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Pharmacology > Spring Exam Qs > Flashcards

Spring Exam Qs Flashcards

0
Q

What is the difference in time to onset of action for labetalol and hydralazine?

A

Labetalol = 2-5 min

Hydralazine = 15-20 min

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1
Q

What is the mechanism of action of Labetalol and Hydralazine?

A

Labetalol = mixed A1, B1 and B2 blocker

Hydralazine is a potent vasodilator - it directly causes vascular smooth muscle relaxation (arterioles>veins)

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2
Q

What is the effect of labetalol on HR?

A

It decreases HR.

Even though it is an A1 blocker which -> decc BP and would usually cause reflex tachycardia, it does not since it also is a B1 blocker.

It causes less bradycardia than pure B antagonists

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3
Q

What is the effect of hydralazine on HR?

A

Increases HR.

Causes reflex tachycardia.

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4
Q

For the Sympathetic nervous system, indicate the neurotransmitter found at the ganglion and the neurotransmitter found at the effector site.

A 
Ganglion = Ach
Effector = NE
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5
Q

For the Parasympathetic nervous system, indicate the neurotransmitter found at the ganglion and the neurotransmitter found at the effector site.

A

ganglion = Ach

effector site = Ach

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6
Q

Match the diuretic to its effect. Answers may be used more than once.

  1. HCTZ A. hyperchloremic metabolic acidosis
  2. Acetazolamide B. hypoCl hypoK metabolic alkalosis
  3. Furosemide C. hyperkalemia
  4. Spironolactone D. hypernatremia
A
  1. B
  2. A
  3. B
  4. C
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7
Q

Which opioid medication does not undergo biotransformation in the liver?

A

Remifentanil

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8
Q

Select the correct combination of antiHTN and side effect.

A. Clonidine          -> diarrhea
B. Hydralazine      -> hyperkalemia
C. Labetalol          -> cough
D. Phentolamine   -> angioedema
E. Propronolol      -> bronchospasm
A

E

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9
Q

Select the BEST statement regarding vasodilators.

A. Exposure to light causes nitroglycerine to break down
B. Nitroglycerine is associated with cyanide toxicity
C. SNP delivers nitric oxide to smooth muscle->vasodilation
D. Respiratory acidosis is a common presentation of SNP toxicity
E. The first-line tx for nitroglycerine toxicity is Na thiosulfate

A

C

Correct drug is in ( )
A. Exposure to light causes nitroglycerine to break down (SNP)
B. Nitroglycerine is associated with cyanide toxicity (SNP)
C. SNP delivers nitric oxide to smooth muscle->vasodilation (true)
D. Respiratory acidosis is a common presentation of SNP toxicity (metabolic acidosis)
E. The first-line tx for nitroglycerine toxicity is Na thiosulfate
(Na Thiosulfate is the 2nd drug given for cyanide toxicity)

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10
Q

Which is a common use for nitroglycerine as an IV bolus?

A. management of chronic HTN
B. prevention of angina pectoris 
C. pulmonary vasodilation in pts w/ pulmonary HTN
D. treatment of methemoglobinemia 
E. Uterine relaxation
A

E

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11
Q

Which statement about nitric oxide is MOST correct?

A. IV nitric oxide is used to treat pulmonary HTN & bronchospasm
B. Methemoglobinemia = side effect of nitric oxide administration
C. Nitric oxide activates platelets and causes aggregation
D. Nitric oxide causes constriction of vascular smooth muscle
E. Normal endothelial function is inhibited by presence of NO

A

B

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12
Q

What organ secretes angiotensin converting enzyme?

A. Adrenals
B. Heart
C. Kidneys
D. Liver
E. Lungs
A

E

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13
Q

Indicate how aldosterone effects Na and K. Does it cause excretion, retention, or have no effect?

A

Aldosterone causes Na retention and K excretion

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14
Q

True or False. ACE inhibitors prevent the conversion of angiotensinogen into angiotensin I.

A

False

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15
Q

T or F. Angiotensin II causes vasodilation and diuresis.

A

False. It causes vasoconstriction and Na & Water retention

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16
Q

T or F. A2RBs (Angiotensin II receptor blockers) are primarily indicated for the treatment on volume overload.

A

False

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17
Q

T or F. Cough is a common side effect of aldosterone antagonists.

A

False. Cough is a common side effect of ACE Inhibitors

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18
Q

T or F. Hyperkalemia is a known risk of ACEIs, A2RBs, and aldosterone antagonists.

A

True

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19
Q

A pt goes into a-fib w/a ventricular rate of 144. Which is most correct about this pt?

A. Amiodarone is effective in treating this arrhythmia
B. Digoxin is used to convert this pt into sinus rhythm
C. Lidocaine would be effective in reducing the ventricular rate
D. Metoprolol would be ineffective in this situation
E. Nifedipine could be used to slow the ventricular rate

A

The answer is not B…i think it is A

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20
Q

Which statement is MOST CORRECT?

A. Aldosterone has a very narrow therapeutic index
B. Brief ventr. asystole usually occurs with amin of Amiodarone
C. Digoxin is currently used as 1st line therapy for tx of CHF
D. Side effects of digoxin =vision changes, rash and pneumonitis
E. The half life of adenosine is about 1 second

A

E

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21
Q

Which of the following is a physical consequence of antagonists binding to L-type Ca channels?

A. Decreased conduction through the AV node
B. Impaired relaxation of cardiac myocytes
C. Increased intracellular Ca
D. Increased myocardial contractility
E. Tacchycardia

A

A

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22
Q

Which Ca channel blocker would be most appropriate to treat a pt suffering from cerebral artery vasospasm?

A. Amlodipine
B. Diltiazem
C. Nicardipine
D. Nimodipine 
E. Verapimil
A

D

23
Q

Which choice describes the most appropriate use of a Ca channel blocker?

A. Amlodipine to treat HTN in a pt w/ EF of 25%
B. Clevidipine to manage chronic HTN in a pt w/ vascular disease
C. Diltiazem to manage SVT in a pt w/acute hypovolemia
D. Nifedipine to treat cerebral vasospasm in pt w/ SAH
E. Verapamil to manage a-fib in a pt w/CAD

A

Answer is not A i think it is C

24
Q

Free water typically follows the movement of which substance in the plasma?

A. bicarb
B. glucose
C. K
D. Na
E. urea
A

D

25
Q

What is the effect of thiazide diuretics on Na and K (excretion, retention, or no effect)?

A

Na - Excretion

K - Excretion

26
Q

A surgeon requests that you administer mannitol to the pt. Whic of the following statements is most correct?

A. ICP may increase as water is drawn from cells into the plasma
B. It acts directly on the kidneys to increase RBF
C. It increases serum and renal tubular osmolarity
D. It is metabolized in the liver before being secreted in urine
E. It protects from renal injury during major vascular surgery

A

C

27
Q

What statement is most correct regarding first order kinetics?

A. It looks like a straight line on a concentration v time plot
B. Many drugs switch from zero order to first order kinetics at high plasma concentrations
C. The fraction of drug metabolized per unit of time depends on plasma concentration
D. The % of drug metabolized per unit of time remains constant
E. The same amount of drug is metabolized per unit of time

A

D

28
Q

In the two compartment model, what process is responsible for the Beta phase decline in serum concentration after an IV bolus?

A. Bioavailability
B. Elimination
C. First pass effect 
D. Protein binding
E. Redistribution
A

B

Alpha phase = Distribution Phase (quick decline)
Beta phase = Elimination Phase (slower decline)

29
Q

Which drug increases SSEP amplitude?

A. Etomidate
B. Ketamine
C. Methohexital 
D. Propofol
E. Remifentanil
A

A. Etomidate

30
Q

Which of the following is an opioid receptor agonist-antagonist?

A. Alfentanil 
B. Hydrocodone
C. Methadone
D. Nalbuphine
E. Naloxone
A

D. Nalbuphine

31
Q

Which selection most correctly matches the opioid with its effect?

A. Fentanyl -> can cause hyperalgesia
B. Hydromorphone -> undergoes renal metabolism
C. Meperidine -> has local anesthetic properties
D. Methadone -> precipitates opioid withdrawal
E. Morphine -> increased risk of seizures

A

C

32
Q

Which best matches the drug with its associated statement?

A. TCAs - risk of serotonin syndrome
B. Lithium - avoid use of NSAIDS and loop diuretics
C. MAOIs - must be held for 2-3 weeks prior to elective surgery
D. SSRIs - best to treat intraop hypoTN w/ephedrine
E. SNRIs - side effects = anticholinergic effects & othostatic HTN

A

B

33
Q

A man with schizophrenia is brought to the PACU. He is given droperidol for N/V and shortly afterward he develops muscle spasms in his face and neck. Which statement is MOST correct?

A. Droperidol is contraindicated in pts w/ 1st heart block.
B. Droperidol works by activating dopamine receptors.
C. Drugs used to treat schizophrenia frequently cause hypoglycemia.
D. His present symptoms should be treated w/ physostigmine.
E. This pt is at risk for developing stridor.

A

E

34
Q

Which of the following statements about NMS is MOST correct?

A. Both MH and NMS display muscle rigidity, myonecrosis and hyperthermia.
B. Dantrolene is used in the treatment of MH but not in NMS.
C. Pts w/ a hx of NMS are high risk for developing MH.
D. Pts w/ NMS will have persistent rigidity after a dose of ROC.
E. Sux is contraindicated in pts w/ NMS.

A

A

Dantrolene is used in treatment for both. Hx of NMS is not associated with risk of MH. Roc will cause flaccid paralysis in NMS. Sux and Halothane are safe to use in NMS

35
Q

Which statement matches the drug with its description?

A. Fosphenytoin - used to stop acute seizure activity but not for chronic prevention
B. Keppra - signif protein binding
C. Lorazepam - unfavorable therapeutic index
D. Phenytoin - disadvantages = hTN and precipitation
E. Propofol - need a higher dose of ND NMBAs

A

D

36
Q

Which statement is MOST correct about Parkinson’s disease.

A. Parkinsons meds should be held on the day of surgery.
B. Levodopa crosses the BBB and then converted to dopamine.
C. Reglan should be given to enhance GI absorption of oral meds.
D. Post Op nausea should be treated w/ droperidol instead of zofran.
E. Small boluses of Dopamine are used to prevent post op parkinsonian sx.

A

B

37
Q

Which is MOST correctly associated w/ the action of endogenous insulin?

A. It transport glucose and K into cells.
B. In type I diabetics basal insulin secretion is > 1 unit/hr.
C. Insulin is secreted by pancreatic alpha cells.
D. Stress and food will inhibit secretion of endogenous insulin.
E. Type I diabetics require higher serum insulin levels than Type II

A

A

38
Q

Which of the following is MOST correct regarding the peri operative management of DM diagnosed at age 6?

A. A dose of IV regular insulin will only work for 5-10 min before its metabolized.
B. A half dose of short acting insulin should be taken on the morning of surgery.
C. An implanted insulin pump may be left running on a continuous infusion during surgery.
D. This pt should not take any long actin insulin on the night before surgery.
E. You should treat w/ insulin in order to achieve a target blood glucose of 80-120 mg per dL.

A

the answer is not E…I think its C

A. A dose of IV regular insulin will only work for 5-10 min before its metabolized.
(half-life is 5-10 min but sustained effect for 30-60min)
B. A half dose of short acting insulin should be taken on the morning of surgery. (no short acting, 1/2 dose of long acting)
C. An implanted insulin pump may be left running on a continuous infusion during surgery. (true)
D. This pt should not take any long actin insulin on the night before surgery. (can take 1/2 dose)
E. You should treat w/ insulin in order to achieve a target blood glucose of 80-120 mg per dL. (under 150 is good..too tightly controlled-> risk of hypoglycemia

39
Q

Which statement about glucagon is most correct?

A. B-blockade will block the effect of glucagon.
B. Glucagon binds to insulin and activates it.
C. It is a sympathomimetic that increases HR and contractility.
D. It is contraindicated during GI procedures involving the biliary system
E. It is secreted in response to elevated serum glucose.

A

C

40
Q

Which statement is MOST correct regarding a pt who takes glyburide and metformin for DM?

A. All oral hypoglycemic agents can be continued in this pt perioperatively.
B. Glyburide acts by binding to an activating insulin receptors.
C. Metformin is used to increase pancreatic beta cell activity.
D. Actos should be held in all pts due to risk of lactic acidosis.
E. Sulfonylureas are an important first choice for outpt mgmt of this pt’s diabetes.

A

A

41
Q

A 37 yo F w/ hx of thyroid dz presents for emergency laparotomy for ruptured ectopic pregnancy. She has tachycardia, diaphoresis (sweating), HTN, and fever. Which med would be most likely to cause this constellation of symptoms?

A. levothyroxine
B. Methimazole
C. Propranolol 
D. Propylthiouracil 
E. Sodium Iodide
A

A

42
Q

A 19 yo F w/ no prenatal care presents to the labor and delivery unit w/ preterm labor. She is acutely intoxicated w/ cocaine and her BP is 210/120. She delivers a 1.2 kg baby and after delivery of the placenta there is ongoing uterine bleeding. After attempting uterine massage which med is the first line therapy to treat the bleeding?

A. Hemabate
B. Mg
C. Methergine
D. Oxytocin
E. Sevo
A

D

43
Q

A 19 yo F w/ no prenatal care presents to the labor and delivery unit w/ preterm labor. She is acutely intoxicated w/ cocaine and her BP is 210/120. She delivers a 1.2 kg baby and after delivery of the placenta there is ongoing uterine bleeding. After attempting uterine massage which med is contraindicated to treat the bleeding?

A. Hemabate
B. Mg
C. Methergine
D. Oxytocin
E. Sevo
A

C - Do not give Methergine to the pt if already HTN

44
Q

Which statement regarding the action of endogenous corticosteroids is MOST correct?

A. Block vascular smooth muscle response to Catecholamines.
B. Cause hypoglycemia due to inhibition of gluconeogenesis.
C. Episodic secretion is inhibited by stress.
D. Inhibit inflammatory response.
E. Retain Na and secrete free water.

A

D

45
Q

Which of the following scenarios best demonstrates proper perioperative use of dexamethasone 10 mg IV?

A. AIDS pt w/ severe PONV, having a parotid gland removed.
B. Breast cancer pt, after prolonged and traumatic intubation.
C. Severe asthmatic w/ bronchospasm in PACU after TAH.
D. Pt having an aortic valve replacement who takes prednisone 20 mg daily for rheumatoid arthritis.
E. Type I diabetic having resection of large intercranial tumor.

A

Not D…I think its E

Would not give it to a pt that is already immunocompromised (A&B). Not in notes as a treatment for asthma (C). I put D on the test and it was wrong. E- event though you have to think about risk of hyperglycemia, you can manage that - the dose is correct for the dec ICP and in the notes he said that the benefit is worth the risk

46
Q

Which of the following statements about NSAIDS is most correct?

A. COX-1 inhibition leads to platelet aggregation
B. COX-2 inhibition leads to decreased RBF
C. NSAIDS such as ibuprofen block only the COX-1 enzyme
D. The COX-1 enzyme is expressed at sites of tissue injury
E. The COX-2 enzyme is inducible

A

E

47
Q

A 24 yo M with severe asthma and chronic renal injury is having an inguinal hernia repair under GA. Which NSAID would be most appropriate to help control his post op pain with the lowest risk of adverse effects?

A. Aspirin
B. Celecoxib
C. Ibuprofen
D. Ketorolac
E. Naproxen
A

B

48
Q

Which of the following pts should probably avoid using acetaminophen regularly?

A. 13 yo F with influenza
B. 32 yo M with acute renal failure
C. 46 yo F with alcoholism 
D. 55 yo M with peptic ulcer disease
E. 61 yo M with CAD
A

C

49
Q

Which of the following statements about agent solubility is most correct?

A. At equilibrium, both the PP’s and concentrations are equal
B. High blood gas coeffs mean insoluble agent
C. Solubility is defined as volume of gas dissolved in a given volume of liquid
D. The blood:gas coeff describes the ratio of PP’s of gas in each phase at equi
E. When the blood:gas coeff is greater than 1 more agent is in the gas than blood

A

C

50
Q

At the end of a procedure MV = 12 L/min and FGF = 10 L/min. After 5 min ET sevo = 0.3%. What is the best explanation?

A. FGF was not set high enough
B. MV was not high enough
C. Sevo undergoes some hepatic metabolism
D. The blood:gas coeff of sevo is

A

E

51
Q

Which one of the following pts should not be given N2O?

A. 4 yo child with severe asthma having dental restorations
B. 23 yo F having emergency C/S
C. 44 yo M having a laparoscopy for acute appendicitis
D. 59 yo M having a laparotomy after a MVA
E. 75 yo F with CAD having an L2-L5 laminectomy

A

D

52
Q

Which correctly matches the NMBA with its metabolism?

A. Atracurium- Pseudocholinesterase
B. Pancuronium- Hoffman elimination
C. Rocuronium - Ester hydrolysis
D. SUX - Renal excretion
E. Vecuronium - Hepatic metabolism
A

E

53
Q

Which of the following pts is at highest risk for MH?

A. 4 yo M whose sibling died suddenly from hyperK cardiac arrest after induction of anesthesia
B. 19 yo M with schizophrenia and NMS after tx w/ haloperidol
C. 25 yo F w/ MMR but nothing else after getting SUX
D. 47 yo M w/ 1 uneventful prior anesthetic whose states his father tested positive for MH
E. 55 yo F w/ no prior anesthetics and a dibucaine # of 42

A

Not A…I think its D

54
Q

Which statement about pts w/ myasthenia gravis is most correct?

A. NDNMBAs are NOT safe to use in these pts
B. disease can be managed w/ glyco or parotid gland removal
C. Home meds may cause reduced pseudocholinesterase activity
D. They are typically sensitive to normal doses of SUX
E. They have autoantibodies to the acetylcholinesterase enzyme

A

Not B…think its C

55
Q

Shortly after a pt receives a fascia ilaca compartment block using 40 ml of .75% bupi, she is found to have somnolence and VT. Which of the following is most correct?

A. Lido can bee used to manage her V-tach
B. Neurologic manifestations of LA toxicity precede cardiac mani
C. Ropi is more likely to cause LA cardiotoxicity than Bupi
D. The toxicity was probably due to intravascular injection
E. This dose would have been acceptable if it was mixed w/ epi

A

B

56
Q

Which of the statements about LA pharmacology is MOST correct?

A. Bicarb can be added to help the block last longer
B. Drugs that bind to the Cl receptor are expected to interfere w/ LA action
C. LA drugs are weak bases that become charged by accepting H
D. LAs bind to their target best when they are uncharged
E. The acidic environment in the tissue due to infection will speed the onset of action

A

C

Pharmacology (22 decks)

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