthesia reduces postoperative incidence of ileus in abdominal surgery.
true
28
Which of the following are effects of neuraxial opioids on the bladder? (select 2)
a.) Decrease in detrusor contraction
b.) Increase in bladder capacitance
c.) Increase in detrusor contraction
d.) Decrease in bladder capacitance
a.) Decrease in detrusor contraction
b.) Increase in bladder capacitance
29
Which of the following are true regarding the effects of sympathetic blockade above T10? (select 2)
a.) Affects bladder control
b.) Urinary sphincter tone relaxed
c.) Increase in renal blood flow
d.) Decrease in bladder capacitance
a.) Affects bladder control
b.) Urinary sphincter tone relaxed
30
What is the effect on renal blood flow when mean arterial pressure (MAP) is maintained during neuraxial anesthesia?
a) Increased renal blood flow
b) Decreased renal blood flow
c) No change in renal blood flow
d) Fluctuating renal blood flow
c) No change in renal blood flow
31
What is a common complication associated with neuraxial anesthesia due to changes in bladder function?
a) Increased urine output
b) Decreased bladder capacitance
c) Urinary retention/incontinence
d) Increased detrusor contraction
c) Urinary retention/incontinence
32
Neuraxial anesthesia causes no change in renal blood flow when __________ is maintained.
A) heart rate
B)MAP
C)CO
D)venous return
B) mean arterial pressure (MAP)
33
True or false
Sympathetic blockade above T10 affects bladder control and causes urinary sphincter tone to be constricted
False
urinary sphincter tone to be relaxed
34
true or false
Addition of neuraxial opioids leads to a decrease in detrusor contraction and an increase in bladder capacitance .
true
35
true or false
These changes in bladder function often lead to urinary retention/incontinence and the need for a foley catheter with neuraxial anesthesia.
true
foley catheter very important
36
Which of the following are elevated due to the activation of somatic and visceral afferent fibers from pain, tissue trauma, and inflammation? (select all that apply)
a.) Cortisol
b.) Epinephrine
c.) Norepinephrine
d.) Vasopressin
e.) Activation of renin-angiotensin-aldosterone system
All the Above:
* a.) Cortisol
* b.) Epinephrine
* c.) Norepinephrine
* d.) Vasopressin
* e.) Activation of renin-angiotensin-aldosterone system
37
Neuraxial **blockade** can: (select 3)
a.) Partially suppress the neuroendocrine response to major invasive surgery
b.) Totally block the neuroendocrine response to lower extremity surgery
c.) Increase in the release of cortisol and epinephrine
d.) Provide maximal benefits if applied before the surgical stimulus
a.) Partially suppress the neuroendocrine response to major invasive surgery
b.) Totally block the neuroendocrine response to lower extremity surgery
d.) Provide maximal benefits if applied before the surgical stimulus
38
What is a key benefit of neuraxial blockade in the context of neuroendocrine response?
a) Increases cortisol and epinephrine levels
b) Partially suppresses or totally blocks the neuroendocrine response
c) Enhances the activation of the renin-angiotensin-aldosterone system
d) Increases vasopressin and norepinephrine levels
b) Partially suppresses or totally blocks the neuroendocrine response
39
Which of the following are characteristics of esters and amides in local anesthetic pharmacology? (select 2)
a.) Esters are metabolized by pseudocholinesterase
b.) Amides are metabolized by the hepatic P450 system
d.) Esters have no cross-sensitivity
c.) Amides produce para-aminobenzoic acid (PABA)
a.) Esters are metabolized by pseudocholinesterase
b.) Amides are metabolized by the hepatic P450 system
40
Which of the following statements are true regarding local anesthetic allergies? (select 4)
a.) More common allergy is with esters
b.) Esters produce para-aminobenzoic acid (PABA)
c.) Amide allergic reaction is rare
d.) There is cross-sensitivity between esters and amides
e.) Amides contain preservative methylparaben, similar to PABA
a.) More common allergy is with esters
b.) Esters produce para-aminobenzoic acid (PABA)
c.) Amide allergic reaction is rare
e.) Amides contain preservative methylparaben, similar to PABA
41
Which type of local anesthetic is metabolized by pseudocholinesterase?
a) Amides
b) Esters
c) Both amides and esters
d) Neither amides nor esters
b) Esters
42
What determines the onset of action for local anesthetics?
a) Protein binding
b) Lipid solubility
c) pKa
d) Metabolism
c) pKa
43
Which of the following is the correct order of peripheral nerve inhibition by local anesthetics?
a) C fibers, B fibers, small diameter A fibers, large diameter A fibers
b) B fibers, C fibers, large diameter A fibers, small diameter A fibers
c) B fibers, C fibers, small diameter A fibers, large diameter A fibers
d) Small diameter A fibers, large diameter A fibers, B fibers, C fibers
c) B fibers, C fibers, small diameter A fibers, large diameter A fibers
44
Cocaine is also metabolized by the __________.
A) gallbladder
B)kidney
C)liver
D)lungs
C) liver
45
Local anesthetic potency is influenced by __________ .
A)pH
B)lipid solubility
C)protein binding
D)pKa
B) lipid solubility
46
Duration of action for local anesthetics is influenced by __________ .
A)pH
B)lipid solubility
C)protein binding
D)pKa
C) protein binding
47
Which of the following statements about the mechanism of action of local anesthetics are correct? (select 3)
a.) Local anesthetic agents are weak bases.
b.) Compounds with a pKa close to physiologic pH will have a faster onset of blockade.
c.) More molecules remain in the nonionized state at physiologic pH.
d.) Local anesthetic agents block calcium channels to exert their effect.
a.) Local anesthetic agents are weak bases.
b.) Compounds with a pKa close to physiologic pH will have a faster onset of blockade.
c.) More molecules remain in the nonionized state at physiologic pH.
48
What is the primary ion channel targeted by local anesthetics?
a) Calcium channel
b) Potassium channel
c) Sodium channel
d) Chloride channel
c) Sodium channel
49
true or false
Local anesthetic agents are weak bases.
true
50
true or false
Compounds with a pKa close to physiologic pH will have a slow onset of blockade.
false
faster onset of action
51
In the nonionized state, local anesthetic molecules are able to cross the __________ to exert their action.
A) cell membrane
B) mitochondria
C) calcium channel
D) sodium channel
A)cell membrane
52
Which of the following factors influence the vascular uptake and plasma concentration of local anesthetics? (select all that apply)
a.) Site of injection
b.) Tissue blood flow
c.) Physiochemical properties
d.) Metabolism
e.) Addition of vasoconstrictor
All the Above
* a.) Site of injection
* b.) Tissue blood flow
* c.) Physiochemical properties
* d.) Metabolism
* e.) Addition of vasoconstrictor
53
Local anesthetic injections in the __________ region result in lower blood concentrations compared to epidural injections.
A)tracheal
B)sciatic
C)Intravenous
D)caudal
B) sciatic
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54
Which of the following statements about isobaric solutions are correct? (select 3)
a.) Density equal to CSF
b.) Has a baricity of 1
c.) Tends to stay in place where it is injected
d.) Sinks within the CSF, moving downward from the point of injection
a.) Density equal to CSF
b.) Has a baricity of 1
c.) Tends to stay in place where it is injected
55
Which of the following local anesthetic solutions are hyperbaric? (select all that apply)
a.) Bupivacaine 0.75% in 8.25% dextrose
b.) Lidocaine 5% in 7.5% dextrose
c.) Tetracaine 0.5% in 5% dextrose
d.) Procaine 10% in water
* All of the above
* * a.) Bupivacaine 0.75% in 8.25% dextrose
* b.) Lidocaine 5% in 7.5% dextrose
* c.) Tetracaine 0.5% in 5% dextrose
* d.) Procaine 10% in water
56
What is the behavior of a hyperbaric solution within the CSF?
a) Tends to stay in place where it is injected
b) Rises within the CSF, moving upward from the point of injection
c) Sinks within the CSF, moving downward from the point of injection
d) Distributes evenly throughout the CSF
c) Sinks within the CSF, moving downward from the point of injection
57
Which local anesthetic solution would be considered hypobaric?
a) Bupivacaine 0.75% in saline
b) Lidocaine 0.5% in water
c) Tetracaine 0.5% in saline
d) Procaine 10% in water
b) Lidocaine 0.5% in water
58
In hypobaric solutions, the anesthetic solution __________ within the CSF, moving upward from the point of injection.
A) falls
B) rises
C) stays
B) rises
59
Which of the following spinal levels are considered high points (apex) in SAB pharmacology? (select 2)
a.) C3
b.) L3
c.) T6
d.) S2
a.) C3
b.) L3
60
Which of the following spinal levels are considered low points (trough) in SAB pharmacology? (select 2)
a.) C3
b.) L3
c.) T6
d.) S2
c.) T6
d.) S2
61
Which of the following statements about spinal anesthetics (LA) are correct? (select 3)
a.) Small amount of LA produces a profound block of nerve transmission
b.) Spinal cord uptake of LA occurs due to the lipid-soluble nature of the drug
c.) Spread of LA occurs in a cephalad and caudad direction from the site of injection simultaneously
d.) Metabolism of LA occurs in the cerebrospinal fluid (CSF)
a.) Small amount of LA produces a profound block of nerve transmission
b.) Spinal cord uptake of LA occurs due to the lipid-soluble nature of the drug
c.) Spread of LA occurs in a cephalad and caudad direction from the site of injection simultaneously
62
Which of the following factors influence the elimination of local anesthetics? (select 3)
a.) Vascular reabsorption
b.) High affinity for epidural fat
c.) Metabolism in the CSF
d.) Reuptake
a.) Vascular reabsorption
b.) High affinity for epidural fat
d.) Reuptake
63
Which local anesthetic has the shortest duration of action when used as a spinal anesthetic?
a) Bupivacaine 0.5 - 0.75%
b) Levobupivacaine 0.5%
c) Ropivacaine 0.5 - 1%
d) 2-Chloroprocaine 3%
d) 2-Chloroprocaine 3%
64
true or false
All local anesthetics are eliminated by reuptake, including vascular reabsorption by vessels in the pia mater.
true
65
Which of the following are benefits of incremental dosing with 5 ml for epidural anesthesia? (select 3)
a.) Avoids accidental "high spinal"
b.) Avoids hypotension from rapid autonomic blockade
c.) Avoids local anesthetic toxicity
d.) Decreases the onset time
a.) Avoids accidental "high spinal"
b.) Avoids hypotension from rapid autonomic blockade
c.) Avoids local anesthetic toxicity
66
Which of the following are true about the spread of epidural anesthesia?
a.) Spread is both cephalad and caudad from the catheter insertion site
b.) Spread is limited to the insertion site only
c.) Spread occurs only in a cephalad direction
d.) Spread occurs only in a caudad direction
a.) Spread is both cephalad and caudad from the catheter insertion site
67
What is the onset time for epidural anesthesia?
a) 2-5 minutes
b) 5-10 minutes
c) 10-25 minutes
d) 25-40 minutes
c) 10-25 minutes
68
Which of the following statements about 2-chloroprocaine are correct? (select all that apply)
a.) Comes in 2% and 3% solutions
b.) Used for 3% surgical anesthesia
c.) Very popular in obstetrics (OB)
d.) Has a rapid onset
e.) Short-lived and metabolized by plasma cholinesterase
a.) Comes in 2% and 3% solutions
b.) Used for 3% surgical anesthesia
c.) Very popular in obstetrics (OB)
d.) Has a rapid onset
e.) Short-lived and metabolized by plasma cholinesterase
69
Which of the following are characteristics of 2-chloroprocaine? (select 2)
a.) Requires redosing every 45 minutes
b.) Long duration of action
c.) Metabolized by the liver
d.) Can be an ester
a.) Requires redosing every 45 minutes
d.) Can be an ester
70
What can be used as an IV marker if added to the epidural anesthesia?
a) Sodium bicarbonate
b) Epinephrine
c) Lidocaine
d) Bupivacaine
b) Epinephrine
71
How often does 2-chloroprocaine need to be redosed due to its short duration?
a) Every 20 minutes
b) Every 30 minutes
c) Every 45 minutes
d) Every 60 minutes
c) Every 45 minutes
72
Which of the following effects are caused by adding NaHCO3 to local anesthetics? (select 4)
a.) Increases the pH of local anesthetics (LA)
b.) Increases the concentration of nonionized free base
c.) Increases the rate of diffusion of the drug
d.) Increases the speed of onset of the block
e.) Decreases the duration of action
a.) Increases the pH of local anesthetics (LA)
b.) Increases the concentration of nonionized free base
c.) Increases the rate of diffusion of the drug
d.) Increases the speed of onset of the block
73
What is the effect of adding NaHCO3 (1 mEq/10 mL) to a local anesthetic solution?
a) Decreases the pH of the local anesthetic
b) Increases the duration of action
c) Increases the pH of the local anesthetic
d) Slows down the onset of the block
c) Increases the pH of the local anesthetic
74
Which of the following increases the speed of onset of a local anesthetic block?
a) Increasing the ionized concentration
b) Increasing the pH by adding NaHCO3
c) Decreasing the concentration of the drug
d) Adding epinephrine
b) Increasing the pH by adding NaHCO3
75
Which factors are crucial for determining the spread and effectiveness of an epidural block? (select 4)
a.) Volume of the local anesthetic (LA)
b.) Initial dose and top-up dose
c.) Epidural space variation
d.) Role of concentration
e.) Patient's age
a.) Volume of the local anesthetic (LA)
b.) Initial dose and top-up dose
c.) Epidural space variation
d.) Role of concentration
76
Which statements about the role of concentration in epidural pharmacology are correct? (select 3)
a.) Determines block density
b.) Affects how dense or strong the block is
c.) A "walking epidural" uses a low concentration to manage pain while allowing some motor function
d.) Higher concentration always means longer duration
a.) Determines block density
b.) Affects how dense or strong the block is
c.) A "walking epidural" uses a low concentration to manage pain while allowing some motor function
77
What is the typical initial dose per segment of the spine for epidural anesthesia?
a) 0.5 - 1 mL
b) 1 - 2 mL
c) 2 - 3 mL
d) 3 - 4 mL
b) 1 - 2 mL
78
Which local anesthetic has the fastest onset time for epidural anesthesia?
a) Ropivacaine
b) Bupivacaine
c) Lidocaine
d) 2-Chloroprocaine
d) 2-Chloroprocaine
79
What is the recommended top-up dose as a percentage of the initial dose?
a) 25% - 50%
b) 50% - 75%
c) 75% - 100%
d) 100% - 125%
b) 50% - 75%
80
Epidural space variation affects the spread of LA; the space is smaller in the __________ region than in the lumbar region.
A) cervical
B) coccyx
C) sacral
D) thoracic
D) thoracic
81
True or false
A "walking epidural" uses a low concentration of LA to manage pain but allows some motor function, making it ideal for laboring mothers.
true
82
Which of the following are effects of neuraxial pharmacologic adjuncts? (select 3)
a.)Provides postoperative analgesia
b.) Extends duration of the block
c.) Improves the density of the block
d.) Reduces the duration of the block
a.)Provides postoperative analgesia
b.) Extends duration of the block
c.) Improves the density of the block
83
Which of the following statements about opioids used as neuraxial adjuncts are correct? (select 2)
a.) Includes sufentanil, fentanyl, and morphine
b.) Provides analgesia and improves density
c.) Extends the duration of the block
d.) Does not improve density
a.) Includes sufentanil, fentanyl, and morphine
b.) Provides analgesia and improves density
84
Which class of drugs improves density, duration, and analgesia when used as neuraxial pharmacologic adjuncts?
a) Opioids
b) Alpha-2 agonists
c) Vasopressors
d) Investigative agents
b) Alpha-2 agonists
85
Investigative agents for neuraxial pharmacologic adjuncts include neostigmine, magnesium, __________, and versed.
A) clonidine
B)ketamine
C)morphine
D) epinephrine
B) Ketamine
86
What is the primary effect of vasopressors when used as neuraxial pharmacologic adjuncts?
a) Improves density
b) Provides analgesia
c) Extends duration
d) Reduces onset time
c) Extends duration
87
Which effects result from mixing neuraxial opioids with local anesthetics (LA)? (select 2)
a.) Results in a stronger block
b.) Results in a more dense block
c.) Reduces the speed of onset of the block
d.) Decreases the overall effectiveness of the block
a.) Results in a stronger block
b.) Results in a more dense block
88
What is the target area of the spinal cord for neuraxial opioids?
a) Substantia nigra
b) Dorsal root ganglion
c) Substantia gelatinosa
d) Central canal
c) Substantia gelatinosa of the dorsal horn (Lamina 2)
89
How do neuraxial opioids reduce neurotransmission? Select 3
a) By increasing cAMP
b) By increasing Ca++ conductance
c) By decreasing cAMP,
d) By decreasing Ca++ conductance,
e) By increasing K+ conductance
f) By increasing Na+ conductance
c) By decreasing cAMP
d) decreasing Ca++ conductance
e) increasing K+ conductance
90
true or false
Neuraxial opioids also diffuse into the general circulation and affect opioid receptors throughout the body, providing broader pain relief.
true
91
Which of the following opioids are considered hydrophilic? (select 3)
a.) Morphine
b.) Hydromorphone
c.) Meperidine
d.) Fentanyl
a.) Morphine
b.) Hydromorphone
c.) Meperidine
92
Which of the following characteristics apply to lipophilic opioids? (select 4)
a.) Stays longer in CSF
b.) Limited spread in CSF
c.) Starts working quickly (5-10 minutes)
d.) Shorter effect (2-4 hours)
e.) Absorbed more by the body
b.) Limited spread in CSF
c.) Starts working quickly (5-10 minutes)
d.) Shorter effect (2-4 hours)
e.) Absorbed more by the body
93
Which of the following opioids has a longer duration in the CSF and spreads widely, affecting a larger area for pain relief?
a) Fentanyl
b) Sufentanil
c) Morphine
d) Remifentanil
c) Morphine
94
What is the onset time for hydrophilic opioids when administered neuraxially?
a) 5-10 minutes
b) 10-20 minutes
c) 20-30 minutes
d) 30-60 minutes
d) 30-60 minutes
95
Which characteristic is true for hydrophilic opioids regarding respiratory depression?
a) Occurs early after administration
b) Does not occur
c) Occurs late
d) Occurs within minutes
c) Occurs late
96
Which of the following opioids have an intrathecal dose specified? (select 4)
a.) Sufentanil
b.) Fentanyl
c.) Hydromorphone
d.) Meperidine
e.) Morphine
a.) Sufentanil
b.) Fentanyl
d.) Meperidine
e.) Morphine
97
Which statements about intrathecal opioid administration is correct? (select 3)
a.) Location: Directly into the intrathecal space
b.) Drug Movement: Quickly diffuses into the spinal cord
c.) Effectiveness: More direct and immediate effect on pain
d.) Dosing: Requires higher doses compared to epidural administration
a.) Location: Directly into the intrathecal space
b.) Drug Movement: Quickly diffuses into the spinal cord
c.) Effectiveness: More direct and immediate effect on pain
98
What is the epidural dose range for Fentanyl?
a) 10-20 mcg
b) 25-50 mcg
c) 50-100 mcg
d) 100-200 mcg
c) 50-100 mcg
99
which opioid has an epidural infusion dose of 0.1-0.2 mg/hr?
a) Sufentanil
b) Fentanyl
c) Hydromorphone
d) Morphine
c) Hydromorphone
100
The intrathecal dose for Morphine is __________ to __________ mg.
A)0.25-0.3
B)0.5-1
C)10-60
D)0.1-1
A 0.25- 0.30
101
For epidural administration, the dose for Meperidine ranges from __________ to __________ mg.
A) 50-100
B) 25-50
C) 10-20
D) 20-30
B 25 - 50
102
The epidural infusion dose for Fentanyl ranges from __________ to __________ mcg/hr.
A)25-50
B)50-100
C)10-20
D) 25-100
D) 25- 100
103
Which of the following **treatments** can be used for pruritus caused by neuraxial pharmacologic adjuncts? (select 3)
a.) Benadryl 25-50 mg IV
b.) Ondansetron 4 mg IV
c.) Naloxone 0.1 mg IV
d) Buprenex (mixed agonist/antagonist)
e.) Nubain 2.5-5.0 mg IV
a.) Benadryl 25-50 mg IV
c.) Naloxone 0.1 mg IV
d) Buprenex (mixed agonist/antagonist)
104
Which of the following are **prophylaxis** measures to minimize pruritus? (select 3)
a.) Minimize the dose of morphine < 300 mcg
b.) Ondansetron 4 mg IV
c.) Benadryl 25-50 mg IV
d.) Nubain 2.5-5.0 mg IV
a.) Minimize the dose of morphine < 300 mcg
b.) Ondansetron 4 mg IV
d.) Nubain 2.5-5.0 mg IV
105
What is considered the best treatment for pruritus caused by neuraxial pharmacologic adjuncts?
a.) Benadryl 25-50 mg IV
b.) Naloxone 0.1 mg IV
c.) Buprenex (mixed agonist/antagonist)
d.) Nubain 2.5 - 5.0 mg IV
b.) Naloxone 0.1 mg IV
106
What is the incidence rate of pruritus as a side effect of neuraxial pharmacologic adjuncts?
a.) 10-30%
b.) 20-50%
c.) 30-100%
d.) 50-100%
c.) 30-100%
107
Which of the following statements about respiratory depression due to neuraxial pharmacologic adjuncts are true? (select 3)
a.) It only occurs immediately after administration.
b.) It has a higher incidence with morphine due to its hydrophilic properties.
c.) The hydrophilic nature of morphine causes cephalad spread.
d.) Intrathecal morphine does not require apnea monitoring.
e.) Respiratory depression can be reversed with Naloxone 0.1-0.2 mg.
b.) It has a higher incidence with morphine due to its hydrophilic properties.
c.) The hydrophilic nature of morphine causes cephalad spread.
e.) Respiratory depression can be reversed with Naloxone 0.1-0.2 mg.
108
Which of the following monitoring methods are recommended for patients receiving intrathecal morphine? (select 3)
a.) Capnography
b.) Electrocardiography
c.) Pulse oximetry
d.) Blood pressure monitoring
e.) Alarms
a.) Capnography
c.) Pulse oximetry
e.) Alarms
109
What is the time frame during which respiratory depression can occur following the administration of neuraxial morphine?
a.) Immediate only
b.) Within the first hour
c.) Delayed or immediate
d.) After 24 hours
c.) Delayed or immediate ***within the first 24 hours***
110
Which of the following opioids requires more extensive monitoring for respiratory depression due to its hydrophilic properties?
a.) Fentanyl
b.) Sufentanil
c.) Morphine
d.) Alfentanil
c.) Morphine
111
Which of the following treatments are used for nausea/urinary retention associated with neuraxial pharmacologic adjuncts? (select 3)
a.) Ondansetron (5 HT antagonist)
b.) Naloxone 0.1 mg
c.) Phenergan 12.5-25 mg IM
d.) Benadryl 25-50 mg IV
e.) Buprenex (mixed agonist/antagonist)
a.) Ondansetron (5 HT antagonist)
b.) Naloxone 0.1 mg
c.) Phenergan 12.5-25 mg IM
112
Which of the following statements about the dose dependence of nausea and urinary retention are true? (select 2)
a.) Morphine < 300 mcg; doses of < 100 mcg almost absent.
b.) Used in combination: Fentanyl/Sufentanil + Morphine has a very high incidence.
c.) Morphine > 300 mcg does not cause nausea.
d.) Fentanyl/Sufentanil alone causes a very high incidence of nausea.
a.) Morphine < 300 mcg; doses of < 100 mcg almost absent.
b.) Used in combination: Fentanyl/Sufentanil + Morphine has a very high incidence.
113
What is the incidence rate of urinary retention as a side effect of neuraxial pharmacologic adjuncts?
a.) 10-20%
b.) 20-30%
c.) 30-40%
d.) 40-50%
c.) 30-40%
114
Which of the following drugs is a 5 HT antagonist used for treating nausea in the context of neuraxial pharmacologic adjuncts?
a.) Naloxone
b.) Phenergan
c.) Ondansetron
d.) Morphine
c.) Ondansetron
115
Which of the following statements about A2 agonists in neuraxial pharmacologic adjuncts are true? (select 3)
a.) Clonidine and dexmedetomidine are used to intensify and prolong the block.
b.) They prolong sensory and motor blockade by approximately 1 hour.
c.) Common side effects include hypertension and tachycardia.
d.) Dexmedetomidine is administered in doses of 15-45 mcg.
e.) Clonidine is administered in doses of 15-45 mcg.
a.) Clonidine and dexmedetomidine are used to intensify and prolong the block.
b.) They prolong sensory and motor blockade by approximately 1 hour.
e.) Clonidine is administered in doses of 15-45 mcg.
116
Which of the following are common side effects of A2 agonists used in neuraxial pharmacologic adjuncts? (select 3)
a.) Hypotension
b.) Bradycardia
c.) Sedation
d.) Nausea
e.) Vomiting
a.) Hypotension
b.) Bradycardia
c.) Sedation
117
What is the dose of dexmedetomidine used in neuraxial pharmacologic adjuncts?
a.) 1 mcg
b.) 3 mcg
c.) 10 mcg
c.) 15-45 mcg
b.) 3 mcg
118
Which of the following statements about vasoconstrictors in neuraxial pharmacologic adjuncts are true? (select 2)
a.) Vasoconstrictors prolong the action of local anesthetics by increasing blood flow.
b.) Epinephrine dose is 0.2 - 0.3 mg, also known as "epi wash."
c.) Phenylephrine dose ranges from 2 - 5 mg.
d.) When added with tetracaine, vasoconstrictors have a variable increase.
e.) When added with bupivacaine or lidocaine, vasoconstrictors have a profound increase.
b.) Epinephrine dose is 0.2 - 0.3 mg, also known as "epi wash."
c.) Phenylephrine dose ranges from 2 - 5 mg.
119
How long do A2 agonists prolong sensory and motor blockade?
a.) 30 minutes
b.) 1 hour
c.) 2 hours
d.) 4 hours
b.) 1 hour
120
What effect do vasoconstrictors have when added with tetracaine in neuraxial pharmacologic adjuncts?
a.) No increase
b.) Variable increase
c.) Profound increase
d.) Decrease
c.) Profound increase
121
What is the main purpose of using vasoconstrictors in neuraxial pharmacologic adjuncts?
a.) To prolong the action of local anesthetics by increasing blood flow
b.) To shorten the action of local anesthetics by reducing blood flow
c.) To prolong the action of local anesthetics by reducing blood flow
d.) To shorten the action of local anesthetics by increasing blood flow
c.) To prolong the action of local anesthetics by reducing blood flow
122
When added with bupivacaine or lidocaine, vasoconstrictors have a ________ increase in their effect.
A)variable
B)fixed
A) variable
123
Which of the following statements are true regarding the use of neuraxial anesthesia in patients on anticoagulants/antiplatelets? (select 2)
a.) Patients on anticoagulants should avoid neuraxial anesthesia due to the risk of epidural hematoma.
b.) Epidural hematoma can compress the spinal cord, leading to temporary neurological damage.
c.) Symptoms of epidural hematoma include lower extremity weakness, numbness, low back pain, and bowel and bladder dysfunction.
d.) Surgical decompression should be performed within 24 hours to optimize recovery chances.
a.) Patients on anticoagulants should avoid neuraxial anesthesia due to the risk of epidural hematoma.
c.) Symptoms of epidural hematoma include lower extremity weakness, numbness, low back pain, and bowel and bladder dysfunction.
124
Which of the following are challenges faced by patients with cardiac stents regarding neuraxial anesthesia? (select 2)
a.) Stopping antiplatelets and anticoagulants increases stent thrombosis risk.
b.) Continuing antiplatelets and anticoagulants raises bleeding risk, including epidural hematoma.
c.) Patients with stents can safely undergo neuraxial anesthesia without any concerns.
d.) There are no special considerations for patients with cardiac stents undergoing neuraxial anesthesia.
a.) Stopping antiplatelets and anticoagulants increases stent thrombosis risk.
b.) Continuing antiplatelets and anticoagulants raises bleeding risk, including epidural hematoma.
125
What is the primary treatment for epidural hematoma in patients on anticoagulants/antiplatelets?
a.) Administering high doses of anticoagulants
b.) Physical therapy
c.) Surgical decompression within 8 hours
d.) Observation and monitoring
c.) Surgical decompression within 8 hours
126
Which of the following statements about COX inhibitors and aspirin are true? (select 2)
a.) COX inhibitors prevent the formation of thromboxane-A2.
b.) Aspirin is only a COX inhibitor.
c.) Determining if aspirin is used for primary or secondary prophylaxis is crucial.
d.) Discontinuing aspirin for secondary prophylaxis is associated with low risk.
e.) Guidelines distinguish between low dose (81mg) and regular dose (325mg) aspirin.
a.) COX inhibitors prevent the formation of thromboxane-A2.
c.) Determining if aspirin is used for primary or secondary prophylaxis is crucial.
127
Which of the following are guidelines for holding aspirin before surgery based on procedure risk level? (select 3)
a.) High-risk procedures: Hold aspirin for 1-2 days.
b.) Intermediate-risk procedures: Hold aspirin for 4-6 days.
c.) Low-risk procedures: Generally, do not need to hold aspirin.
d.) Central neuraxial blocks: No additional precautions needed.
e.) Low-risk procedures: Hold aspirin for 4-6 days.
b.) Intermediate-risk procedures: Hold aspirin for 4-6 days.
c.) Low-risk procedures: Generally, do not need to hold aspirin.
d.) Central neuraxial blocks: No additional precautions needed.
128
What is the main function of COX inhibitors?
a.) Increase platelet aggregation
b.) Prevent the formation of thromboxane-A2
c.) Promote the formation of prostaglandins
d.) Inhibit leukotriene synthesis
b.) Prevent the formation of thromboxane-A2
129
What percentage of acute cardiovascular syndromes are preceded by aspirin withdrawal in secondary prophylaxis?
a.) 5%
b.) 10%
c.) 15%
d.) 20%
b.) 10%
130
Which of the following procedures are considered low cardiac risk (<1%) for patients on COX-1 inhibitors? (select 3)
a.) Endoscopic procedures
b.) Carotid endarterectomy
c.) Cataract surgery
d.) Emergency surgeries
e.) Breast surgeries
a.) Endoscopic procedures
c.) Cataract surgery
e.) Breast surgeries
131
Which of the following statements are true regarding considerations for NSAID use in surgical procedures? (select 2)
a.) For high-risk procedures, hold for 5 half-lives.
b.) For intermediate-risk procedures, hold for 1 half-life.
c.) For low-risk procedures, do not need to routinely hold.
d.) Central neuraxial blocks require additional precautions.
e.) For high-risk procedures, hold for 10 half-lives.
a.) For high-risk procedures, hold for 5 half-lives.
c.) For low-risk procedures, do not need to routinely hold.
132
Which of the following procedures are considered high cardiac risk (>5%) for patients on COX-1 inhibitors?
a.) Cataract surgery
b.) Orthopedic surgeries
c.) Open aortic surgeries
d.) Ambulatory surgeries
c.) Open aortic surgeries
133
What are the considerations for regional anesthesia in patients on glycoprotein IIB/IIIA antagonists? (select 3)
a.) Avoid until platelet function has recovered.
b.) Tirofiban and Eptifibatide: Hold for 24-48 hours.
c.) Abciximab: Hold for 4-8 hours.
d.) Tirofiban and Eptifibatide: Hold for 4-8 hours.
e.) Abciximab: Hold for 24-48 hours.
a.) Avoid until platelet function has recovered.
d.) Tirofiban and Eptifibatide: Hold for 4-8 hours.
e.) Abciximab: Hold for 24-48 hours.
134
What is the mechanism of action of glycoprotein IIB/IIIA antagonists as mentioned in the slide?
a.) Inhibits platelet aggregation via surface receptors
b.) Inhibits cyclooxygenase
c.) Promotes platelet aggregation
d.) Inhibits thromboxane-A2 synthesis
a.) Inhibits platelet aggregation via surface receptors
135
Before performing regional anesthesia, ensure platelet function has ________ in patients on glycoprotein IIB/IIIA antagonists.
A)recovered
B)equalized
C) decreased
D) maintained
A) recovered
136
Which of the following are regional anesthesia considerations for patients taking thienopyridine derivatives? (select 3)
a.) Clopidogrel: Hold for 1-2 days
b.) Prasugrel: Hold for 7-10 days
c.) Ticlopidine: Hold for 10 days
d.) Clopidogrel: Hold for 5-7 days
e.) Prasugrel: Hold for 4-6 days
b.) Prasugrel: Hold for 7-10 days
c.) Ticlopidine: Hold for 10 days
d.) Clopidogrel: Hold for 5-7 days
137
What is the mechanism of action of thienopyridine derivatives?
a.) Inhibits platelet aggregation by blocking ADP transferase
b.) Inhibits cyclooxygenase
c.) Promotes platelet aggregation
d.) Inhibits thromboxane-A2 synthesis
a.) Inhibits platelet aggregation by blocking ADP transferase
138
Which of the following statements about unfractionated heparin (UFH) are true? (select 3)
a.) UFH potentiates antithrombin, inhibiting thrombin (factor 2) and factors 9, 10, 11, and 12.
b.) UFH is only administered subcutaneously for DVT prophylaxis.
c.) Low-dose UFH (<5,000 U) should be held for 4-6 hours before regional anesthesia.
d.) Higher-dose UFH (≤20,000 U daily) should be held for 24 hours before regional anesthesia.
e.) Therapeutic dose UFH (>20,000 U daily) or in pregnant patients should be held for 24 hours before regional anesthesia.
a.) UFH potentiates antithrombin, inhibiting thrombin (factor 2) and factors 9, 10, 11, and 12.
c.) Low-dose UFH (<5,000 U) should be held for 4-6 hours before regional anesthesia.
e.) Therapeutic dose UFH (>20,000 U daily) or in pregnant patients should be held for 24 hours before regional anesthesia.
139
What is the recommended action for patients on UFH for more than 4 days before undergoing a central neuraxial block?
a.) Increase the dose of UFH
b.) Hold UFH for 4-6 hours
c.) Check a platelet count
d.) Administer additional anticoagulants
c.) Check a platelet count
140
Which of the following statements about low molecular weight heparin (LMWH) are true? (select 3)
a.) LMWH inhibits factor 10a.
b.) LMWH includes medications such as Enoxaparin, Dalteparin, and Tinzaparin.
c.) Ensure coagulation status appears normal before regional anesthesia.
d.) No need to check platelet count if on LMWH for more than 4 days.
e.) Delay at least 12 hours after a therapeutic dose before block/catheter placement.
a.) LMWH inhibits factor 10a.
b.) LMWH includes medications such as Enoxaparin, Dalteparin, and Tinzaparin.
c.) Ensure coagulation status appears normal before regional anesthesia.
141
Which of the following drugs are classified as low molecular weight heparin (LMWH)? (select 2)
a.) Warfarin
b.) Enoxaparin (Lovenox)
c.) Dalteparin (Fragmin)
d.) Rivaroxaban (Xarelto)
b.) Enoxaparin (Lovenox)
c.) Dalteparin (Fragmin)
142
When planning regional anesthesia, ensure that the patient's coagulation status appears normal and that no other ______ should be in use.
A) anticoagulants
B) blood thinners
C) medications
D) antiplatelets
A) anticoagulants
143
Before block/catheter placement, delay at least ______ after a prophylactic dose of LMWH and at least ______ after a therapeutic dose.
A) 6 hours; 12 hours
B) 12 hours; 24 hours
C) 24 hours; 48 hours
D) 48 hours; 72 hours
B) 12 hours; 24 hours
144
If a patient has been on LMWH for more than 4 days, consider checking the ______ count, and if elderly or if there is renal insufficiency, consider checking ______ activity.
A) hemoglobin; prothrombin
B) white blood cell; fibrinogen
C) platelet; anti-factor 10a
D) red blood cell; anti-thrombin
C) platelet; anti-factor 10a
145
Vitamin K antagonists impair vitamin K-dependent clotting factors such as ______ and are commonly represented by the drug ______.
A) factors 2, 7, 9, and 10; warfarin
B) factors 1, 3, 5, and 8; heparin
C) factors 11, 12, 13, and 14; aspirin
D) factors 2, 6, 8, and 10; warfarin
A) factors 2 (thrombin), 7, 9, and 10; warfarin
146
When planning regional anesthesia, vitamin K antagonists should be held for ______ and a normal ______ should be verified.
A) 24 hours; platelet count
B) 5 days; INR
C) 48 hours; APTT
D) 1 week; hemoglobin level
B) 5 days; INR
*INR should <1.5*
147
Thrombolytic agents activate ______ and include medications such as ________,________,________, __________ and ___________.
A) fibrinogen; warfarin; plasminogen; T-PA and urokinase
B) plasminogen; T-PA; platelets; streptokinase and urokinase
C) plasminogen; T-PA, streptokinase; alteplase and urokinase
D) thrombin; heparin; streptokinase; ateplase and urokinase
C) plasminogen; T-PA, streptokinase, alteplase, and urokinase
148
# True or False
Neuraxial anesthesia is contraindicated in thrombolytic agents
True
149
Direct oral anticoagulants inhibit ______ and include medications such as ______.
A) thrombin, warfarin (Coumadin)
B) factor 10a, apixaban (Eliquis)
C) platelet aggregation, aspirin
D) plasminogen, garlic
B) factor 10a, apixaban (Eliquis)
150
When planning regional anesthesia, direct oral anticoagulants should be discontinued at least ______ before the block, and it may be necessary to check ______ if the discontinuation period is less than 72 hours.
A) 24 hours, blood pressure or PT
B) 48 hours, drug level or PTT
C) 72 hours, drug level or anti-factor 10a
D) 1 week, renal function or anti-factor 10a
C) 72 hours, drug level or anti-factor 10a
151
When considering regional anesthesia, it is generally safe to proceed with neuraxial anesthesia if the patient taking herbal therapies is not on other ______.
A) antihypertensives
B) blood-thinning drugs
C) antidiabetics
D) antibiotics
B) blood-thinning drugs
152
Herbal therapies such as ______ activate plasminogen.
A) turmeric, ginger, ginkgo
B) garlic, ginkgo, and ginseng
C) cinnamon, clove, ginseng
D) rosemary, thyme, garlic
B) garlic, ginkgo, and ginseng
