Anesthesia Buddy: Pharmacology Flashcards by Alyssa Rivera

Which intravenous agent is also known as 2, 6-diisopropylphenol)?
A) Etomidate
B) Ketamine
C) Propofol
D) Midazolam

C) Propofol

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Which component is NOT part of propofol formulation?
A) Egg lecithin
B) Soybean oil
C) Glycerol
D) Silica gel

D) Silica gel

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Which compound is added to generic propofol formulations as an antimicrobial?
A) Sodium metabisulfite
B) Hydroxycobalamin
C) Sodium nitrite
D) Sodium thiosulfate

A) Sodium metabisulfite

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Which agent hyperpolarizes neurons by increasing chloride conductance?
A) Lidocaine
B) Fentanyl
C) Propofol
D) Rocuronium

C) Propofol

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Which of the following effects is INCREASED by propofol administration?
A) Systemic vascular resistance
B) Myocardial contractility
C) Preload
D) Respiratory depression

D) Respiratory depression

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Which effect is MOST likely to occur from propofol administration?
A) Myoclonus
B) Increased cerebral blood flow
C) Increased intraocular pressure
D) Analgesia

A) Myoclonus

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Which intravenous agent possess antioxidant properties?
A) Propofol
B) Midazolam
C) Etomidate
D) Ketamine

A) Propofol

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Which intravenous agent is likely to produce green color urine?
A) Propofol
B) Midazolam
C) Etomidate
D) Ketamine

A) Propofol

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Which is NOT part of propofol infusion syndrome?
A) Metabolic acidosis
B) Rhabdomyolysis
C) Kidney failure
D) Hypokalemia

D) Hypokalemia

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Which intravenous agent possess long chain triglycerides?
A) Propofol
B) Midazolam
C) Etomidate
D) Ketamine

A) Propofol

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Clearance of propofol from the — exceeds hepatic blood flow.

plasma

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— is added to soda lime absorbent granules to provide hardness and minimize alkaline dust formation.

Silica

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— formulation is composed of long chain triglycerides (soybean oil and egg lecithin)

Propofol

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Generic formulation of propofol contains — as the preservative

sodium metabisulfite

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Sodium thiosulfate, sodium nitrite and hydroxycobalamin are used in the treatment of —

cyanide toxicity

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Propofol is a relatively selective modulator of —

y-aminobutyric acid (GABAA)

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Mechanism of action of —: Activation of GABAA increases transmembrane chloride conductance and results in hyperpolarization of the postsynaptic cell membrane. Subsequently, functional inhibition of the postsynaptic neuron occurs.

propofol

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Mechanism of action of —: blockade of voltage-gated sodium channels

lidocaine

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Mechanism of action of —: Fentanyl binds to opioid receptors, especially the mu opioid receptor, which are coupled to G-proteins

fentanyl

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Mechanism of action of —: Nondepolarizing neuromuscular blocking agent that competes with acetylcholine on the neuromuscular nicotinic receptors

rocuronium

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— is the principal inhibitory neurotransmitter in the brain

GABA

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Negative inotropic effect may result due to decrease in intracellular — availability

calcium

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Propofol administration has been associated with —

myoclonus

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Propofol — cerebral metabolic rate for oxygen (CMRO2), cerebral blood flow, and intracranial pressure (ICP)

decreases

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Propofol has the ability to produce burst — on electroencephalography (EEG)

suppression

— has potent antioxidant properties similar to endogenous vitamin E

Propofol

— scavenges free radicals and inhibits lipid peroxidation

Propofol

Prolonged infusions of propofol can cause excretion of green urine due to the presence of —

phenols

Cloudy urine may occur after — administration due urinary uric acid excretion

propofol

Propofol infusion syndrome has been described in patients after prolonged high dose propofol infusions for longer than — hours

Common clinical findings associated with — include anion-gap metabolic acidosis, cardiac dysfunction, rhabdomyolysis, hypertriglyceridemia, elevated liver enzymes, hyperkalemia, and renal failure

propofol infusion syndrome

Measurement of the — can be used to differentiate hyperchloremic metabolic acidosis from lactic acidosis

anion gap

— formulation is composed of long chain triglycerides (soybean oil and egg lecithin)

Propofol

Propofol — prolong the QTc interval on the electrocardiogram

does not

Which effect is NOT likely to occur from propofol administration? A) Antiemetic effect B) Antiprutitic effect C) Anticonvulsant effect D) Analgesic effect

D) Analgesic effect

Which intravenous agent is a phencyclidine derivative? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

D) Ketamine

Which intravenous agent antagonizes glutamate? A) Midazolam B) Dexmedetomidine C) Etomidate D) Ketamine

D) Ketamine

Which effect is NOT likely to occur from ketamine administration? A) Bronchodilation B) Antisialogue C) Increased cerebral oxygen consumption (CMRO2) D) Nystagmus

B) Antisialogue

Which agent is most effective at preventing emergence delirium from ketamine administration? A) Atropine B) Physostigmine C) Midazolam D) Sevoflurane

C) Midazolam

Which intravenous agent is a carboxylated imidazole? A) Propofol B) Fentanyl C) Etomidate D) Ketamine

C) Etomidate

Which is CORRECT about the imidazole ring of etomidate? A) Imidazole ring closes at an acidic pH B) Imidazole ring opens at physiologic pH C) At an acidic pH, imidazole ring has increased lipid solubility D) When the imidazole ring is closed, lipid solubility increases

D) When the imidazole ring is closed, lipid solubility increases

Which intravenous agent should be avoided in patients with adrenal failure? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

C) Etomidate

Which intravenous agent can inhibit cortisol and aldosterone synthesis? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

C) Etomidate

Which intravenous agent can inhibit 11-beta-hydroxylase enzyme? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

C) Etomidate

Does propofol relieve nociceptive pain?

Regardless of anesthetic technique, propofol administration reduces incidence of —.

postoperative nausea and vomiting

— is a phencyclidine derivative that produces dissociative anesthesia

Ketamine

Phencyclidine (PCP) is an illegal street drug also known as —.

angel dust

Ketamine inhibits activation of — receptors by glutamate and decreases presynaptic release of glutamate

NMDA

— is the most abundant excitatory neurotransmitter in the brain

Glutamate

Ketamine — cerebral blood flow and cerebral oxygen consumption (CMRO2)

increases

Ketamine produces — effects such as sympathomimetic action, bronchodilation, and emergence delirium

anticholinergic

Ketamine administration — salivary and tracheobronchial mucous gland secretions

increases

Ketamine may produce a sensation of bodily — or — in space

detachment or floating

Benzodiazepines such as midazolam have proven most effective at reducing the incidence of emergence delirium after — administration

ketamine

— may increase the incidence of emergence delirium

Atropine

— is a carboxylated imidazole– containing compound

Etomidate

— and — also contain an imidazole nucleus

Midazolam and dexmedetomidine

The imidazole nucleus renders etomidate — soluble at an acidic pH and — soluble at physiologic pH

water ; lipid

Etomidate 99% — at physiologic pH

unionized

— can transiently depress adrenocortical function

Etomidate

— produces a dose-dependent inhibition of the conversion of cholesterol to cortisol

Etomidate

The enzyme inhibited by — is 11-beta-hydroxylase

etomidate

Which intravenous agent is MOST likely to cause postoperative nausea and vomiting (PONV)? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

C) Etomidate

Which agent is derived from barbituric acid? A) Propofol B) Methohexital C) Etomidate D) Ketamine

B) Methohexital

Which agent is likely to cause histamine release and hypotension? A) Propofol B) Thiopental C) Etomidate D) Ketamine

B) Thiopental

Which agent is SAFEST to administer to patient with acute intermittent porphyria? A) Propofol B) Thiopental C) Etomidate D) Ketamine

A) Propofol

Which agent decreases cAMP and inhibits the locus ceruleus? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

B) Dexmedetomidine

Which agent produces sedative effects by stimulation of pre-synaptic alpha 2 adrenergic receptors? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

B) Dexmedetomidine

Which agent is MOST likely to cause bradycardia and hypotension? A) Propofol B) Dexmedetomidine C) Etomidate D) Ketamine

B) Dexmedetomidine

Which agent has an anti-shivering effect? A) Dexmedetomidine B) Ketamine C) Fentanyl D) Etomidate

A) Dexmedetomidine

Which agent is LEAST likely to provide reliable amnesia? A) Propofol B) Sevoflurane C) Midazolam D) Dexmedetomidine

D) Dexmedetomidine

Which agent does NOT have an imidazole ring? A) Propofol B) Midazolam C) Etomidate D) Dexmedetomidine

A) Propofol

Which agent is NOT associated with myoclonus? A) Propofol B) Methohexital C) Etomidate D) Dexmedetomidine

A) Propofol

Negative effects associated with — administration include myoclonus, pain on injection, adrenocortical suppression and increased incidence of postoperative nausea and vomiting

etomidate

— seems to occur due to disinhibition of subcortical structures that generally suppress extrapyramidal motor activity

Myoclonus

— possess hypnotic properties, lowers the seizure threshold, and causes myoclonus on induction

Methohexital

The decreased anticonvulsant effect of methohexital is useful during —

electroconvulsive therapy

— can cause an allergic reaction in the absence of prior exposure (anaphylactoid response)

Thiopental

— administration is associated with direct release of histamine from tissue mast cells

Thiopental

Barbiturates, especially phenobarbital, produce liver enzyme induction and may exacerbate acute intermittent —

porphyria

The — are a group of inherited disorders of heme biosynthesis

porphyrias

Ketamine, etomidate, and thiopental are considered unsafe and possibly —

porphyrinogenic

— is a highly selective, and potent alpha 2-adrenergic agonist

Dexmedetomidine

The pontine locus ceruleus has one of the highest densities of — receptors

alpha 2

Central alpha2-binding at presynaptic neurons inhibits the release of —

norepinephrine

It is well known that alpha 2 receptors are coupled to Gi (G protein) and cause suppression of — levels

cAMP

The elimination half-time of dexmedetomidine approximately — hours

— is an effective treatment for nonthermally induced shivering

Dexmedetomidine

— has sympatholytic actions and may be accompanied by systemic hypotension and bradycardia

Dexmedetomidine

— produces decreases in systemic blood pressure, but heart rate normally remains unchanged. However, bradycardia and asystole have rarely been observed with induction

Propofol

At therapeutic doses, — produces minimal changes in heart rate at induction

etomidate

— generally produces cardiovascular stimulation and increases in heart rate at induction

Ketamine

— has been reported to be effective at decreasing the postanesthetic delirium effects of ketamine

Dexmedetomidine

— is an effective treatment for nonthermally induced shivering

Dexmedetomidine

The analgesic effects of — originate at the level of the spinal cord

dexmedetomidine

— administration generally results in a calm, easily arousable patient to full consciousness

Dexmedetomidine

— produces sedation by decreasing sympathetic nervous system activity

Dexmedetomidine

Midazolam, ketamine, and dexmedetomidine are — compounds

imidazole

— is a substituted isopropylphenol

Propofol

— can effectively prevent the incidence of etomidate-induced myoclonus

Dexmedetomidine

— seems to occur due to disinhibition of subcortical structures that generally suppress extrapyramidal motor activity

Myoclonus

Which agent is least likely to produce an isoelectric EEG? A) Midazolam B) Propofol C) Thiopental D) Isoflurane

A) Midazolam

Which is NOT an effect of intravenous midazolam? A) Anterograde amnesia B) Anticonvulsant C) Anxiolysis D) Analgesia

D) Analgesia

Which agent antagonizes the actions of benzodiazepines? A) Flumazenil B) Glucagon C) N-acetylcysteine D) Physostigmine

A) Flumazenil

Which inhaled anesthetic is classified as an ether? A) Halothane B) Nitrous oxide C) Sevoflurane D) Xenon

C) Sevoflurane

Which inhaled anesthetic is classified as an alkane? A) Halothane B) Nitrous oxide C) Isoflurane D) Desflurane

A) Halothane

Which inhaled anesthetic requires a heated vaporizer? A) Sevoflurane B) Nitrous oxide C) Isoflurane D) Desflurane

D) Desflurane

Which agent undergoes the greatest hepatic biotransformation? A) Sevoflurane B) Desflurane C) Isoflurane D) Nitrous oxide

A) Sevoflurane

Which agent has the lowest blood:gas coefficient of 0.42? A) Sevoflurane B) Desflurane C) Isoflurane D) Nitrous oxide

B) Desflurane

Which agent has a blood:gas coefficient of 0.65? A) Sevoflurane B) Desflurane C) Isoflurane D) Nitrous oxide

A) Sevoflurane

Which agent has been associated with the toxic byproduct Compound A? A) Sevoflurane B) Desflurane C) Isoflurane D) Nitrous oxide

A) Sevoflurane

Which agent has a vapor pressure of 669 mmHg? A) Sevoflurane B) Desflurane C) Isoflurane D) Nitrous oxide

B) Desflurane

—, in contrast to barbiturates and propofol, is unable to produce an isoelectric EEG

Midazolam

Isoflurane appears to cause burst suppression at about — MAC, and electrical silence at — MAC

1.5 ; 2

Midazolam produces significant — amnesia

ANTEROGRADE

Midazolam decreases anesthetics requirements of volatile anesthetics, but does NOT produce — when administered intravenously

analgesia

— may be an effective treatment for paradoxical vocal cord motion

Midazolam

— is a COMPETITIVE benzodiazepine antagonist

Flumazenil

The recommended initial dose of flumazenil is — mg IV

0.2

The duration of action of flumazenil is — to — minutes

30 to 60

— is a fluorinated methyl isopropyl ETHER

Sevoflurane

— is a halogenated ALKANE derivative

Halothane

— is a colorless, odorless to sweet-smelling INORGANIC gas

Nitrous oxide

— is an INERT gas with anesthetic properties

Xenon

— is nonpungent and produces bronchodilation

Sevoflurane

— administration has been associated with postoperative liver dysfunction

Halothane

Isoflurane, desflurane, and sevoflurane are halogenated —

ETHERS

— can boil at normal operating room temperature and it requires a heated and pressurized vaporizer that needs an electrical power. This creates an environment in which the agent has a lower and more predictable volatility

Desflurane

— produces the highest carbon monoxide concentrations in desiccated CO2 absorbents.

Desflurane

Desflurane has a vapor pressure near — atm (— mmHg) at 20 C

1 atm (669 mmHg)

— is not suitable for inhalational induction due to its pungency and airway irritant effects.

Desflurane

— results from the interaction between sevoflurane and the carbon dioxide absorbent. This can occur with soda lime or baralyme

Compound A

— is nephrotoxic in rats, causing renal proximal tubular injury

Compound A

Isoflurane, desflurane, and sevoflurane all prolong the electrocardiographic — interval

Blood:gas coefficients of inhalational agents: Sevoflurane — Desflurane — Nitrous oxide — Isoflurane —

Sevoflurane 0.65 Desflurane 0.42 Nitrous oxide 0.47 Isoflurane 1.4

— increases cerebral blood flow (CBF) with a mild increase in cerebral metabolic rate of oxygen consumption (CMRO2)

N2O

— decrease the cerebral metabolic rate of oxygen consumption (CMRO2)

Volatile anesthetics

All volatile anesthetics are biotransformed in the — to a variable extent

liver

— undergoes oxidative metabolism of 15- 40%

Halothane

Metabolism of — leads to release of inorganic fluoride

sevoflurane

Which factor INCREASES FA/FI and speeds onset of inhaled anesthetics? A) Low alveolar ventilation B) High agent solubility C) Low functional residual capacity (FRC) D) Low fresh gas flow

C) Low functional residual capacity (FRC)

Which factor DECREASES FA/FI and slows onset of inhaled anesthetics? A) Right to left intracardiac shunt B) Low cardiac output C) Low agent solubility D) High fresh gas flow

A) Right to left intracardiac shunt

Which agent undergoes the LEAST amount of metabolism? A) Halothane B) Sevoflurane C) Isoflurane D) Nitrous oxide

D) Nitrous oxide

Nitrous oxide is ___________ more soluble than nitrogen A) 12 times B) 24 times C) 34 times D) 50 times

C) 34 times

What is the minimum alveolar concentration (MAC) of desflurane? A) 1.2% B) 2.2% C) 6.6% D) 10%

C) 6.6%

Which agent is the MOST potent? A) Isoflurane B) Desflurane C) Sevoflurane D) Nitrous oxide

A) Isoflurane

Which factor INCREASES minimum alveolar concentration (MAC) of inhalational agents? A) Hypernatremia B) Hypothermia C) Metabolic acidosis D) Older age

A) Hypernatremia

Which evoked potentials monitor the corticospinal path? A) SSEPs B) MEPs C) VEPs D) BAEPs

B) MEPs

Which evoked potentials monitor the dorsal column medial lemniscus path? A) SSEPs B) MEPs C) VEPs D) BAEPs

A) SSEPs

Local anesthetics are: A) Strong bases B) Weak bases C) Strong acids D) Weak acids

B) Weak bases

Which is NOT part of the local anesthetic molecular structure? A) Benzene ring B) Intermediate chain (ester or amide) C) Tertiary amine D) Phenylpiperidine compound

D) Phenylpiperidine compound

Which local anesthetic is metabolized by pseudocholinesterase? A) Chloroprocaine B) Lidocaine C) Ropivacaine D) Mepivacaine

A) Chloroprocaine

All volatile anesthetics are biotransformed in the liver to a variable extent: Sevoflurane —% Isoflurane —% Desflurane —%

Sevoflurane 2-5% Isoflurane 0.2% Desflurane 0.02%

A low FRC will — the onset of inhalational induction.

speed

Speed or delay onset of inhalational induction: High minute ventilation

Speed

Speed or delay onset of inhalational induction: High inspired partial pressure of anesthetic

Speed

Speed or delay onset of inhalational induction: Low solubility of anesthetic in tissues

Speed

Speed or delay onset of inhalational induction: Low cardiac output

Speed

Speed or delay onset of inhalational induction: Low volume breathing circuit

Speed

— is the most pungent of the inhaled anesthetics and can potentially cause coughing, breath holding, sialorrhea, and laryngospasm

Desflurane

A right to left shunt causes a dilutional effect of shunted blood that is not mixed with anesthetic. This — the rate of inhalational induction.

slows

All of the inhaled anesthetics except — are greenhouse gases. Global warming effects are based on their infrared absorption and atmospheric lifetimes

xenon

— is metabolized by anaerobic bacteria from the human intestine (0.004%)

Nitrous oxide

— possesses good analgesic properties

Nitrous oxide (N2O)

Nitrous oxide is — times more soluble than nitrogen in blood

— can easily diffuse out of the circulation and occupy air-filled compartments

Nitrous oxide

presence of a closed pneumothorax is a contraindication to — administration

nitrous oxide

Minimum alveolar concentration of inhaled anesthetics: Halothane — Isoflurane — Sevoflurane — Desflurane — Nitrous oxide —

Halothane 0.75 Isoflurane 1.17 Sevoflurane 1.8 Desflurane 6.6 Nitrous oxide 104

— is an isomer of enflurane and is highly pungent

Isoflurane

Factors that increase or decrease MAC: Pregnancy, anemia, hyponatremia, hypoxia, hypothermia, older age, acidosis

Decrease

Factors that increase or decrease MAC: Acute use of cocaine, amphetamine, and ephedrine Chronic alcohol use Hyperthermia and hypernatremia

Increase

Administration of lithium and verapamil — MAC

decrease

— are used to assess the integrity of the corticospinal tracts during surgery

Motor evoked potentials (MEPs)

— are used to monitor dorsal column integrity

Somatosensory evoked potentials (SSEPs)

Generally, a —% decrease in amplitude or a —% increase in latency of SSEPs is a warning signal

50 ; 10

Local anesthetics are — and have pKa values above physiologic pH

weak bases

— is unique with a pKa of 3.5 (weak acid), so it exists most likely in the nonionized form at physiologic pH

Benzocaine

The — portion is usually a tertiary amine

hydrophilic

The — portion is usually an unsaturated aromatic ring

lipophilic

An — or — bond links the hydrocarbon chain to the aromatic ring

ester or an amide

— are a subclass of opioids

Phenylpiperidines

Ester local anesthetics such as chloroprocaine undergo hydrolysis by —

plasma cholinesterase (aka pseudocholinesterase)

Lidocaine, ropivacaine, and mepivacaine are amide local anesthetics and undergo — metabolism by microsomal enzymes

liver

— is metabolized by both plasma and liver cholinesterases

Cocaine

Which local anesthetic is metabolized by hepatic CYP450? A) Benzocaine B) Procaine C) Tetracaine D) Bupivacaine

D) Bupivacaine

Which local anesthetic has a pKa of 3.5 (lower than physiologic pH)? A) Mepivacaine B) Lidocaine C) Benzocaine D) Bupivacaine

C) Benzocaine

Which local anesthetic has the MOST protein binding? A) Bupivacaine B) Lidocaine C) Mepivacaine D) Tetracaine

A) Bupivacaine

Which local anesthetic is metabolized by plasma pseudocholinesterase as well as hepatic CYP450? A) Bupivacaine B) Lidocaine C) Cocaine D) Tetracaine

C) Cocaine

Which local anesthetic has the LEAST protein binding? A) Ropivacaine B) Lidocaine C) Tetracaine D) Chloroprocaine

D) Chloroprocaine

Which modality is MOST likely to be associated with local anesthetic systemic toxicity (LAST)? A) Spinal anesthesia B) Epidural anesthesia C) Peripheral nerve block D) Topical anesthesia

C) Peripheral nerve block

Which local anesthetic has the highest pKa of 8.7? A) Chloroprocaine B) Lidocaine C) Bupivacaine D) Mepivacaine

A) Chloroprocaine

Which local anesthetic is MOST likely to cause cardiac arrest from toxicity? A) Bupivacaine B) Lidocaine C) Ropivacaine D) Prilocaine

A) Bupivacaine

Which is an ester-type local anesthetic? A) Prilocaine B) Mepivacaine C) Tetracaine D) Ropivacaine

C) Tetracaine

Which agent is the BEST option for ventricular dysrhythmias in the setting of local anesthetic systemic toxicity (LAST)? A) Diltiazem B) Amiodarone C) Lidocaine D) Procainamide

B) Amiodarone

Which of the following local anesthetics can cause methemoglobinemia? A) Mepivacaine B) Benzocaine C) Bupivacaine D) Tetracaine

C) Bupivacaine

Bupivacaine is an — local anesthetic and undergoes — metabolism by microsomal enzymes

amide ; liver

Benzocaine, procaine, and tetracaine are — local anesthetics and undergo metabolism by —

ester ; plasma cholinesterase

alpha 1-acid glycoprotein is the most important plasma protein-binding site of —

bupivacaine

Protein binding of local anesthetics: Bupivacaine —% Mepivacaine —% Tetracaine —% Lidocaine —%

Bupivacaine 96% Mepivacaine 78% Tetracaine 76% Lidocaine 65%

— is thought to have the lowest central nervous system and cardiovascular toxicity of all currently used local anesthetics

Chloroprocaine

— has the lowest protein binding of all clinically used local anesthetics

Chloroprocaine

Epidurally administered — can interfere with the action of epidural opioids

chloroprocaine

Rapid onset of chloroprocaine is not associated with its pKa, but the use of high concentrations due to —

low systemic toxicity

Addition of — to local anesthetics increases pH and favors the neutral base form, speeding onset of action

bicarbonate

— can be a significant problem after administration of benzocaine to mucosal surfaces

Methemoglobinemia

— is the treatment of methemoglobinemia

Methylene blue

Most local anesthetics have a pKa greater than — (physiologic pH). An exception is benzocaine, which has a pKa of approximately 3.5. This makes benzocaine predominantly nonionized at physiologic pH

7.4

— is suited for topical anesthesia of mucous membranes

Benzocaine

Local anesthetic systemic toxicity (LAST) occurs due to excessive — drug concentration

plasma

Accidental intravascular injection of local anesthetic drug during — anesthesia is the most common cause of LAST

peripheral nerve block

At the earliest sign of local anesthetic toxicity, — is recommended for treatment

lipid emulsion

— is the most cardiotoxic agent from this list.

Bupivacaine

The more potent and lipophilic agents are generally more — (bupivacaine, tetracaine, etidocaine)

cardiotoxic

Which is metabolized by the liver to O-toluidine, which oxidizes hemoglobin (Fe2+) to methemoglobin (Fe3+)? A) Prilocaine B) Mepivacaine C) Tetracaine D) Ropivacaine

A) Prilocaine

Which additive can be combined with local anesthetics to speed onset of action? A) Epinephrine B) Clonidine C) Dexamethasone D) Sodium bicarbonate

D) Sodium bicarbonate

Which statement regarding succinylcholine is INCORRECT? A) Succinylcholine is a trigger agent for malignant hyperthermia B) Succinylcholine increases intragastric pressure C) Succinylcholine decreases lower esophageal sphincter tone D) Succinylcholine is two acetylcholine molecules joined together

C) Succinylcholine decreases lower esophageal sphincter tone

Which is an amide local anesthetic that inhibits normal plasma cholinesterase? A) Tetracaine B) Lidocaine C) Mepivacaine D) Dibucaine

D) Dibucaine

Which agent undergoes Hofmann elimination? A) Succinylcholine B) Rocuronium C) Cisatracurium D) Vecuronium

C) Cisatracurium

Which non-depolarizing neuromuscular blocking agent is metabolized by pseudocholinesterase? A) Mivacurium B) Atracurium C) Cisatracurium D) Succinylcholine

A) Mivacurium

Which neuromuscular blocking agent produces metabolite laudanosine? A) Succinylcholine B) Rocuronium C) Cisatracurium D) Vecuronium

C) Cisatracurium

Which of the following statements is CORRECT regarding Hofmann elimination? A) Reaction occurs faster with acidosis and hypothermia B) Reaction occurs slower with alkalosis and hyperthermia C) Reaction occurs faster with alkalosis and hypothermia D) Reaction occurs slower with acidosis and hypothermia

D) Reaction occurs slower with acidosis and hypothermia

Which agent undergoes the GREATEST amount of renal elimination? A) Rocuronium B) Vecuronium C) Cisatracurium D) Pancuronium

D) Pancuronium

Which of the following factors ANTAGONIZES nondepolarizing neuromuscular blockers? A) Aminoglycosides B) Magnesium C) Burns D) Hypothermia

C) Burns

A metabolite of prilocaine, O-toluidine, may result in —

methemoglobinemia

methemoglobinemia generally occurs at prilocaine doses greater than — mg

600

— is an oxidizing compound (oxidizes hemoglobin to methemoglobin)

O-toluidine

— of local anesthetics speeds the onset of action

Alkalinization

Alkalinization with — increases the lipid soluble form of local anesthetic administered

sodium bicarbonate

Addition of — to lidocaine prolongs the duration of action and decreases systemic absorption

epinephrine

Administration of — is associated with an increase in intragastric and lower esophageal sphincter pressures

succinylcholine

— is mostly known for its ability to inhibit normal plasma cholinesterase

Dibucaine

— is responsible for the prolonged effects of drugs such as succinylcholine and chloroprocaine

Atypical plasma cholinesterase

— is an isomer of atracurium

Cisatracurium

— is metabolized by Hofmann elimination to laudanosine and monoquaternary alcohol metabolite

Cisatracurium

Hofmann elimination is dependent on the — and — of plasma

pH and temperature

Mivacurium’s clearance is dependent on the —

enzyme plasma cholinesterase

Mivacurium is associated with — release

histamine

Cisatracurium does — invoke histamine release

not

Hofmann elimination is an — elimination process. It is appropriate for the renally and hepatically compromised patients

organ-independent

Approximately — to —% of pancuronium is cleared by the kidney

40-60

— has vagolytic effects and it also inhibits plasma cholinesterase

Pancuronium

Factors that — nondepolarizers: -Inhalational anesthetics -Aminoglycoside antibiotics -Hypothermia -Magnesium sulfate -Most local anesthetics

potentiate

Factors that — nondepolarizers: -Chronic anticonvulsant therapy -Hyperparathyroidism -Hypercalcemia -Burns

antagonize

— inhibits the prejunctional release of acetylcholine and can potentiate nondepolarizing neuromuscular blockers

Clindamycin

Which of the following factors POTENTIATES nondepolarizing neuromuscular blockade? A) Respiratory acidosis B) Carbamazepine C) Epinephrine D) Corticosteroids

A) Respiratory acidosis

Which of the following factors ANTAGONIZES nondepolarizing neuromuscular blockade? A) Clindamycin B) Sevoflurane C) Furosemide D) Hypercalcemia

D) Hypercalcemia

Which of the following factors POTENTIATES nondepolarizing neuromuscular blockade? A) Norepinephrine B) Hypermagnesemia C) Theophylline D) Alkalosis

B) Hypermagnesemia

Which agent has a vagolytic effect and stimulates release of catecholamines? A) Cisatracurium B) Vecuronium C) Pancuronium D) Succinylcholine

C) Pancuronium

Which is a tertiary amine and crosses the blood brain barrier (BBB)? A) Edrophonium B) Neostigmine C) Pyridostigmine D) Physostigmine

D) Physostigmine

Which of the following agents has anti-shivering properties? A) Dexmedetomidine B) Morphine C) Glycopyrolate D) Neostigmine

A) Dexmedetomidine

Which is NOT a side effect of neostigmine? A) Bradycardia B) Increased salivation C) Bronchodilation D) Miosis

C) Bronchodilation

All of these are side effects of neostigmine EXCEPT: A) Bronchoconstriction B) Constipation C) Increased secretions D) Nausea

B) Constipation

Which agent increases heart rate the MOST? A) Atropine B) Glycopyrolate C) Scopolamine D) Milrinone

A) Atropine

Which agent may decrease the effectiveness of hormonal contraceptive (birth control) for up to 7 days? A) Neostigmine B) Sugammadex C) Metoclopramide D) Cisatracurium

B) Sugammadex

Respiratory acidosis — the blockade of most nondepolarizing neuromuscular blockers and — reversal

potentiates ; antagonizes

Carbamazepine, epinephrine, and corticosteroids — neuromuscular blockade

antagonize

Hypothermia prolongs blockade by — metabolism

decreasing

Hypocalcemia and hypokalemia — a nondepolarizing block

augment

— may be seen in preeclamptic patients managed with magnesium sulfate.

Hypermagnesemia

Magnesium competes with calcium and — nondepolarizing neuromuscular blockade

potentiates

Neonates have increased sensitivity to nondepolarizing relaxants due to their —

immature neuromuscular junctions

— produces vagal blockade (vagolytic effect) and sympathetic stimulation

Pancuronium

How does pancuronium produce tachycardia and hypertension? (3)

-Ganglionic stimulation -Decreased catecholamine reuptake -Catecholamine release from adrenergic nerve endings

Patients allergic to — may exhibit reactions (pancuronium bromide)

bromides

— is tertiary amine and lipid soluble. This means it freely passes the blood brain barrier

Physostigmine

— is effective as treatment for central anticholinergic toxicity from scopolamine or atropine overdose

Physostigmine

— has shown to be effective in preventing postoperative shivering

Physostigmine

— can promote perioperative hypothermia

Dexmedetomidine

— inhibits acetylcholinesterase

Neostigmine

Muscarinic side effects of — administration include: bradyarrhythmias, bronchoconstriction, increased secretions, miosis, and increased peristalsis

neostigmine

— is a quaternary ammonium, lipid insoluble molecule. It cannot pass the blood brain barrier

Neostigmine

atropine doses (<0.4 mg) have been associated with a paradoxical transient —

slowing of the heart rate

— is a modified cyclodextrin molecule

Sugammadex

Sugammadex is mainly eliminated by the —

kidneys

Hormonal contraceptive structures with steroidal structure are impaired by sugammadex for approximately — days

Which of the following statements is INCORRECT about succinylcholine? A) It is a quaternary ammonium compound B) It is two molecules of acetylcholine linked together C) It is metabolized predominantly by acetylcholinesterase D) Succinylcholine’s neuromuscular block can be potentiated by administration of neostigmine

C) It is metabolized predominantly by acetylcholinesterase

Which of the following statements is INCORRECT about succinylcholine? A) Succinylcholine produces muscarinic as well as nicotinic effects B) Decreases intragastric pressure C) Causes transient increased intraocular pressure D) Normally causes muscle fasciculations

B) Decreases intragastric pressure

Which drug slightly INHIBITS plasma cholinesterase and may increase duration of action of succinylcholine? A) Pancuronium B) Rocuronium C) Vecuronium D) Cisatracurium

A) Pancuronium

Which agent is LEAST likely to cause anaphylactic reaction? A) Atracurium B) Mivacurium C) Succinylcholine D) Cisatracurium

D) Cisatracurium

What electrolyte disturbance is likely to POTENTIATE neuromuscular blocking agents? A) Hypokalemia B) Hypercalcemia C) Hypernatremia D) Hypomagnesemia

A) Hypokalemia

Which opioid is MOST unionized at physiologic pH? A) Morphine B) Fentanyl C) Alfentanil D) Sufentanil

C) Alfentanil

Which of the following opioids is chemically related to meperidine, a phenylpiperidine derivative? A) Codeine B) Hydrocodone C) Oxycodone D) Fentanyl

D) Fentanyl

Which opioid is structurally like atropine? A) Morphine B) Hydromorphone C) Alfentanil D) Meperidine

D) Meperidine

Which opioid is the LEAST potent? A) Morphine B) Hydromorphone C) Meperidine D) Alfentanil

C) Meperidine

Which opioid is the MOST potent? A) Alfentanil B) Sufentanil C) Remifentanil D) Fentanyl

B) Sufentanil

Which of the following is a side effect of neostigmine? A) Anhidrosis B) Xerostomia C) Mydriasis D) Increased peristalsis

D) Increased peristalsis

Succinylcholine is — metabolized by acetylcholinesterase

NOT

Succinylcholine is metabolized by —

plasma cholinesterase (pseudocholinesterase)

— inhibitors can prolong blockade of succinylcholine

Cholinesterase

Metoclopramide — pseudocholinesterase activity

reduces

Drugs known to — pseudocholinesterase activity: -Echothiophate -Neostigmine -Phenelzine -Cyclophosphamide -Metoclopramide -Esmolol -Pancuronium -Oral contraceptives

decrease

Succinylcholine, atracurium, and mivacurium are associated with — release

histamine

Cisatracurium does — invoke histamine release

not

Hypocalcemia and hypokalemia — a nondepolarizing block

augment

Factors that — nondepolarizers: -Inhalational anesthetics -Aminoglycoside antibiotics -Hypothermia -Magnesium sulfate -Most local anesthetics

potentiate

Factors that — nondepolarizers: -Chronic anticonvulsant therapy -Hyperparathyroidism -Hypercalcemia -Burns

antagonize

Succinylcholine and mivacurium are metabolized by —

plasma cholinesterase

Muscarinic side effects of — administration include: bradyarrhythmias, bronchoconstriction, increased secretions, miosis, and increased peristalsis

neostigmine

— is used for treatment of non-obstructive ileus

Neostigmine

— is 5 to 10 time as potent as fentanyl

Sufentanil

— is approximately 50 to 100 times as potent as morphine

Fentanyl

— is 1/10th as potent as morphine

Meperidine

— shares similar structural features to local anesthetics.

Meperidine

Structurally, — is similar to atropine

meperidine

Meperidine is likely to increase —

heart rate

Large doses of meperidine result in decreased —

myocardial contractility

— is a phenylpiperidine derivative structurally related to meperidine

Fentanyl

An estimated 75% of initial fentanyl dose undergoes first-pass — uptake

pulmonary

— has a low pKa and nearly 90% of administered drug will be in its nonionized form at physiologic pH

Alfentanil

It is the nonionized fraction of — that crosses the blood brain barrier

Alfentanil

— inhibits the metabolism of alfentanil and prolongs its effects

Erythromycin

Which is NOT a common side effect of opioids? A) Decreased biliary pressure B) Miosis C) Delayed gastric emptying D) Bradycardia

A) Decreased biliary pressure

Which is a common side effect of opioids? A) Vasoconstriction B) Pruritus C) Diuresis D) Increased cellular immunity

B) Pruritus

Metabolism of this opioid is completely unrelated to hepatic clearance mechanisms A) Fentanyl B) Alfentanil C) Sufentanil D) Remifentanil

D) Remifentanil

Which opioid has a metabolite that has analgesic and excitatory central nervous system properties? Effects from this metabolite range from anxiety and tremors to myoclonus and franks seizures A) Morphine B) Meperidine C) Alfentanil D) Fentanyl

B) Meperidine

After administration of meperidine, the patient develops serotonin syndrome. Which is NOT a sign and symptom of serotonin syndrome? A) Hyperthermia B) Hyporeflexia C) Seizures D) Altered mental status

B) Hyporeflexia

Which opioid is MOST likely to cause anticholinergic effects such as tachycardia and mydriasis? A) Morphine B) Hydromorphone C) Alfentanil D) Meperidine

D) Meperidine

Patient is on phenelzine (MAO inhibitor). What drug is contraindicated in this patient? A) Meperidine B) Morphine C) Hydromorphone D) Alfentanil

A) Meperidine

What opioid possesses anti-shivering properties via stimulation kappa receptor? A) Morphine B) Meperidine C) Hydromorphone D) Sufentanil

B) Meperidine

Which drug is LEAST protein bound? A) Sufentanil B) Meperidine C) Fentanyl D) Morphine

D) Morphine

Which agent has an ester linkage that renders it susceptible to hydrolysis? A) Hydromorphone B) Alfentanil C) Remifentanil D) Sufentanil

C) Remifentanil

— increase biliary pressure

Opioids

Gastrointestinal — side effects include spasm of biliary smooth muscle, biliary colic, constipation, and delayed gastric emptying

opioid

Generally, — cause vasodilation, pruritus, urinary retention, and decreased cellular immunity

opioids

Paradoxically, sufentanil, fentanyl, and alfentanil may be associated with reflex —

coughing

— has an ester structure that renders it susceptible to ester hydrolysis by nonspecific and tissue esterases

Remifentanil

— metabolism is unchanged in renal and hepatic failure

Remifentanil

Independent of duration of infusion, remifentanil’s context sensitive half-time is approximately — minutes

— may produce myoclonus and seizures (CNS stimulation) and may also be associated with delirium (confusion and hallucinations)

Normeperidine

Normeperidine has an elimination half-time of — hours

Signs and symptoms of — include agitation, seizures, clonus, diaphoresis, tremor, hyperreflexia, hypertonia, and fever among others

serotonin syndrome

Serotonin syndrome is most likely to occur when certain — are taken with drugs that modulate serotonin levels

antidepressants

The duration of action of meperidine is — to — hours

2 to 4

In a substantial number of patients, — is associated with histamine release

meperidine

Stimulation of — receptors may be responsible for meperidine’s anti-shivering effects

kappa

Additionally, meperidine is an — receptor agonist, which might contribute to its anti-shivering effects

alpha 2

It is estimated less than 0.1% of intravenous — dose enters the central nervous system at peak plasma concentrations

morphine

Morphine is — lipid soluble and is — ionized at physiologic pH

poorly ; highly

Ester linkage renders — susceptible to hydrolysis by nonspecific plasma and tissue esterases

remifentanil

Remifentanil is — metabolized by plasma cholinesterase (pseudocholinesterase)

NOT

Which agent INCREASES cerebral blood flow while DECREASING cerebral metabolic rate? A) Midazolam B) Sevoflurane C) Fentanyl D) Etomidate

B) Sevoflurane

Which drug is LEAST likely to cross the placenta? A) Midazolam B) Bupivacaine C) Fentanyl D) Vecuronium

D) Vecuronium

What explains the short duration of action of a fentanyl bolus? A) Short elimination half time B) Low lipid solubility C) Rapid redistribution D) Small volume of distribution

C) Rapid redistribution

Which is LEAST likely to occur from administration of neostigmine? A) Decreased gastric motility B) Bronchoconstriction C) Bradycardia D) Increased urinary bladder tone

A) Decreased gastric motility

Which physiologic derangement results in slower metabolism of ester local anesthetics? A) Hyperkalemia B) Acute renal failure C) Atypical plasma cholinesterase D) Diabetes insipidus

C) Atypical plasma cholinesterase

Which of the following is an important stimulus for aldosterone release? A) Low levels of antidiuretic hormone B) Hypernatremia C) Low serum potassium D) High serum potassium

D) High serum potassium

Which must heparin bind to for its anticoagulant effects to take effect? A) Thrombin B) Antithrombin III C) Von Willebrand factor D) GP IIb/IIIa receptor

B) Antithrombin III

All of these are known adverse effects of amiodarone EXCEPT: A) Hypothyroidism B) Cinchonism C) Pulmonary fibrosis D) Blue skin discoloration

B) Cinchonism

What is the antidote for acetaminophen overdose? A) Vitamin K B) Protamine C) Physostigmine D) N-acetylcysteine

D) N-acetylcysteine

Which of the following receptors belongs to the tyrosine kinase family of receptors? A) Beta adrenergic receptor B) GABAa receptor C) Insulin receptor D) Nicotinic II receptor

C) Insulin receptor

After a single dose of intravenous —, the short duration of action is due to rapid redistribution to inactive tissues (skeletal muscles and fat)

fentanyl

Fentanyl is — to — times more potent than morphine

75 to 125

Ester local anesthetics are metabolized by — enzyme

plasma cholinesterase

— local anesthetics should be avoided in patients with atypical plasma cholinesterase

Ester

— is more likely to result in elevated plasma concentrations than chloroprocaine

Tetracaine

The — receptor belongs to the receptor tyrosine kinase superfamily

insulin

— is a ligand-gated ion channel

GABAa

The — receptor belongs to the family of G-protein coupled receptors

beta- adrenergic

— receptors are ligand-gated sodium channels

Nicotinic

— is an anabolic hormone secreted by the beta cells of the pancreas

Insulin

— overdoses deplete the liver of glutathione stores

Acetaminophen

— prevents hepatic injury primarily by restoring hepatic glutathione

Acetylcysteine

— can cause cinchonism (tinnitus, blurry vision, decreased hearing acuity)

Quinidine

Side effects associated with — administration: -Pulmonary toxicity -QT prolongation -Bradycardia -Hypotension -Corneal microdeposits -Peripheral neuropathy -Photosensitivity -Hyperthyroidism or hypothyroidism -Blue skin discoloration

amiodarone

— is 37% iodine by weight and structurally resembles thyroxine

Amiodarone

Unfractionated heparin produces its effects by biding to —

antithrombin (AT) aka antithrombin III

Heparin acts as an anticoagulant by enhancing the — complex by 1,000 to 10,000 times.

thrombin-AT

Anticoagulant effect of heparin depends on adequate amounts of circulating —

antithrombin III

Aldosterone is a — hormone produced in the zona glomerulosa of the adrenal cortex

mineralocorticoid

— stimulates the release of aldosterone from the adrenal cortex

Angiotensin II

— is an aldosterone antagonist that blocks the renal tubular effects of aldosterone

Spironolactone

Which agent is likely to cause reflex bradycardia secondary to baroreceptor stimulation? A) Phenylephrine B) Ephedrine C) Epinephrine D) Glycopyrolate

A) Phenylephrine

Which drug INCREASES intrabiliary pressure? A) Glucagon B) Naloxone C) Morphine D) Atropine

C) Morphine

Inadvertent rubbing of the eyes with this drug may lead to prolonged pupillary dilation A) Dexamethasone B) Ondansetron C) Metoclopramide D) Scopolamine

D) Scopolamine

Which of the following is an effect of magnesium? A) Potentiates effects of calcium B) Decreases prejunctional release of acetylcholine C) Decreases acetylcholine binding D) Decreases acetylcholine metabolism

B) Decreases prejunctional release of acetylcholine

Acetazolamide is most likely to cause: A) Bradycardia B) Metabolic alkalosis C) Increased minute ventilation D) Hypoglycemia

C) Increased minute ventilation

Which agent is most likely to decrease ability to sweat? A) Atropine B) Neostigmine C) Epinephrine D) Phenylephrine

A) Atropine

Which is a non-selective beta antagonist? A) Atenolol B) Metoprolol C) Propranolol D) Esmolol

C) Propranolol

Which is a benzothiazepine? A) Nifedipine B) Diltiazem C) Verapamil D) Hydralazine

B) Diltiazem

Administration of succinylcholine in pregnancy rarely causes fetal neuromuscular blockade. Why? A) It is metabolized by the liver B) It is highly lipid soluble C) It is highly ionized D) It is highly protein bound

C) It is highly ionized

Administration of a nonselective beta blocker is most likely cause: A) Hypokalemia B) Relaxation of the uterus C) Constipation D) Increased airway resistance

D) Increased airway resistance

Phenylephrine predominantly stimulates —-adrenergic receptors

alpha 1

Phenylephrine mainly causes — rather than — vasoconstriction

venoconstriction ; arterial

Phenylephrine exerts a baroreceptor-mediated reflex —

bradycardia

Naloxone, nitroglycerin, atropine, and glucagon can — opioid-induced biliary spasms

reverse

Glucagon enhances —

myocardial contractility

Side effects of — include sedation, cycloplegia, drying of secretions (dry mouth), blurry vision, and photophobia

scopolamine

Scopolamine causes — upon contact with the eyes

mydriasis

— is contraindicated in patients with closed-angle glaucoma

Scopolamine

At presynaptic nerve terminal, high magnesium concentrations inhibit — channels responsible for release of acetylcholine

calcium

Magnesium sulfate can — the neuromuscular blockade of nondepolarizing neuromuscular blockers

potentiate

— has analgesic properties via antagonism of NMDA receptors and calcium regulation

Magnesium

— is a carbonic anhydrase inhibitor

Acetazolamide

Acetazolamide produces metabolic — and may stimulate the respiratory drive

acidosis

Acetazolamide prevents Na+ and HCO3- absorption (mostly in the proximal tubule). This results in — urine and metabolic —

alkaline ; acidosis

Clinical uses of —: -Diuretic properties -Treatment of glaucoma -Decreases intraocular pressure -Inhibits cerebrospinal fluid formation -Treatment of altitude sickness -Treatment of familial periodic paralysis -Treatment of idiopathic intracranial hypertension

acetazolamide

Beta adrenergic blockade may produce increased plasma concentration of — due to inhibition of — uptake into skeletal muscles

potassium ; potassium

Nonselective beta blockers interfere with glycogenolysis that normally occurs with —

hypoglycemia

Beta adrenergic agonists (terbutaline and ritodrine) produce uterine — and suppress uterine — (tocolysis)

relaxation ; contractions

Chronic — administration leads to increased beta-adrenergic receptors (upregulation)

beta blocker

Succinylcholine does — have a direct action on the uterus or smooth muscle structures

not

Succinylcholine is highly — and has low —. It does not readily cross the placenta

ionized ; solubility

— is a quaternary ammonium compound

Succinylcholine

— is a benzothiazepine derivative calcium channel blocker

Diltiazem

— is a phenylalkylamine calcium channel blocker

Verapamil

— is a dihydropyridine calcium channel blocker

Nifedipine

— is a hydrazine derivative vasodilator

Hydralazine

Propranolol is a competitive antagonist at — beta 1 and beta 2 adrenoceptors

both

The cardio-selective beta blockers include?

“MANBABE” Metoprolol, atenolol, nebivolol, betaxolol, acebutolol, bisoprolol, esmolol

Atropine may — sweat glands (sweating), which can potentially lead to — in body temperature

inhibit ; rise

Which is synthesized from tyrosine and is the immediate precursor of norepinephrine? A) Dopamine B) Epinephrine C) Ephedrine D) Dobutamine

A) Dopamine

Side effects include anal/vulvar pruritus and hyperglycemia A) Ondansetron B) Promethazine C) Haloperidol D) Dexamethasone

D) Dexamethasone

The degradation product of its metabolism is p-aminobenzoic acid A) Lidocaine B) Chloroprocaine C) Bupivacaine D) Ropivacaine

B) Chloroprocaine

Epinephrine may be added to local anesthetics for the following reason: A) Reduce duration of anesthesia B) Increase rate of absorption into circulation C) Increase intensity of the block D) Provides local vasodilation

C) Increase intensity of the block

Pruritus that occurs with administration of neuraxial opioids can be treated with all these agents EXCEPT: A) Simvastatin B) Naloxone C) Ondansetron D) Propofol

A) Simvastatin

Ionization of local anesthetics best correlates with: A) Potency B) Onset of action C) Duration of action D) Allergic potential

B) Onset of action

Which agent is MOST likely to increase pulmonary vascular resistance? A) Sevoflurane B) Etomidate C) Succinylcholine D) Nitrous oxide

D) Nitrous oxide

Epinephrine 1:400,000 solution contains: A) 1 mcg/mL B) 2.5 mcg/mL C) 5 mcg/mL D) 10 mcg/mL

B) 2.5 mcg/mL

A 1% solution of any drug contains: A) 5 mg/mL B) 100 mg/mL C) 500 mg per 100 mL D) 1000 mg per 100 mL

D) 1000 mg per 100 mL

Awakening after a single bolus of propofol is determined by the kinetics of: A) Elimination B) Metabolism C) Redistribution D) Ventilation

C) Redistribution

Which of the following is CORRECT about ketamine? A) Decreases pulmonary vascular resistance B) Inhibits catecholamine release C) It is a direct myocardial depressant D) It is a potent cerebral vasoconstrictor

C) It is a direct myocardial depressant

Tyrosine is the immediate precursor of —

dopamine

Epinephrine is synthesized from — within the adrenal medulla by the enzyme phenylethanolamine N-methyltransferase

norepinephrine

— control endorphin release and inhibit prostaglandin synthesis

Corticosteroids

Ester local anesthetics such as chloroprocaine produce metabolite paraaminobenzoic acid and are more likely than — to evoke an allergic reaction

amides

Cross-sensitivity does — exist between local anesthetic (LA) classes. An ester LA can be administered to a patient allergic to an amide LA

NOT

— produces vasoconstriction — limits systemic absorption — prolongs duration action of local anesthetic — enhances intensity of block

Epinephrine x4

Addition of — to local anesthetic does not affect onset of action

epinephrine

— is the most common side effect of neuraxial opioids

Pruritus

Treatment of neuraxial opioid induced —: -Antihistamines -Low dose propofol -Ondansetron -Naloxone

pruritus

Anesthetic — is mostly associated with the ionization constant (pKa)

onset

— is mostly associated with the lipid solubility of the local anesthetic

Potency

The aromatic ring and its substitutions are responsible for — solubility.

lipid

Awakening after a single bolus of propofol occurs due to — from the brain to other compartments

redistribution

Clearance of propofol from plasma exceeds — blood flow

hepatic

Ketamine is a cerebral —

vasodilator

Ketamine — sympathetic nervous system outflow

increases

Ketamine can become a — if endogenous catecholamine stores are depleted

myocardial depressant

— receptors are thought to be involved in mental depression

NMDA

Vapor pressure is 240 mmHg at 20 C A) Nitrous oxide B) Desflurane C) Sevoflurane D) Isoflurane

D) Isoflurane

A disadvantage of intravenous benzodiazepines is their lack of: A) Antiemetic effects B) Analgesia C) Anterograde amnesia D) Anticonvulsant activity

B) Analgesia

Endogenous norepinephrine release has been found to accompany the administration of: A) Ketamine B) Etomidate C) Dexmedetomidine D) Midazolam

A) Ketamine

Which is 10 times more potent than fentanyl at equivalent doses? A) Alfentanil B) Remifentanil C) Sufentanil D) Hydromorphone

C) Sufentanil

Termination of effect is due to metabolism instead of redistribution A) Fentanyl B) Remifentanil C) Sufentanil D) Hydromorphone

B) Remifentanil

Which is CORRECT about propofol? A) It blunts baroreceptor reflex B) It increases cardiac output C) It has vasoconstrictor properties D) It increases sympathetic activity

A) It blunts baroreceptor reflex

Which drug possesses the MOST mineralocorticoid potency? A) Fludrocortisone B) Prednisone C) Cortisone D) Methylprednisolone

A) Fludrocortisone

Which antiemetic should be avoided in patients with Parkinson’s disease? A) Scopolamine B) Metoclopramide C) Ondansetron D) Dexamethasone

B) Metoclopramide

Which drug is contraindicated in pregnancy? A) Hydralazine B) Acetaminophen C) Enalapril D) Esmolol

C) Enalapril

Which drug is useful in obstetrics due to rapid hydrolysis and lower risk of systemic toxicity? A) Chloroprocaine B) Lidocaine C) Ropivacaine D) Mepivacaine

A) Chloroprocaine

Volatile agents vapor pressure at 20 C: Desflurane — mmHg Isoflurane — mmHg Sevoflurane — mmHg

Desflurane 669 mmHg Isoflurane 240 mmHg Sevoflurane 157 mmHg

Boiling point of desflurane is — C

22.8

Intravenous benzodiazepines do not provide —

analgesia

— is unable to produce an isoelectric EEG

Midazolam

Principal pharmacologic effects of —: -Anxiolysis -Sedation -Anticonvulsant effects -Anterograde amnesia -Skeletal muscle relaxation (spinal cord mediated)

benzodiazepines

Ketamine administration is associated with increases in — and — plasma concentration

epinephrine and norepinephrine

— is 5 to 10 times more potent than fentanyl

Sufentanil

Sufentanil is rapidly — by N-dealkylation

metabolized

— may be associated with acute opioid tolerance and hyperalgesia

Remifentanil

Chloroprocaine is contraindicated in patients allergic to —

para-aminobenzoic acid (PABA)

— should be avoided during the second and third trimester of pregnancy

ACE inhibitors

The only intravenous ACE inhibitor is —

enalaprilat

Due to its antidopaminergic activity, — should be avoided in Parkinson’s disease and restless leg syndrome

metoclopramide

The anti-inflammatory effect of 0.75 mg dexamethasone is equivalent to 20 mg of —

cortisol

Propofol does — prolong QTc interval on ECG

not

What is the boiling point of desflurane at 760 mmHg? A) 15.6 C B) 22.8 C C) 39 C D) 45 C

B) 22.8 C

All these agents POTENTIATE neuromuscular blockers EXCEPT: A) Cephalosporins B) Local anesthetics C) Volatile anesthetics D) Aminoglycosides

A) Cephalosporins

Which is CORRECT about etomidate? A) It has antiemetic properties B) It induces histamine release C) It is associated with myoclonus D) It increases the activity of 11-beta hydroxylase enzyme

C) It is associated with myoclonus

Which drug is MOST likely to preserve airway reflexes among the IV anesthetics? A) Propofol B) Midazolam C) Ketamine D) Etomidate

C) Ketamine

Which is INCORRECT about ketamine? A) It causes bronchodilation B) It increases oral secretions C) It produces profound analgesia and amnesia D) It is associated with profound respiratory depression

D) It is associated with profound respiratory depression

Which drug INCREASES the risk of nausea and vomiting? A) Midazolam B) Haloperidol C) Etomidate D) Metoclopramide

C) Etomidate

Calcium chloride is commonly used for treatment of these conditions EXCEPT: A) Hyperkalemia B) Hypocalcemia C) Hypermagnesemia D) Hypernatremia

D) Hypernatremia

Which of the following is NOT a common side effect of atropine? A) Dilated pupils B) Dry mouth C) Diuresis D) Decreased sweating

C) Diuresis

Which is INCORRECT about albuterol? A) It may cause tachycardia and tremors B) It may result in hyperkalemia C) It is a beta 2 adrenergic agonist D) It stimulates adenylyl cyclase and increases cAMP

B) It may result in hyperkalemia

Which inhibits the release and depolarizing effect of acetylcholine? A) Penicillin B) Edrophonium C) Sevoflurane D) Magnesium

D) Magnesium

Which forms a water-soluble complex with relaxants having a steroidal nuclei? A) Neostigmine B) Cisatracurium C) Sugammadex D) Glycopyrolate

C) Sugammadex

Succinylcholine administration is contraindicated in: A) Chronic renal failure B) Duchene muscular dystrophy C) Myasthenia gravis D) Pregnancy

B) Duchene muscular dystrophy

Which agent can INCREASE emergence delirium from ketamine administration? A) Atropine B) Propofol C) Midazolam D) Fentanyl

A) Atropine

Which drug is excreted as glucuronide and sulfate conjugates in urine? A) Propofol B) Esmolol C) Remifentanil D) Chloroprocaine

A) Propofol

Which agent is LEAST likely to result in nausea and vomiting? A) Etomidate B) Ketamine C) Nitrous oxide D) Midazolam

D) Midazolam

A polar solute will be more soluble in a: A) Lipophilic solvent B) Hydrophilic solvent C) Hydrophobic solvent D) Nonpolar solvent

B) Hydrophilic solvent

Which agent antagonizes glutamate? A) Midazolam B) Ondansetron C) Ketamine D) Propofol

C) Ketamine

Which is an arylcyclohexylamine? A) Midazolam B) Propofol C) Fentanyl D) Ketamine

D) Ketamine

Opioids stimulate the chemoreceptor trigger zone located in the: A) Amygdala B) Area postrema C) Substantia gelatinosa D) Hippocampus

B) Area postrema

Which agent possess local anesthetic properties and antagonizes voltage-sensitive sodium channels? A) Midazolam B) Fentanyl C) Propofol D) Ketamine

D) Ketamine

Mechanism of action: Cyclooxygenase inhibition A) Clopidogrel B) Abciximab C) Aspirin D) Heparin

C) Aspirin

Mechanism of action: Direct factor Xa inhibition A) Clopidogrel B) Apixaban C) Warfarin D) Abciximab

B) Apixaban

All the following are opioid side effects EXCEPT: A) Nausea and vomiting B) Pruritus C) Biliary tract relaxation D) Urinary retention

C) Biliary tract relaxation

Which herbal supplement is most likely to cause INDUCTION of CYP450 enzymes? A) Ginger B) Ginkgo C) Garlic D) St. John’s wort

D) St. John’s wort

Which agent is a selective arterial vasodilator? A) Nicardipine B) Nitroglycerin C) Esmolol D) Nitrous oxide

A) Nicardipine

Which is a benzylisoquinolinium agent? A) Succinylcholine B) Rocuronium C) Sugammadex D) Cisatracurium

D) Cisatracurium

Neostigmine will result in accumulation of acetylcholine, causing the following side effect: A) Urinary retention B) Constipation C) Decreased salivation D) Bradycardia

D) Bradycardia

Which is a quaternary amine (polar molecule)? A) Glycopyrolate B) Fentanyl C) Atropine D) Propofol

A) Glycopyrolate

A muscarinic antagonist is MOST likely to: A) Cause bronchospasm B) Increase heart rate C) Produce defecation D) Increase secretions

B) Increase heart rate

Speaking of local anesthetics, the aromatic ring has: A) Hydrophilic properties B) Lipophilic properties C) Lipophobic properties D) None of the above

B) Lipophilic properties

Which drug may produce a sensation of bodily detachment or floating in space? A) Midazolam B) Dexmedetomidine C) Propofol D) Ketamine

D) Ketamine

The specific enzyme inhibited by etomidate appears to be: A) 11-deoxycorticosterone B) 11-B hydroxylase C) 18-oxidase D) Aromatase

B) 11-B hydroxylase

Which is NOT an adverse effect of succinylcholine? A) Hyperkalemia B) Malignant hyperthermia C) Postoperative myalgia D) Hyperalgesia

D) Hyperalgesia

A phosphodiesterase III (PDE III) inhibitor is MOST likely to: A) Decrease intracellular calcium B) Increase systemic vascular resistance C) Cause vasodilation D) Decreases cAMP

C) Cause vasodilation

Which is a precursor of norepinephrine synthesis? A) Metanephrine B) Epinephrine C) Tyrosine D) Vanillylmandelic acid

C) Tyrosine

Pharmacological agent of choice during acute laryngospasm A) Albuterol B) Ipratropium C) Succinylcholine D) Rocuronium

C) Succinylcholine

Which is an antimuscarinic agent? A) Physostigmine B) Salmeterol C) Scopolamine D) Clonidine

C) Scopolamine

Which agent is NOT a cholinesterase inhibitor? A) Neostigmine B) Edrophonium C) Echothiophate D) Glycopyrolate

D) Glycopyrolate

Which is contraindicated in a patient receiving cholinesterase inhibitor echothiophate? A) Esmolol B) Remifentanil C) Succinylcholine D) Etomidate

C) Succinylcholine

A farmer who uses insecticides may fall victim of cholinergic syndrome. Which drug can cause cholinergic syndrome? A) Atropine B) Physostigmine C) Scopolamine D) Glycopyrolate

B) Physostigmine

Which is most likely to decrease lower esophageal sphincter tone? A) Glycopyrolate B) Metoclopramide C) Succinylcholine D) Neostigmine

A) Glycopyrolate

Which agent is LEAST likely to cross blood brain barrier? A) Atropine B) Scopolamine C) Physostigmine D) Glycopyrolate

D) Glycopyrolate

Which is a good amnestic and can be used to treat motion sickness? A) Glycopyrolate B) Scopolamine C) Physostigmine D) Metoclopramide

B) Scopolamine

Which is derived from cholesterol? A) Epinephrine B) Prostaglandins C) Acetylcholine D) Aldosterone

D) Aldosterone

Most likely to INHIBIT hypoxic pulmonary vasoconstriction and increase shunt A) Sufentanil B) Propofol C) Sodium nitroprusside D) Dexmedetomidine

C) Sodium nitroprusside

Which agent is LEAST likely to help during an acute bronchospasm? A) Sevoflurane B) Albuterol C) Ketamine D) Hydrocortisone

D) Hydrocortisone

Which agent would be INEFFECTIVE to break a bronchospasm? A) Epinephrine B) Albuterol C) Magnesium D) Rocuronium

D) Rocuronium

Which agent is most likely to cause a bronchospasm in susceptible patients? A) Dexmedetomidine B) Esmolol C) Succinylcholine D) Ketamine

C) Succinylcholine

Which is an anticholinergic? A) Ipratropium B) Salmeterol C) Fluticasone D) Montelukast

A) Ipratropium

Which is a potent bronchodilator? A) Phenylephrine B) Norepinephrine C) Isoproterenol D) Phentolamine

C) Isoproterenol

Its action on alpha receptors is insignificant A) Phenylephrine B) Norepinephrine C) Ephedrine D) Isoproterenol

D) Isoproterenol

The immediate metabolic precursor of norepinephrine A) Epinephrine B) Dopamine C) Phenylephrine D) Tryptophan

B) Dopamine

Directly stimulates alpha receptors on blood vessels supplying the nasal mucosa A) Oxymetazoline B) Fenoldopam C) Dopamine D) Isoproterenol

A) Oxymetazoline

The boiling point of desflurane is —°C (73°F) at 1 atm

22.8

The vapor pressure of desflurane is — mm Hg at 20°C

669

Cephalosporins do — potentiate neuromuscular blockade

not

Factors that — nondepolarizers: -Inhalational anesthetics -Aminoglycoside antibiotics -Hypothermia -Magnesium sulfate -Most local anesthetics

potentiate

Factors that — nondepolarizers: -Chronic anticonvulsant therapy -Hyperparathyroidism -Hypercalcemia -Burns

antagonize

Hypocalcemia and hypokalemia — a nondepolarizing block

augment

11 beta-hydroxylase catalyzes the conversion of 11-deoxycortisol to —

cortisol

— is a carboxylated imidazole

Etomidate

Ketamine does — produce significant respiratory depression

not

Etomidate — the incidence of postoperative nausea and vomiting

increases

Etomidate is a potent cerebral —

vasoconstrictor

— is generally administered for treatment of hyperkalemia, hypocalcemia and hypermagnesemia

Calcium chloride

— antagonizes the cardiac effects of hyperkalemia and increases the cell depolarization threshold

Calcium

— is used as an adjuvant treatment of hyperkalemia and may cause HYPOkalemia

Albuterol

At presynaptic nerve terminal, high magnesium concentrations inhibit calcium channels responsible for release of —

acetylcholine

Magnesium sulfate can — the neuromuscular blockade of nondepolarizing neuromuscular blockers

potentiate

Magnesium has analgesic properties via antagonism of — receptors and calcium regulation

NMDA

— is a modified y-cyclodextrin relaxant biding agent that results in the formation of a water-soluble guest-host complex

Sugammadex

Sugammadex does — bind to plasma protein

not

In patients with Duchene muscular dystrophy, — and — are avoided because due to the risk of severe hyperkalemia and rhabdomyolysis

succinylcholine and volatile anesthetics

— may increase the incidence of emergence delirium after ketamine administration

Atropine

— shares a binding site with local anesthetic and interacts with voltage-gated sodium channels

Ketamine

— is metabolized hepatically by conjugation to glucuronide and sulfate and excreted via the kidneys

Propofol

— is metabolized by hydrolysis of its ester linkage, mainly by the esterases in the cytosol of red blood cells

Esmolol

Polar compounds are naturally —

hydrophilic

Polar solvents love — solutes

polar

Arylcyclohexylamines include — and —

ketamine and PCP

— (phencyclidine) aka angel dust is a hallucinogen. Ketamine’s chemical structure is so similar to —

PCP ; PCP

The — trigger zone includes receptors for dopamine, serotonin, histamine, and opioids

chemoreceptor

Stimulation of the chemoreceptor trigger zone located on the floor of the — ventricle triggers the vomiting center

fourth

The area postrema is located on the — at the caudal end of the fourth ventricle

medulla oblongata

Acetylsalicylic acid (Aspirin) acts by blocking the action of the — enzymes and preventing the production of prostaglandins

COX

— is an oral direct factor Xa inhibitor

Apixaban

— irreversibly binds to P2Y12 receptors and blocks adenosine diphosphate (ADP) binding

Clopidogrel

— inhibits vitamin K epoxide reductase. This inhibits the hepatic synthesis of coagulation factors II, VII, IX, and X, and coagulation regulatory factors protein C and protein S

Warfarin

— is a glycoprotein IIb/IIIa inhibitor

Abciximab

— is a direct thrombin inhibitor

Dabigatran

— is a potent herb inducer of CYP 3A4

St. John's wort

Valerian and kava-kava may delay — from anesthesia by prolonging sedative effects

awakening

— is a dihydropyridine calcium channel blocker that produces significant dilatation of the peripheral arterioles

Nicardipine

Nicardipine does — produce effects on the sinoatrial node and atrioventricular node

not

— is an isomer of atracurium

Cisatracurium

— is a benzylisoquinolinium compound

Cisatracurium

Cisatracurium in therapeutic dose range does not cause — release

histamine

Muscarinic side effects of — administration include: bradyarrhythmias, bronchoconstriction, increased secretions, miosis, and increased peristalsis

neostigmine

— is a quaternary amine (polar molecule)

Glycopyrolate

— does not cross the blood-brain barrier or the placenta

Glycopyrrolate

Commonly used — include atropine, scopolamine, glycopyrrolate, and ipratropium bromide

muscarinic antagonists

— consist of a lipophilic and a hydrophilic portion separated by a hydrocarbon chain

Local anesthetics

local anesthetics hydrophilic portion is usually a — amine

tertiary

local anesthetics lipophilic portion is usually an — aromatic ring

unsaturated

local anesthetics aromatic ring and its substitutions are responsible for — solubility

lipid

— administration may be associated with increased myocardial oxygen requirements (caution on coronary artery disease)

Ketamine

— produces a dose-dependent inhibition of the conversion of cholesterol to cortisol

Etomidate

Undesirable effects of —: -Hyperkalemia -Rhabdomyolysis -Myalgia -Cardiac arrhythmias -Malignant hyperthermia -Increased intraocular pressure -Increased intragastric pressure -Increased intracranial pressure

succinylcholine

— has been associated with the development of opioid-induced hyperalgesia

Remifentanil

— decrease cAMP hydrolysis, leading to increased intracellular concentrations of cAMP in the myocardium and vascular smooth muscle

Phosphodiesterase III (PDE III) inhibitors

In vascular smooth muscle, increased cAMP decreases calcium availability, leading to smooth muscle — and —

relaxation and vasodilation

— is a methylxanthine-derived phosphodiesterase inhibitor

Caffeine

Norepinephrine is synthesized from — as a precursor

tyrosine

— is a mnemonic of cholinergic crisis:

SLUDGE S: Salivation L: Lacrimation U: Urination D: Diaphoresis G: Gastrointestinal upset E: Emesis

—, a potent inhibitor of both true cholinesterase and pseudocholinesterase

Echothiophate

Because succinylcholine is metabolized by this enzyme, — will prolong its duration of action

echothiophate

The antidote for echothiophate iodide toxicity is —

pralidoxime chloride

— is tertiary amine and lipid soluble. This means it freely passes the blood brain barrier

Physostigmine

The antidote for physostigmine toxicity is —

atropine

Tonsillectomy and adenoidectomy carry great risk of —

laryngospasm

Glycopyrolate — lower esophageal sphincter tone

decreases

— is a tertiary amine that readily crosses the blood-brain barrier

Atropine

Side effects of — include sedation, cycloplegia, drying of secretions (dry mouth), blurry vision, and photophobia

scopolamine

— is synthesized from cholesterol

Aldosterone

— is a mineralocorticoid hormone produced in the zona glomerulosa of the adrenal cortex

Aldosterone

— is synthesized from cholesterol

Aldosterone

— biosynthesis begins with uptake of the amino acid tyrosine. Choline is a precursor to the neurotransmitter acetylcholine

Catecholamine

Prostaglandins can be produced from three different precursors. The most important one is —

arachidonic acid

Attenuation of hypoxic pulmonary vasoconstriction (HPV) may cause decreases in PaO2 after administration of —

sodium nitroprusside

Clinical effect of hydrocortisone may be seen in — to — hours.

2-4

— would not provide benefit during the ACUTE phase of bronchospasm

hydrocortisone

Magnesium sulfate is thought to produce additional —

bronchodilation

Succinylcholine is associated with — release

histamine

— is a cardioselective beta- adrenergic blocker

Esmolol

— is a long-acting beta-2 adrenergic receptor agonist

Salmeterol

— belongs to the family of medicines known as corticosteroids

Fluticasone

— is a leukotriene receptor antagonist

Montelukast

— is the most potent agonist of all the sympathomimetics with beta 1 and beta 2 receptor activity

Isoproterenol

Adverse effects of isoproterenol include — and —

vasodilation and decreased blood pressure

— may decrease coronary blood flow due to increased heart rate, decreased diastolic blood pressure and cardiac dysthymias

Isoproterenol

In therapeutic doses, — is devoid of alpha agonist activity and does not cause vasoconstriction

isoproterenol

— is the immediate precursor of dopamine

Tyrosine

— is the immediate metabolic precursor of norepinephrine

Dopamine

— is made from the essential amino acid tryptophan

Serotonin

— is also important to the reward centers of the brain

Dopamine

— is a direct-acting sympathomimetic with marked alpha- adrenergic activity

Oxymetazoline

— decreases congestion when applied to mucous membranes due to its vasoconstrictive effects

Oxymetazoline

— may be used prior to nasal intubation

Oxymetazoline

Anesthesia Buddy: Pharmacology Flashcards

(613 cards)